Wednesday, May 24, 2017
I was catching up on some reading last week when I ran into some information about the PREPARE project. PREPARE for your care provides folks with "a range of tools to help people discuss their wishes for medical care with family, friends, and medical providers." Voice over narration accompanies the web pages in either English or Spanish. The purpose of PREPARE is to help someone "make medical decisions for yourself and others... talk with your doctors ...[and] get the medical care that is right for you." PREPARE not only helps a person make decisions and talk to her doctors, it provides assistance with evaluating priorities, communicating one's wishes to others, and providing flexibility for the decision-maker. PREPARE also helps to ready the person for conversations with her doctors and to complete a 5-step interactive action plan.
Tuesday, May 23, 2017
Kaiser Health News ran a story about the impact of loneliness in elders. Like Hunger Or Thirst, Loneliness In Seniors Can Be Eased explains that loneliness is "fixable".
[L]oneliness is the exception rather than the rule in later life. And when it occurs, it can be alleviated: It’s a mutable psychological state... Only 30 percent of older adults feel lonely fairly frequently, according to data from the National Social Life, Health and Aging Project, the most definitive study of seniors’ social circumstances and their health in the U.S....The remaining 70 percent have enough fulfilling interactions with other people to meet their fundamental social and emotional needs.
There are significant physical and psychological manifestations of loneliness but the good news is that it can be resolved. The article discusses a study on loneliness, with one result worth mentioning here, "[w]hat helped older adults who had been lonely recover? Two factors: spending time with other people and eliminating discord and disturbances in family relationships." The study also examined loneliness prevention factors; the "study also looked at protective factors that kept seniors from becoming lonely. What made a difference? Lots of support from family members and fewer physical problems that interfere with an individual’s independence and ability to get out and about."
The article distinguishes between loneliness and isolation, an important point. The article discusses a couple of ways to alleviate loneliness: altering perceptions and investing in relationships. The article also mentions a project from The Netherlands, "a six-week “friendship enrichment program” [with the] goal is to help people become aware of their social needs, reflect on their expectations, analyze and improve the quality of existing relationships and develop new friendships."
As I reported here for the first time recently, Pennsylvania's Governor Wolf has proposed consolidation -- or as he prefers to call it -- unification -- of four separate administrative agencies, the Departments of Aging, Health, Human Services (formerly Public Welfare) and Drug & Alcohol Treatment Programs. Are similar budget-driven changes occurring in your state?
As I catch up with events in Pennsylvania, I'm learning from readers about growing concerns about the possible merger.
- As one recently retired PA legislator pointed out, there seems to be little in the way of a written plan for how services will be handled under this merger. Rather, the merger appears mostly as a description of budget items, with a lot of "minus" signs to indicate cuts. Perhaps by design, Pennsylvania government is often a bad example of transparency for governments. What is the real plan, if any?
- With the consolidation, at a minimum, older Pennsylvanians would be losing a cabinet level post, their singular, dedicated spokesperson. This would be likely to affect all future budget and programming battles.
- The timing is, to use a favorite Trump adjective, "sad." While the leading edge of the big wave of aging baby boomers began to be felt a few years ago when those born in in 1945 started turning age 65 in 2010, the "real" need for an effective advocate is when boomers start turning age 75, age 80 and so on, the higher ages when they are more likely to need or question access to services.
Perhaps of greatest significance is the potential impact of consolidation on the process for assessment of need for services and assistance, especially Medical Assistance.
Under the current allocation of resources, "assessment" of need is handled by individuals employed under the authority of Pennsylvania's Department of Aging.
However, the financial allocations are currently determined under the authority of the Department of Human Services. Consolidation might make sense on paper, but wait!
As one of my mentors in aging, Northern Ireland's former Commissioner of Older People Claire Keatinge, says, to be helpful, fair and effective, any individual assessment of need for health care, social care and security, should be exactly that -- individualized and focused on the client, and should not be simply a match to "what services (if any) are available." That process-based distinction is critical to determining current and future funding priorities.
In Pennsylvania, the lion's share of budget and personnel for aging services has long been housed in the Department of Human Services (formerly Public Welfare), but those workers -- perhaps by necessity and perhaps by design, have often functioned as dedicated bean counters, as in "here's what services we fund, so do you or don't you meet the eligibility criteria?"
