Tuesday, January 5, 2016

Portraits of Aging in Cuba

During this first week of January, I am in Cuba with a group of Dickinson Law students who are part of an introductory course on "Cuban Legal Systems."  While we are in the country -- my second time here in less than 12 months -- I hope to continue to learn more about Cuba's demographics, including their reported successes on infant mortality, longevity and health care.  

In the meantime, I came across an interesting photo essay from the National Geographic, providing a window into aging in Cuba.  A key observation from Looking Into the Eyes of Cuba's Elderly, On the Verge of Change, is that Cubans "want tourists to come and experience their country but not just for salsa dancing, cigars and to see those amazing old cars -- but also to share stories about their countries, family, and lives...." 

January 5, 2016 in Health Care/Long Term Care, International, Science | Permalink | Comments (0)

Monday, January 4, 2016

Japan's Aging Population

Aging populations is something faced in every country.  The Wall Street Journal is examining demographics in 2050 as part of Demographic Destiny 2050. WSJ explains it

The year 2050 is right around the corner, and yet it​ is hard to imagine the sweeping changes the world will confront by then. In a multimedia series, The Wall Street Journal helps readers ​envision how we will work, how we will age and how we will live.

Graying Japan Tries to Embrace the Golden Years, an article focusing on Japan,  is accompanied by 360 video as well as the ability to watch in virtual reality. Examining trends and past history of demographics leads some in Japan to be pessimistic about the graying of the population, while others take a different view,

Pessimists say the only way to keep Japan from inexorably drifting into bankruptcy is radical change, like a sudden, sharp influx of immigrants—an unlikely prospect given Japan’s history as one of the world’s most homogeneous cultures.

But a growing number of Japanese executives, policy makers and academics challenge that proposition. They are exploring whether modest adaptations can ease the woes of an aging society, or even turn the burdens into benefits… start[ing] with steering the growing number of healthy 60- and 70-year-olds from retirement into work… point[ing] to new aging-related growth engines, including an automation spending boom to stretch Japan’s declining labor force, and a growing “silver market” of elderly consumers drawing down savings from a lifetime of hard work and thrift….

The article discusses the ups and downs of an elder workforce and the potential of technologies to help workers. It also covers how the increasing aging population impacts the consumer goods market. It's a fascinating read and I think it would be useful to assign to students.

January 4, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, International, Retirement | Permalink | Comments (0)

Jimmy Carter, Nonagenarians and Health Care

In a recent Associated Press article, Jimmy Carter Shows 90+ Age Not a Barrier to Major Surgery, the writers cite several examples of successful surgeries or advanced treatments for the most senior of senior citizens.  

Irwin Weiner felt so good after heart surgery a few weeks before turning 90 that he stopped for a pastrami sandwich on the way home from the hospital. Dorothy Lipkin danced after getting a new hip at age 91. And at 94, William Gandin drives himself to the hospital for cancer treatments.

 

Jimmy Carter isn't the only nonagenarian to withstand rigorous medical treatment. Very old age is no longer an automatic barrier for aggressive therapies, from cancer care like the former president has received, to major heart procedures, joint replacements and even some organ transplants.

 

In many cases, the most senior citizens are getting the same treatments given to people their grandchildren's age — but with different goals.

 

"Many elderly patients don't necessarily want a lot of years, what they want is quality of life," said Dr. Clifford Kavinsky, a heart specialist at Rush University Medical Center in Chicago. "They want whatever time is left for them to be high quality. They don't want to be dependent on their family. They don't want to end up in a nursing home."

The article makes the point that "some 90-year-olds" are fitter than some 60-year-olds" and that age alone should not be the deciding factor.  Indeed, in my own family we have faced major surgery questions with both my father and, more recently, my mother, and the result was a "different" decision in each instance, based on a whole host of factors.  These can be tough calls. 