By losing the aging assessment focus of the current Department of Aging, it seems likely the state would compromise, and perhaps lose entirely, the independent thinking and opportunity for critical needs-based assessment.
Several elder-focused organizations have raised these and other key points in opposition to the existing budget-based consolidation proposal. Those active in the debate include:
- The Pennsylvania chapter of the National Association of Elder Law Attorneys (PAELA) has asked thoughtful legislators to "oppose such consolidation" as presented in the current budget proposal. As Pittsburgh Elder Law attorney Julian Gray testified on May 1 in state Senate hearings, a "bigger" agency is not necessarily a "better" agency.
- Representatives for the service organization for Pennsylvania senior service workers, P4A, testified strongly in favor of the role of the Department of Aging as the advocate for the "unique needs of seniors." Speakers focused too on the Department's historical role in protecting and managing a unique funding stream dedicated to seniors, "lottery" funds.
- Long-time practitioner and elder law guru, Jeff Marshall, has a comprehensive commentary, with links, detailing the history and importance of Pennsylvania's Department of Aging. There's a simple bottom line expressed here -- "if it ain't broke, don't fix it."
- Related articles
Monday, May 22, 2017
In what is described as a "first" for the National Academy of Elder Law Attorneys (NAELA), the organization through its New York Chapter will present argument on behalf of individuals seeking to establish access to "aid in dying." On April 27, the New York Chapter was granted leave to appear as amicus curiae in Myers v. Schneiderman before the New York Court of Appeals. Oral arguments are scheduled in Albany on May 30, 2017.
At issue is New York's penal law prohibiting assistance in "suicides." The original suit, filed in February 2015, sought a ruling that the statute, characterized by opponents as "antiquated," should be interpreted as not reaching the conduct of a physician that provides aid-in-dying where the patient is terminally ill and mentally competent and voluntarily seeks "terminal medication." Alternatively, the opponents of the law argue that the statute violates the rights of privacy and/or equal protection guaranteed by the New York State Constitution. New York's trial level court dismissed the challenge as a matter of law, on the grounds that New York's penal law was "clear on its face."
In joining the challenge to the dismissal, which was affirmed by appellate division, New York NAELA wrote:
As an organization of lawyers who represent the elderly and persons with disabilities, the New York Chapter [of NAELA] believes that a proper interpretation of New York's "assisted suicide" laws and due consideration of Appellants' constitutional challenges should be based on a fully developed factual record. These are issues of great moment to the elderly and those who love them and to the administration of justice in this State. This Court should have the benefit of a hearing and findings of relevant evidence before deciding them. . . .
What would assist this Court in fairly construing the Penal Law are facts relating to aid-in-dying. While the language of the statute is the starting point for interpretation, its words do not exist in a vacuum.
For more on the arguments, including links to the various parties' appellate briefs in Myers, see the "End of Life Liberty Project."
May 22, 2017 in Advance Directives/End-of-Life, Cognitive Impairment, Discrimination, Ethical Issues, Health Care/Long Term Care, Science, State Cases, State Statutes/Regulations | Permalink | Comments (0)
Wednesday, May 17, 2017
Earlier this month Kaiser Health News (KHN) ran a story about Ombudsman volunteers. Volunteers Help Ombudsmen Give Nursing Home Residents ‘A Voice’ In Their Care discusses the local ombudsman volunteers and their importance regarding a resident's quality of care.
Ombudsman’s offices, which operate under federal law in all 50 states, Washington, D.C., Puerto Rico and Guam, investigated 200,000 complaints in 2015, according to the Administration on Aging, a part of the Department of Health and Human Services.
Of those, almost 117,000 were reported to have been resolved in a way that satisfied the person who made the complaint, and about 30,000 were partially resolved. At the top of the list were problems concerning care, residents’ rights, physical environment, admissions and discharges, and abuse and neglect.
Ombudsmen volunteers have a right to enter a long term care facility and talk to residents or anyone else. They investigate complaints and can find issues on their own, and maintain confidentiality. The article emphasizes the importance of volunteer ombudsmen to the success of the programs. There's more involved than putting your name on a list. Ombudsmen volunteers go through training, must pass background checks, are supervised on a few first visits and attend monthly meetings. The article notes the spectrum of experience held by the volunteers but identifies one commonality, "an abundance of compassion."