January 4, 2016 in Advance Directives/End-of-Life, Health Care/Long Term Care, Science | Permalink | Comments (1)

Long Term Care Insurance-the Choices Are Complex

The New York Times on December 18, 2015 ran an article about LTC insurance. Long-Term Care Insurance Can Baffle, With Complex Policies and Costs opens with this compelling statement: "[insuring] for long-term care is a lot like trying to cover the future financial impact of climate change. It’s a universal problem that looms large, is hard to predict and will be costly to mitigate."  The article provides a critical look at the need for long term care insurance and the hurdles that are faced by those considering the need for long term care.

[I]t is a notoriously confusing and not always reliable product. That’s why few people turn to such insurance. Some 70 percent of those over age 65 will require some form of long-term care before they die, but only about 20 percent own a policy.

Instead, millions of those who end up needing long-term care pay for it out of pocket or, after impoverishing themselves, turn to the government for support.

The article takes a look at the costs of the policies, when coverage kicks in, and the limitations of such insurance.  The article offers some suggestions for those considering such a policy and concludes with  some food for thought:

As if these questions weren’t difficult enough, there are also estate planning considerations. You may want to leave something to your heirs and not want to see your estate consumed by long-term care expenses in your final years.

Several newer products called hybrids add on long-term care benefits to life insurance and annuities that may address this concern. But they add even more layers of cost and complexity.

For those in such situations, experts advise consulting an elder law attorney and fee-only financial planner who doesn’t make money from recommending the policies. That’s the best way to receive an objective — and nuanced — evaluation on whether this product makes sense for you.

January 4, 2016 in Consumer Information, Current Affairs, Estates and Trusts, Health Care/Long Term Care, Medicaid | Permalink | Comments (1)

Thursday, December 31, 2015

Living Wills: Do they have utility in end of life decision-making?

An article in the most recent issue of the ABA Commission on Law & AgingBIFOCAL focuses on instructional directives.  In light of CMS reimbursing doctors for end of life discussions with patients,  author Susan P. Shapiro, in The Living Will as Improvisation, suggests  "it is appropriate to reflect on the legacy of advance directives and ask how physicians might best serve their patients as they anticipate life’s end."

The author notes that

Although the value of proxy directives, which designate a medical decision maker in the event that a person loses capacity in the future, has been repeatedly demonstrated, that of instructional directives or so-called living wills, which state treatment preferences, has not. A new report by the Institute of Medicine concludes that legal approaches embodied in living wills have “been disappointingly ineffective in improving the care people nearing the end of life receive and in ensuring that this care accords with their informed preferences .... (citations omitted).

However, the author discusses the lack of hard data makes it difficult to determine whether living wills have little usefulness these days. The author turns to her own research, explaining that for 3 years she and hospital social worker

observed medical decision making on behalf of patients without decision-making capacity, day after day, from admission to discharge. Daily observations over the course of each patient’s ICU stay tracked when anyone asked about or referred to an advance directive, how the directive was used, and the correspondence between the patient’s treatment preferences articulated in the directive and the host of decisions made on their behalf....

The article discusses her findings regarding the role of advance directives in these cases .  It's quite illuminating, especially the discussion about the correlation (or lack thereof) between the directive's existence and how decisions are made.  The author suggests there are significant differences between making the directive when all is well and using the directive when all is not.    The author concludes the article with  this thought: "[a] truly directive living will is not a script, but rather an evolving, ongoing dialogue throughout the life course with those who may someday be called to improvise on our behalf. Let’s hope that Medicare dollars are used to help enrich the conversation."

December 31, 2015 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Current Affairs, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Tuesday, December 29, 2015

Nursing Home Residents-Privacy Violations

An article in the Washington Post shortly before Christmas had me shaking my head at the cluelessness of some employees of nursing homes regarding resident privacy.  Nursing home workers have been posting abusive photos of elderly on social media gave me one of those "you have got to be kidding me moments."  Maybe it's an age-gap thing, but I just can't fathom why it would be appropriate to post intimate photos of individuals with whose care one is entrusted.  The article indicates that this is not a geographically isolated problem:

Nursing home workers across the country are posting embarrassing and dehumanizing photos of elderly residents on social media networks such as Snapchat, violating their privacy, dignity and, sometimes, the law.

ProPublica has identified 35 instances since 2012 in which workers at nursing homes and assisted-living centers have surreptitiously shared photos or videos of residents, some of whom were partially or completely naked. At least 16 cases involved Snapchat, a social media service in which photos appear for a few seconds and then disappear with no lasting record.

The article offers some illustrations of these photos and the remedies available against the perpetrators.  The article also notes that not only are those photos invading resident privacy, they serve as evidence of the violations.

The incidents illustrate the emerging threat that social media poses to patient privacy and, at the same time, its powerful potential for capturing transgressions that previously might have gone unrecorded. Abusive treatment is not new at nursing homes. Workers have been accused of sexually assaulting residents, sedating them with antipsychotic drugs and failing to change urine-soaked bedsheets. But the posting of explicit photos is a new type of mistreatment — one that sometimes leaves its own digital trail.

How often is this violation of resident privacy occurring? The article notes that "ProPublica identified incidents by searching government inspection reports, court cases and media reports. [A district attorney in Massachusetts] said she suspects such incidents are underreported, in part because many of the victims have dementia and do not realize what has happened."  So far HHS' Office of Civil Rights hasn't sanctioned any nursing homes "for violations involving social media or issued any recommendations to health providers on the topic." The article notes that CMS, in the process of revising the regs dealing with nursing homes, plans to deal with the issue when revising the definitions of various types of elder abuse. Even one of the social media sites referenced in the article expressed concern about the actions of  those nursing home employees.

The article summarizes some cases where charges have been filed.  Read the story and assign it to your students. 

 

December 29, 2015 in Consumer Information, Crimes, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Health Care/Long Term Care, Other | Permalink | Comments (0)

Tuesday, December 22, 2015

Telephone-Based Hearing Test -- a Low-Cost Screening Tool for Everyone

I was listening to NPR's Morning Edition recently while working on this Blog and that's how I learned about  a great resource, a telephone-based screening test for hearing problems, that individuals can take at home.  Offered by The National Hearing Test, the cost is $5 (free for AARP members) and the process was developed with the help of an NIH grant.  What impressed me is it tests for the ability to hear words (numbers) against background noise, a very realistic screen for many people's concerns.  After taking the test, you are offered guidance and resources for follow-up. The NPR story made the point that unlike vision problems, which are hard to blame on others, it is all too easy for those with hearing problems to assume the problem "is" background noise or a failure of younger people to "speak up."  Further, evaluation of hearing can be an important marker for other health issues, including problems with cognition.

For most reliable results, the website encourages you to use a traditional wired-phone connection, not a cell phone.

According to operation's website (linked above):

The National Hearing Test is provided on a nonprofit basis. It has no financial connections with any hearing products or services. (Free tests are typically offered by organizations selling hearing aids or providing services for a fee.) The $5.00 fee helps defray the costs of making it widely available to the public and processing test data; any remaining money goes to support further research on hearing loss.

Perhaps "taking" the screening test is a holiday present we can give our families

December 22, 2015 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Science | Permalink

Monday, December 21, 2015

If Your Clients are Mostly "Older," Are You Practicing Elder Law?

The November/December 2015 issue of the ABA magazine (Volume 32, Issue 2) GPSOLO, the publication for members of the Solo, Small Firm and General Practice division of the American Bar Association, is devoted to Elder Law. The issue can be found on-line (and viewing does not seem to be restricted to division members!).  The articles are also available on Westlaw.