Monday, May 15, 2017
The Commonwealth Fund has released a new issue brief regarding Medicare out of pocket costs. Medicare Beneficiaries’ High Out-of-Pocket Costs: Cost Burdens by Income and Health Status examines the out of pocket costs faced by Medicare beneficiaries" "Fifty-six million people—17 percent of the U.S. population—rely on Medicare. Yet, its benefits exclude dental, vision, hearing, and long-term services, and it contains no ceiling on out-of-pocket costs for covered services, exposing beneficiaries to high costs." The issue brief concludes that
More than one-fourth of all Medicare beneficiaries—15 million people—spend 20 percent or more of their incomes on premiums plus medical care, including cost-sharing and uncovered services. Beneficiaries with incomes below 200 percent of the poverty level (just under $24,000 for a single person) and those with multiple chronic conditions or functional limitations are at significant financial risk. Overall, beneficiaries spent an average of $3,024 per year on out-of-pocket costs. Financial burdens and access gaps highlight the need to approach reform with caution. Already-high burdens suggest restructuring cost-sharing to ensure affordability and to provide relief for low-income beneficiaries.
The Commonwealth Fund used 2 "indicators" in doing the research, the "High total cost burden" and "underinsurance". The issue brief notes that lower-income beneficiaries may have significant out of pocket costs. "When premiums, cost-sharing, and spending on uncovered services are included, more than one-fourth of all beneficiaries (27%)—an estimated 15 million people—and two of five beneficiaries with incomes below 200 percent of the federal poverty level spent 20 percent or more of their income on health care and premium costs in 2016." As far as the other indicator, the Commonwealth Fund found "that one-fourth of beneficiaries are underinsured—that is, they spend at least 10 percent of their total annual incomes on medical care services, excluding premiums. Of beneficiaries with incomes below the poverty level, one-third spent 10 percent or more... Despite having Medicare or supplemental coverage, these people are effectively underinsured." (citations omitted).
The brief concludes with these observations:
Despite the substantial set of benefits that Medicare provides, many beneficiaries are left vulnerable because of financial burdens and unmet needs. As Medicare enters its sixth decade and the baby boom population becomes eligible, the costs of the program will increase, likely placing it on the policy agenda. Despite Medicare’s notable recent success in controlling costs per beneficiary, total spending will increase as the program covers more people.
The high financial burdens documented in this brief illustrate the need for caution. Half of Medicare beneficiaries have low incomes; one-third have modest incomes (200% to 399% of poverty). Any potential policy should first consider the impact on beneficiaries.
Access and affordability remain key concerns. In any discussions of potential Medicare reform, it will be important to pay particular attention to consequences for those vulnerable because of poor health or low income. Indeed, the findings point to the need to limit out-of-pocket costs and enhance protection for low-income or sicker beneficiaries.
As the single largest purchaser of health care in the country, Medicare policies directly influence insurance and care systems across the country. With a projected one-fifth of the population on Medicare by 2024, keeping beneficiaries healthy and financially independent is important to beneficiaries, their families, and the nation. (citations omitted).
Friday, May 12, 2017
On May 10, 2017, my research colleagues Gavin Davidson (Queens University Belfast) and Subhajit Basu (University of Leeds) participated in a policy briefing at Stormont, the Northern Ireland Assembly in Belfast. They appeared in support of recommendations by the Commissioner of Older People (COPNI) Eddie Lynch on a major plan for modernization of social care programs for vulnerable adults (of any age).
Professors Davidson and Basu focused on three key recommendations:
- Northern Ireland should have a single legislative framework for adult social care with accompanying guidance for implementation. This could either be new or consolidated legislation, based on human rights principles, bringing existing social care law together into one coherent framework.
- All older people in Northern Ireland, once they reach the age of 75 years, should be offered a Support Visit by an appropriately trained professional. This will be based on principles of choice and self-determination and is aimed at helping older people to be aware of the support and preventative services that are available to them.
- Increasing demands for health and social care reinforce the importance of considering how these services should be funded. All future funding arrangements must be equitable and not discriminate against any group who may have higher levels of need.