Articles include:

  • How to Make Money Practicing Elder Law, by Andrea G. Van Leesten, who practices in California and who is the 2015-16 Diversity Director for the Division;
  • Representing Elder Physical Abuse Victims,  by California practitioner Mark Redmond, who has "focused primarily on representation of elders in cases of physical and financial abuse for the last 15 years;" 
  • Advocating for Elders Suffering Financial Abuse and Exploitation, by Nicole Le Hudson, who focuses her San Diego practice on disability and elder law and who is a "member of the court-appointed attorney panel for conservatorships;"
  • The State of Age Discrimination Law: An Update, by Brian McCaffrey, who focuses his New York practice on employment litigation;
  • Estate Planning for Old Age and Incapacity, by Sheila-Marie Finkelstein, who practices estate planning in Irvine, California; 
  • Counseling Clients about Health Care Toward the End of Life, by Sally Balch Hurme (who I just discovered while reading her article recently retired from 23 years of consumer advocacy with AARP -- but who is still clearly very active in elder law, thank goodness!); 
  • How to Fund Long-Term Care Without Medicaid, by Eileen Walsh, from Louisville,  and I have to admit I read her article first - she explores Medicare, insurance, VA benefits and reverse mortgage options); and 
  • What Every Lawyer Needs to Know About Planning for Retirement, by Cynthia Sharp who "works with motivated lawyers seeking to generate additional income."   

Charlie Sabatino brings to bear his 30 years of experience and careful thought to the question of whether having older clients automatically means you are practicing "elder law," in his column "GP Mentor: When Does Serving Older Clients Become Elder Law?"  Hint?  The answer may depend on whether you are working in the best interests of the senior.

In addition, there is a great Resource Guide of recent texts on Elder Law  and the Division Chair's essay on recognizing Elder Abuse. PLUS, there's a detailed shoppers's guide to cameras, mobile phones ans more in the 2015 Tech Gift Guide -- for those of you still searching for gift ideas for your favorite elder law attorney!  

December 21, 2015 in Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Health Care/Long Term Care, Housing, Legal Practice/Practice Management, Retirement | Permalink | Comments (0)

Friday, December 18, 2015

Research on "Immunosenescence" May Lead to More Effective Vaccines for the Elderly

Here's your new vocabulary word for the week -- "immunosenesence" -- and no, my spell checker doesn't recognize it as a word (yet).  But the definition is interesting as the word refers to the gradual deterioration of the immune system that may accompany natural aging.  Recent studies by researchers at the University of California San Diego and Emory University have focused on why older persons (defined in the study as over age 65) have weaker immune responses to seasonal flu vaccines.  In turn, better understanding of the phenomenon may help to identify new approaches to immunizations for older persons.   

The San Diego Union-Tribune offers a lay person's breakdown of the studies linked above. 

December 18, 2015 in Health Care/Long Term Care, Science | Permalink | Comments (0)

Thursday, December 17, 2015

Pennsylvania Issues Post-Zahner Operations Memo on "Evaluating Non-Qualified Annuities"

Following the Third Circuit's ruling in the Zahner case in September 2015, Pennsylvania's Department of Human Services recently issued an Operations Memo providing guidance on how the state will evaluate the effect on Medicaid eligibility of so-called "non-qualified" annuities purchased during the look-back period.   The Ops Memo #15-11--01, issued November 16, 2015, provides in part:

Prior to the Zahner decision, in order to be actuarially sound, an annuity had to have a payment term that was equal to the individual's life expectancy.  If the annuity was either shorter or longer than the annuity owner's life expectancy found on the Life Expectancy Tables in LTC Handbook Chapter 440 Appendix D, then the purchase price of the annuity was used to determine an ineligibility period for payment of LTC [long term care] services. 

 

Effective immediately, due to the Zahner decision, the definition of "actuarially sound" has changed.  Annuities will now be considered actuarially sound if the annuity payment term is either short than, or equal to, the owner's life expectancy.

It will be interesting to see "what happens next" in the world of Medicaid planning.  My thanks to Pennsylvania Elder Law attorney and all-round research guru Rob Clofine for sharing the link.

December 17, 2015 in Estates and Trusts, Federal Cases, Health Care/Long Term Care, Medicaid, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Wednesday, December 16, 2015

Caregiver Drones and Other Robot Caregivers?