The audience, which included researchers, social service program administrators and elected officials (not only from Northern Ireland, but elsewhere, including the Isle of Man), reportedly responded strongly to the recommendations, especially to the concept of specially-trained "support visitors," offered to persons age 75 or older. The intent is to provide individuals with planning support and, where needed, medical assessment. Guidance and information is often needed for pre-crisis planning, thus moving in the direction of prevention of crises and reduction of need for last-minute response. The support visitor concept has been used successfully in Denmark and other locations in Europe. The next step for Northern Ireland would likely be a pilot or test project.
As a co-author of the research reports that led to the COPNI recommendations, working with Professors Gavin Davidson and Subhajit Basu as part of a team headed by Dr. Joe Duffy of Queens University Belfast, I found it an interesting coincidence that at almost the same time as the Northern Ireland government session, I was addressing similar interests in "preventative" planning while speaking on elder abuse in a "Day on the Hill" program at the Capitol in Pennsylvania, hosted by the Alzheimer's Association. It is clear that on both sides of the Atlantic, we are interested in cost-effective, proactive measures to help people stay in their homes safely.
Thursday, May 11, 2017
Pennsylvania Governor Pushes State Merger of Departments of Aging, Health, Human Services and Drug & Alcohol
I'm on a crash course of "catching up" now that I am back in Pennsylvania, having been away on sabbatical for the last academic year and living (mostly) in Arizona. On May 9 I participated in a "Day on the Hill" event in Harrisburg, sponsored by the Alzheimer's Association in Pennsylvania.
To kick off the afternoon sessions, Secretary of Aging Teresa Osborne, along with Deputy Secretary of Health Corey Coleman, spoke in support of Pennsylvania Governor Wolf's plan to merge operations of four separate state departments, that of Aging, Health, Human Services (formerly Public Welfare) and Drug and Alcohol Programs into a single department called Department of Health and Human Services. The timeline for this decision is looming, as the Pennsylvania Legislature's budget session is scheduled to end on June 30.
Secretary Osborne pointed out that overlapping programs between the different departments complicate the ability of the state to serve related interests. For example, "protective services" are administered by separate units for children, disabled adults, and older adults. While acknowledging cost savings from consolidation is certainly one goal -- as the state is in an on-going budget crisis -- Secretary Osborne expressed her strong support for a clearer organizational chart, as a way to clarify and meet the needs of Pennsylvanians on common issues.
The Alzheimer's Association is not taking a position on the consolidation, instead focusing on the state's accountability and continued or enhanced dedication to serving impaired Pennsylvanians and their families, especially caregiver family members.
For more on Pennsylvania Tom Wolf's budget plan as it affects seniors, see the PA website on the Budget Documents. And as anyone knows who follows Pennsylvania legislative sessions, the real language and details are likely to emerge in the wee hours of the session, following a lot of horse-trading.
Wednesday, May 10, 2017
Writing for the Institute for Family Studies, George Washington Law Professor Naomi Cahn and University of Minnesota Law Professor June Carbone dig into the black and white of statistics on "gray" divorce, with interesting observations. For example:
First, some good news for everyone: the divorce rate is still not all that high for those over the age of 50. Yes, it has doubled over the past 30 years: in 1990, five out of every 1,000 married people divorced, and in 2010, it was 10 out of every 1,000 married people. And yes, the rate has risen much more dramatically for gray Americans than for those under 50; in fact, there was a decline in the rate for those between the ages of 25-39. But the divorce rate for those over 50 is still half the rate for those under 50.
Divorce for older individuals often does have significant impacts for individuals in retirement, as they point out:
These statistics don’t mean that gray divorce isn’t a problem. Those who divorce at older ages, like those who divorce at younger ages, tend to have less wealth than those who remain married, with the gray divorced having only one-fifth of the assets of gray married couples. Compared to married couples, gray divorced women have relatively low Social Security benefits and relatively high poverty rates. While gray married, remarried, and cohabiting couples have poverty rates of four percent or less, 11 percent of men who divorced after the age of 50 were in poverty, and 27 percent of the women were in poverty.
For more, read "Who is at Risk for a Gray Divorce? It Depends."
Tuesday, May 9, 2017
Kaiser Health News ran a story about a boot camp for caregivers who care for those with dementia or Alzheimer's. ‘Boot Camp’ Helps Alzheimer’s, Dementia Caregivers Take Care Of Themselves, Too explains the importance of caregivers learning to take care of themselves while caring for others. The boot camp featured in the story hosted "25 people who went to a Los Angeles-area adult day care center on a recent Saturday for a daylong “caregiver boot camp.” In the free session, funded in part by the Archstone Foundation, people caring for patients with Alzheimer’s or another form of dementia learned how to manage stress, make their homes safe and handle difficult patient behaviors. They also learned how to keep their loved ones engaged, with card games, crossword puzzles or music." The article mentions the direct correlation between the caregiver's health and the care the provide to others.
UCLA's boot camp was started 2 years ago; the catalyst in part was the frequency of hospitalizations for those whose caregivers weren't ready for the job. UCLA currently offers 4 boot camps a year, but plans are underway to increase the number. California is not the only location for boot camps. Boot camps have taken place in Florida, New Jersey and Virginia.
Monday, May 8, 2017
Justice in Aging, the Center for Medicare Advocacy and the National Consumer Voice for Quality Long-Term Care have issued another in the series of issue briefs about the revised nursing home regulations. Return to Facility After Hospitalization covers several important topics including notice, bed holds, right to return and appeal rights. Here is the executive summary:
Bed hold rights are set by state law. Federal law complements state law by requiring facilities to notify residents of those rights. Notice of bed hold rights must be provided at two separate times: in advance of a hospitalization, and at the time of transfer to a hospital. The advance notification must include the resident’s right to a bed hold, whether the state’s Medicaid program pays for a bed hold, and the facility’s bed hold policies (which must be consistent with state and federal law). The time-of-transfer notification must describe the resident’s bed hold rights under the facility’s policy.
Federal law also establishes a resident’s right to return to the facility even if a bed hold period has been exceeded, or if the resident did not have a bed hold. The resident can return to her previous room if available, or to the next available room if the previous room is not available. The regulations specify that the resident can request a transfer/discharge hearing if the facility refuses to accept her back.
Wednesday, May 3, 2017
Justice in Aging announced the release of two additional issue briefs concerning the revised nursing home regs. One brief concerns quality of care and the other, grievances and resident/family councils.
The executive summary for the quality of care issue brief explains
The substantive requirements for quality of care are retained in the revised regulations, and the Centers for Medicare & Medicaid Services (CMS) affirms the regulations’ overriding goals: supporting person-centered care and enabling each resident to attain or maintain his or her highest level of well-being. Finding all of the requirements presents a challenge, however. CMS has significantly reorganized the quality of care provisions, moving some provisions to other regulatory sections, expanding the standards of the prior regulations, and adding several entirely new requirements.
The executive summary for the grievances and resident/family councils issue brief explains:
Residents have the right to file grievances and the facility must work to resolve those concerns promptly. A grievance official at the facility is responsible for complaint handling. Each facility must have a grievance policy and provide residents with information about how to file a grievance, how to contact the grievance official, a time frame for complaint review, a written decision, and information about other entities with which grievances can be filed. Written decisions must include, but are not limited to, the steps the facility took to investigate the complaint, the findings, whether the complaint was confirmed or not, and the action the facility has taken or will take to correct the problem.
The resident has a right to: form and participate in a resident council; have family member(s) or other resident representative(s) meet in the facility with the families or resident representative(s) of other residents; and participate in the family council. There must be a staff person assigned to assist both resident and family councils and the council, along with the facility, must approve this person. The councils must be given a private space in which to meet and no one outside of a resident or family member can attend without invitation. The facility must act upon council concerns and recommendations and provide a reason for its decision, although it does not have to implement all that the councils request.
All of the issue briefs are available here.
Monday, May 1, 2017
I blogged a few days ago about an upcoming hearing for the Senate Committee on Aging. That hearing, on April 27, 2017, concerned the Mental and Physical Effects of Social Isolation and Loneliness. Testimonies from the hearing can be accessed here.
The April 27, 2017 hearing was the first of two parts looking into the issue. As noted in the first hearing
The risks of social isolation and loneliness compare with smoking and alcohol consumption and exceed those associated with physical inactivity and obesity. According to researchers, prolonged isolation is comparable to smoking 15 cigarettes a day. Isolation and loneliness are associated with higher rates of heart disease; weakened immune system; depression and anxiety; dementia, including Alzheimer’s disease; and nursing home admissions.
The next hearing is set for May 10, 2017 and will focus on Aging With Community: Building Connections that Last a Lifetime.