I'm fascinated by technology and I've read several articles about the use of technology in caregiving for elders.  With the proliferation of drone use by consumers, I was interested in the December 4, 2015 article in the New York Times As Aging Population Grows, So Do Robotic Health Aides. A robotics prof at the University of Illinois has a grant "to explore the idea of designing small autonomous drones to perform simple household chores, like retrieving a bottle of medicine from another room. Dr. Hovakimyan [the professor] acknowledged that the idea might seem off-putting to many, but she believes that drones not only will be safe, but will become an everyday fixture in elder care within a decade or two."  The use of robotic caregivers is viewed as a way to help folks stay at home longer than now. 

Can technology or robots be used to combat isolation and loneliness?  The article turns to "Brookdale Senior Living, one of the nation’s largest providers of assisted living and home care... [which] is using a variety of Internet-connected services to help aging clients stay more closely connected with family and friends."  According to the senior director of dementia care and programs at Brookdale, "there was growing evidence that staying connected, even electronically, offsets the cognitive decline associated with aging." 

The article features several technologies under development, not just the drones which Dr. Hovakimyan refers to as “Bibbidi Bobbidi Bots."  The article notes that Toyota is even getting into the field, noting that adding artificial intelligence to vehicles to make driving safer and to"make it possible for aging people to drive safely longer."

There are concerns about downsides to the use of such technologies, which are discussed in the article. The article turns to other countries leading the way in these advances and concludes with discussing a number of products currently on the market and how those may compare with in-person interactions. 

Interesting times...

 

December 16, 2015 in Cognitive Impairment, Consumer Information, Current Affairs, Health Care/Long Term Care, Science, Web/Tech | Permalink | Comments (1)

Tuesday, December 15, 2015

Is There a New "War on Drugs" -- or rather, on Drug Pricing?

The Senate Special Committee on Aging is taking up the important issue of drug pricing:

A Senate investigation of drug-price spikes at four companies kicked off Wednesday with specialists from all corners of the health-care system testifying that they're powerless to manage the out-of-control prescription costs.

 

The hearing launches the Special Committee on Aging's investigation into the soaring prices of old drugs, including the recent overnight price hike of Daraprim from $18 to $750.  Doctors and policy experts offered a slew of proposed policy solutions, such as expediting applications for generic drugs to increase competition and requiring companies to reveal how much drugs really cost.

 

But the testimony to the committee in advance of the hearing underlined a stark fact about the current system, too: Doctors, companies that manage prescription drug benefits, hospitals, and health care policy experts alike feel fairly powerless to control high drug prices -- because they are allowed.

 

For instance, a pediatrician from the University of Alabama at Birmingham testified that an infant needed a treatment that had increased from $54 a month to $3,000 a month, causing the pharmacist to scramble for a solution. A kidney transplant patient in Baltimore began experiencing hallucinations as her medical team tried to obtain a drug once easily available.

For more coverage, read the Washington Post's article, Doctors, Hospitals Condemn Out-of-control Drug Prices as Senate Investigation Begins.

December 15, 2015 in Consumer Information, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (1)

Sunday, December 13, 2015

More on Elder Abuse

I don't know whether the issue of elder abuse is just getting more coverage or whether cases of elder abuse are increasing. We all know that elder abuse is a global issue.  I ran across a few recent articles about elder abuse that I wanted to share in this post.

First, The Conversation published Why are we abusing our parents? The ugly facts of family violence and ageism . The article opens with the story of Gwen, who was being abused by her son. The article suggests that "[o]lder people experiencing abuse from family members share the same experience as women suffering intimate partner violence in having someone close to them, whom they ought to be able to trust, perniciously erode their sense of safety and wellbeing through excessive use of power and control." But, when its a child who is the perpetrator, "feelings of parental love and responsibility coupled with shame and guilt for having “failed” as a parent often stop the parent from seeking help and protecting themselves." Turning to Australia, the article examines the prevalence and frequency of multiple abuses of a victim. "For example, financial abuse was coupled with another form of abuse in 65% of cases." Linking abuse and ageism, the article offers that "[promoting the dignity and inherent value of older people is a crucial component of elder abuse prevention."  The article calls for educating professionals, elders and society about the issues.