Late last week I learned that CMS may be reversing course on prohibiting pre-dispute arbitration clauses in nursing home admission contracts. I couldn't decide if my response should be "say it isn't so" or "you have got to be kidding me". Nevertheless, Justice in Aging reported in their weekly newsletter, This Week in Health Care Defense that:
CMS Backtracks on Nursing Home Arbitration Prohibition
As part of last year’s revision of nursing facility regulations, CMS prohibited federally-certified nursing facilities from obtaining arbitration agreements at the time of admission. CMS concluded that it was unfair to have residents and families waive legal rights during such a difficult and chaotic time. Now, however, CMS has reversed course and has filed language that would revise the regulation to allow facilities to obtain arbitration agreements at admission. For more on the revised regulations, see the series of issue briefs developed by Justice in Aging in partnership with the Center for Medicare Advocacy and the National Consumer Voice for Quality Long Term Care.
Wednesday, April 26, 2017
Justice in Aging has announced a free webinar for May 17th, 2017 from 2-3 edt on Elder Financial Abuse & Medicaid Denials. Here is a description of the webinar
Financial exploitation can devastate low-income older adults, especially those who rely on Medicaid for their health and long-term care. For example, older adults who are victims of financial abuse may be denied eligibility for Medicaid because their abuser won’t turn over their bank records. Without Medicaid eligibility, the older adult may be threatened with eviction or involuntary discharge from a nursing home because of nonpayment. Legal services are critical to helping older victims of financial exploitation receive the medical care and services to which they are entitled. Join us for Elder Financial Abuse and Medicaid Denials to learn how to identify victims of elder financial abuse, what problems this exploitation can cause for Medicaid eligibility, and how legal services attorneys can help their older clients receive the benefits they need and prevent future problems accessing Medicaid.
To register for the webinar,https://attendee.gotowebinar.com/register/5875005469626032643?source=SALSA. Did I mention, it's free!
April 26, 2017 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Programs/CLEs, Webinars | Permalink | Comments (0)
Tuesday, April 25, 2017
The Senate Special Committee on Aging has a hearing scheduled for April 27, 2017 starting at 9:45 a.m. The topic of the hearing: Aging Without Community: The Consequences of Isolation and Loneliness. Four witnesses are scheduled to testify, including two academics and the head of a Council on Aging from Pima County, Arizona. Video of testimony and resources will be posted to the committee's hearings website subsequently. Stay tuned.
Monday, April 24, 2017
Last week Kaiser Health News (one of my favorite go-to sites) ran this story, How To Help Alzheimer’s Patients Enjoy Life, Not Just ‘Fade Away’. The article opens explaining that Alzheimer's is #1 on the list of diseases folks in the U.S. most fear. The loss of self is a big part of that fear. However, "a sizable body of research suggests this Alzheimer’s narrative is mistaken. It finds that people with Alzheimer’s and other types of dementia retain a sense of self and have a positive quality of life, overall, until the illness’s final stages... They appreciate relationships. They’re energized by meaningful activities and value opportunities to express themselves. And they enjoy feeling at home in their surroundings."
Just how many folks with Alzheimer's have a good quality of life? According to Dr. Peter Rabins, "[o]verall, about one-quarter of people with dementia report a negative quality of life, although that number is higher in people with severe disease.” What are the implications of this? To make sure that folks with Alzheimer's have a quality of life, "[promote] well-being [which] is both possible and desirable in people with dementia, even as people struggle with memory loss, slower cognitive processing, distractibility and other symptoms."
Folks with severe or end-stage Alzheimer's present a different challenge. For others, the article suggests the following: emphasis social connections, maximize physical health, improve communications, respond to unmet needs, and give deference to individuality and autonomy.
"None of this is easy. But strategies for understanding what people with dementia experience and addressing their needs can be taught. This should become a priority, Rabins said, adding that 'improved quality of life should be a primary outcome of all dementia treatments.'"