Next, a newspaper in Bend, Oregon ran the story, Financial exploitation hits close. Report: Most financial exploitation done by someone the victim trusts. "A report by Oregon’s Office of Adult Abuse Prevention and Investigations found nearly three-fourths of Central Oregon’s financial-exploitation cases involved someone known or trusted by the victim." The cases in Oregon are similar to what is happening across the country:"[s]tate investigators recorded 1,059 cases in which people 65 or older, who lived on their own or with a loved a one, were victims of theft or someone had misused their money, medication or property...Financial exploitation for seniors living outside of a long-term care facility was the most common type of elder abuse for the third year running in 2014."

Finally (but finally only for this post; I have no doubt that there will be more posts on elder abuse, unfortunately) CNBC ran a story on elder abuse with a headline that caused me to do a double-take.  Why seniors don't fear elder financial abuse discusses a new report from Allianz Life that "queried over 1,200 seniors and more than 1,000 people ages 40 to 64 about seniors' finances and found that among the seniors, 89 percent were confident they could handle their money on their own. At the same time, 22 percent of the younger group said they were not confident in their own ability to recognize elder financial abuse, or were not sure."

The CNBC story indicates that family members worry more about the elder being a victim than the elder does. "The confidence of the seniors may make them even more vulnerable to financial scams or financial abuse by friends or family members, said Walter White, president and CEO of Allianz Life. ..."Everything we understand about the prevalence of the issue would suggest that confidence is misplaced," he said."  The CNBC story cites some other reports that provide good statistics and discusses the connection between financial exploitation and ultimately a nursing home placement.

That kind of loss can devastate a person's finances, and elder financial abuse is often a major reason why seniors wind up in nursing homes and assisted living facilities on public assistance. Dr. Mark Lachs, co-chief of the division of geriatrics and gerontology at Weill Medical College, has studied the issue and found that an older person who falls victim to abuse, including financial exploitation, is four times more likely to be placed in a nursing home, after adjusting for other known risk factors for nursing home placement.

Discussing the reasons a victim may fail to report financial exploitation, the story adds overconfidence as a reason, citing to the Allianz report. The CNBC story concludes with some links to resources to help fight elder abuse.

More information about the Allianz report is available here.  Allianz also offers a number of materials for elders and professionals available on the Allianz website, here.

 

 

December 13, 2015 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care, Property Management, Retirement, Statistics | Permalink | Comments (0)

Friday, December 11, 2015

More on Family Caregiving

We all know how important caregivers are in the life of those elders.  Two articles about caregiving caught my eye recently.  First, a few days ago Kaiser Health News (KHN) ran a story on Who are America's Caregivers? Nearly a Quarter are Millennials.  It's not just the Baby Boomers as caregivers;  "almost a quarter of the adults who take care of older people – on top of their regular jobs and responsibilities – are between the ages of 18 and 34, according to research by AARP Policy Institute and the National Alliance for Caregiving."  More attention is being devoted to the issue, and the article notes that the Institute of Medicine will be "putting out a report next year on the state of family caregiving, and a number of states have passed or are considering legislation that would help hospitals better communicate with and train an older person’s caregiver, especially after a hospitalization."

The New York Times ran a story on caregiving's impact on careers. Caregivers Sometimes Must Sacrifice Their Careers highlights one caregiver who used up all of her leave time before having to quit her job to be a fulltime caregiver. And once having left the workforce, rejoining the workforce later may not be that easy.  There is no real comparison between child care and elder care-the two are quite different.

Elder care, however, takes life-altering turns without warning: the crippling fall, the massive stroke. An older person’s need for assistance generally rises; given increased life spans, some workers will care for their parents longer and more intensively than they did their children.

Moreover, “the emotional toll is different,” said Kenneth Matos, senior research director at the Families and Work Institute.

“Someone raising a child is headed for happier events” and greater independence. “Someone caring for an elder is headed for sadder experiences.”

Some states have stepped up to provide benefits for family caregiving.  Also not to be overlooked, the financial impact on family caregivers who have to quit their jobs-now and in the future when they themselves retire.

December 11, 2015 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care | Permalink | Comments (0)

Wednesday, December 9, 2015

Dementia-A Global Social Issue

Last month Kaiser Health News ran a story about a global initiative on dementia.  New Brain Institute Plans To Refocus Third World’s Attention On Dementia As ‘Societal Issue’ explains the launch of an institute between University of California, San Francisco and the University of Dublin that is "aimed at helping developing countries learn more about the disease and cope with the burden it places on patients, families and caregivers."  Known as the Global Brain Health Institute, both universities will house the institute. Focusing initially on Latin America and parts of the Mediterranean, the goal is to train a wide variety of professionals  to understand dementia including prevention and delay.  The press release from UC San Francisco is available here.

The Global Brain Health Institute is currently holding its first invitation-only conference in Havana.

December 9, 2015 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, International, Programs/CLEs, Science | Permalink | Comments (0)

Monday, December 7, 2015

The Costs of Dementia-Part Three

Money Magazine's final article in the series on the costs of dementia focuses on the costs in the final stages of the disease. Coping With the Costs of Dementia: The Final Stage discusses the costs and the options for caring for an individual in the final stage of this disease.

In the final stages of dementia, which typically last four to five years, the need for care intensifies. [One's] spouse eventually will require around-the-clock assistance with most activities of daily living. [One's] toughest decision: whether to try to continue caregiving at home or move [one's] loved one to an assisted-living facility or a nursing home. [One] may feel guilty at the prospect of putting someone [one] love[s] in “a home”—that’s common and understandable—but a setting where professionals are providing the intense level of care needed at this point is often the best path, especially if they’re trained in the needs of dementia patients. That said, it’s also the most expensive care option by far.

The article urges caregivers to take proactive action, suggests caregivers pick a nursing home with a memory care unit, get advice on the order in which to spend assets and start planning for the caregiver's own future.  "Caring for someone with dementia is emotionally exhausting and financially draining, but it comes with one particular satisfaction: knowing that you’ve done whatever you can to make the last years easier for someone you love."

December 7, 2015 in Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Medicare | Permalink | Comments (1)

News from the International Long Term Care Policy Network (Mark Your Calendars!)

During my recent visit in England, I had the fortunate experience of having lunch with Bernard Casey, Associate Professor at the Personal Social Services Research Unit at the London School of Economics and Principal Research Fellow at the University of Warwick.  He has deep interest and experience as a social economist in evaluation of the economic implications of societal ageing.  We could have talked for hours -- so much so that I almost missed my train from London to Leeds. 

Bernard introduced me to a fascinating network of academics and policy makers with related interests, the International Long Term Care Policy Network. I encourage you to check out their website, and especially to browse the short interviews with international experts who are following long-term care system developments around the world. 

Mark Your Calendars: The ILP Network is hosting its 4th International Conference on Evidence-based Policy in Long-term Care  at the London School of Economics and Political Science (LSE) in London from the 4th to the 7th of September in 2016.  Key themes of the conference will include: care models, case management, economics of long-term care, equity and efficiency, funding systems, health and social care integration, housing, institutional dynamics, local vs. central policy interactions, personalization of the care system, policy implications of dementia, technology and long-term care, unpaid carers, and workforce and migrant workers. More information about registration and submission of abstracts will be available in the near future.