Tuesday, April 18, 2017
I had mentioned a new book on Monday at the bottom of my post, congratulating the authors, Naomi Cahn and Amy Ziettlow. The book, Homeward Bound: Modern Families, Elder Care, and Loss is published by Oxford University Press (April 2017) and runs 240 pages. The book is available to order from a number of book sellers. Last week the authors wrote on the Institute for Family Studies blog explaining the background of and catalyst for this book. Homeward Bound: Lessons on Modern Families and Elder Care
In 2010, we began the Homeward Bound project, hoping to study the intersection of modern families and elder care because we saw, all around us, how elder care is changing. Seven years later, it is exciting to see the results of the project in the form of a published book, Homeward Bound: Modern Families, Elder Care, and Loss, and to share some of what we learned in this post.
The catalyst for the project was a conversation with a dear friend of ours, Julie, whose Baby Boomer parents are divorced; each parent then remarried and divorced again. One of Julie’s ex-stepparents—her ex-stepmother Tina—was about to undergo critical surgery, and Julie didn’t know what to do. Tina had been married to Julie’s father for 15 years, starting when Julie was a toddler. While Julie was growing up, she spent holidays with her father and Tina. After the divorce, Julie no longer visited Tina, but they remained in regular contact by phone and email over the years. Julie fondly remembers how Tina mothered her during childhood illnesses and crises, and she felt some responsibility for Tina, especially since Tina had no children of her own. However, Julie felt overwhelmed as she thought of handling all of the medical, financial, and legal caretaking that her parents, stepparents, and ex-stepparents would need from her as they aged. Julie, who also has two young children, explained that she simply was not prepared financially or emotionally to care for all the people who might need her—and she felt alone in her worries, with few resources and little support.
So that explains the reasons and inspiration for the book. As far as what the authors learned, they explain the 3 lessons:
- Families shape the quality of the elder care and grieving experience of grown children...
- Formal planning helps facilitate a positive experience.... and
- Families rely on medical, legal, and religious professionals to begin and guide the decision-making conversation in a way that is catered to their unique structure....
But, overall they learned there is room for hope but a need for action. "Many family members showed great resilience in finding ways to understand each other, to work together to each contribute something to the care process, and to decide that they would remain a family after the death of one of its members. In other families, the lack of shared norms and an absence of experienced professional support meant that caretaking and grief became a time of division, rather than unity. But, as we also learned, the time to plan is now."
Congratulations Naomi and Amy!
Thursday, April 13, 2017
Registration is now open for Stetson's annual Fundamentals of SNT Administration webinar. This half-day webinar is scheduled for May 5, 2017 from 1-5 p.m. The 4 speakers will cover topics on how to become a SNT administrator, Tax issues when making distributions, services and products a SNT administrator can provide, and an update on the laws, regs and POMS. The agenda is available here and registration is available here. (you can register online and fill out and submit a pdf).
Full disclosure, I'm the conference chair. Hope to see you virtually at this webinar!
Wednesday, April 12, 2017
NAPSA and NCPEA have released a research to practice brief on Correlates of Depression in Self-Neglecting Older Adults: A Cross-Sectional Study Examining the Role of Alcohol Abuse & Pain in Increasing Vulnerability Here is the summary from this one page brief:
Older adults with confirmed self-neglect report high rates of depressive symptoms. It has been estimated that between 50-62% of older adults with confirmed self-neglect suffer from at least sub-clinical levels of depressive symptomatology. Depressive symptoms in this population have been linked to untreated medical conditions. Further study is needed to understand the association between elder self-neglect and depressive symptoms, including studies determining potential correlates of depression in this population. Identifying such correlates could inform clinical social work and other mental health approaches for reducing depressive symptoms and self-neglect behaviors in this population. The cur-rent cross-sectional study reviewed a host of self-reported cognitive, functional, demo-graphic and clinical measures and identified a positive history of alcohol abuse, low self-rated health and pain as significant correlates of depressive symptomatology in older adults with Adult Protective Services (APS) validated self-neglect. Those with a positive screen for prior alcohol abuse were approximately 3 times more likely to have at least sub-clinical depression (Geriatric Depression Scale-15 >4). Having lower self-rated health was associated with a 53% increase in the likelihood of reporting at least sub-clinical depression. Reporting pain was associated with a 37% increase in the likelihood of reporting at least sub-clinical depression. These findings did not allow for establishing a temporal direction between depression, history of alcohol abuse, low self-rated health or pain. Nevertheless, they do provide insight into possible targets for improving out-comes in elder self-neglect populations given their evidence-based associations with both depression and self-management activities including accessing healthcare and completing activities critical for safety and protection.