December 7, 2015 in Current Affairs, Health Care/Long Term Care, Housing, International, Programs/CLEs, Science, Statistics | Permalink | Comments (0)

Sunday, December 6, 2015

The Costs of Dementia-Part Two

Money Magazine's second article on the costs of dementia focuses on the middle stage of dementia. Coping With the Costs of Dementia: The Middle Stage discusses a series of steps for the caregivers and family to take, not only for the present, but in positioning themselves for the final stage of the disease.  The article discusses a number of suggestions:

  • greater levels of care, including adult day care and respite care and recommends only hiring caregivers with experience in caring for individuals with dementia;
  • examine the terms of any long term care insurance policy, if the individual has one;
  • if the individual is a veteran, look into VA benefits;
  • examine the individual's and family member's investment portfolio; rearranging allocations to more conservative investments may be needed;
  • investigate a reverse mortgage;
  • caregivers should talk to employers about options; and
  • begin to research nursing homes.

December 6, 2015 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Medicare | Permalink | Comments (0)

Thursday, December 3, 2015

The Costs of Dementia

Money Magazine ran a series on the costs of dealing with dementia.  Separating dementia into three stages, early, middle, and late, the series breaks down the costs for each of the stages.

Coping With the Costs of Dementia: The Early Stage looks at both the personal costs as well as the financial costs of copying with the disease in the beginning.

The financial toll can be nearly as large as the personal loss. Over the last five years of life, the average out-of-pocket cost of care for dementia patients totaled $61,500—81% more than for people without dementia—according to a new study in the Annals of Internal Medicine. Nearly half of the dementia patients ended up on Medicaid, the government health care program for impoverished Americans, compared to about 20% of patients suffering from heart disease or cancer.

If you were asked what is the reason for the costs of dementia early on, would you say drugs or treatments? According to the article, if you did, you'd be wrong.  "Driving the cost aren’t drugs or treatments, but the years of care necessary to get a person safely through life’s everyday activities. Medicare, the primary health insurance for people 65 and older, doesn’t cover that long-term nonmedical care." 

The article discusses the differences between "normal" aging and early signs of Alzheimer's.  As far as costs in the early stage of the disease, "which lasts an average of two years, [one's] out-of-pocket costs won’t be burdensome. But [one will] need to plan for more expensive care later on, and move quickly, since [one's] husband, wife, or parent has a limited window to participate in financial decisions and sign any necessary legal documents before cognitive abilities fade."

The article recommends a number of steps to take to prepare, including obtaining the needed documents, appointing agents, talking to a doctor, organizing finances and preparing for Medicaid.  Check out the graphic of expenses in the last 5 years of life.

December 3, 2015 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid | Permalink | Comments (0)

Wednesday, December 2, 2015

Nursing Home Quality: Another GAO Report

The GAO has released another report on Nursing Home Quality.  Dated October, 2015, Nursing Home Quality: CMS Should Continue to Improve Data and Oversight is a 52 page report issued by the GAO  that "examines (1) the extent to which reported nursing home quality has changed in recent years and the factors that may have affected any observed changes, and (2) how CMS oversight activities have changed in recent years."

The report notes some issues with the data collected as well as some efforts regarding oversight, and in the conclusion the GAO discusses the issues with the data and also

according to CMS officials, the agency faces the challenge of conducting effective oversight of nursing home quality with its limited resources, while meeting all of its oversight requirements. CMS has made modifications to some activities it considered essential to its oversight, without knowing whether the modifications have affected the agency’s ability to assess nursing home quality. Further, some modifications made by CMS regional offices and state survey agencies to their own nursing home oversight activities could adversely affect the CMS central office’s ability to oversee nursing home quality, while other modifications could be effective strategies that could be adopted more widely among regional offices and state survey agencies....

The GAO makes 3 recommendations: 

  • Establish specific timeframes, including milestones to track progress, for the development and implementation of a standardized survey methodology across all states.
  • Establish and implement a clear plan for ongoing auditing to ensure reliability of data self-reported by nursing homes, including payroll-based staffing
  • The Administrator of CMS should establish a process for monitoring modifications of essential oversight activities made at the CMS central office, CMS regional office, and state survey agency levels to better understand the effects on nursing home quality oversight.

A one page highlights sheet is available here and an accompanying podcast here.

 

 

 

December 2, 2015 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Housing | Permalink | Comments (0)