Friday, April 29, 2016

Is Nursing Home Operator Entitled to Bar Plaintiff Firm's Use of Finger-Pointing Ads?

It seems nursing home operators are calling upon some of the same "trade practice" laws they are sometimes accused of violating, in an effort to thwart what the operators see as misleading advertising by personal injury attorneys.  

One of the latest suits has reached the Georgia Supreme court, where the Mississippi-based law firm of McHugh Fuller Group is seeking to overturn a lower court's injunction preventing it from running a statewide ad campaign, including full-page color ads, seeking potential clients who "suspect that a loved one was NEGLECTED or ABUSED" by a nursing home run by PruittHealth, Inc.  From an April 27, 2016  Georgia Courts' summary of parties' arguments before the high court

PruittHealth sued the law firm under the Georgia Deceptive Trade Practices Act, which authorizes a court to issue an injunction (a court order requiring a certain action be halted) against anyone who uses someone’s trade name without permission if there is even a “likelihood” that the use will injure the business reputation of the owner or dilute its trade name or mark. The trial court entered a temporary restraining order against the law group, scheduled a hearing and notified the parties that it intended to consider PruittHealth’s request for a permanent injunction. The trial court issued another order on June 1, 2015, permanently stopping the law group from running ads that used PruittHealth’s trade names, service marks, or other trade styles. The law group filed a motion for reconsideration, which the trial court denied. The law firm is now appealing to the Georgia Supreme Court....

 

The law group argues, among other things, that the court erred in determining the ads violated Georgia Code section 10-1-451(b), which is called Georgia’s “antidilution statute.” That statute says dilution occurs “where the use of the trademark by the subsequent user will lessen the uniqueness of the prior user’s mark with the possible future result that a strong mark may become a weak mark.” The law firm argues that it is not eroding the strength of PruittHealth’s mark, but is only identifying specific nursing homes against which it is accepting cases, and that PruittHealth failed to demonstrate that actual injury occurred as a result of the ads.

This isn't the first time that the McHugh Fuller Law Group has been on the receiving end of a lawsuit by a nursing home company.  In February 2015, Heartland of Portsmouth in Ohio and McHugh Fuller Law Group were in federal court arguing about diversity jurisdiction over Heartland's claim the law firm was using "false and misleading advertising in order to encourage tort litigation" against the nursing home's operations in Ohio.  Similar litigation, seeking injunctive relief, was underway by Genesis Healthcare Corporation against the McHugh Fuller firm in West Virginia in 2007, although it is unclear from my research whether either of those cases reached a final resolutions.  

My thanks to Professor Laurel Terry, Dickinson Law, for pointing me to this ABA Journal post that encouraged my search for more about these cases.

April 29, 2016 in Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Cases, Health Care/Long Term Care, Legal Practice/Practice Management | Permalink | Comments (0)

Wednesday, April 27, 2016

Physician-Aided Death Legislation and the Impact on the Medical Profession

JAMA's Journal of Internal Medicine ran an article in the April issue, The Challenge of New Legislation on Physician-Assisted Death .  From the legal profession, we know how these laws work. But from the medical profession, according to the article, doctors need to think about how to incorporate this into their practices.   Here is a sample of the article:

By the end of 2016, more than 80 million people in the United States and Canada will live in a jurisdiction allowing physician-assisted death. As such, this practice can no longer be considered a quirky experiment in a few states. The North American experience with physician-assisted death began in 1994, when voters in Oregon approved a ballot measure, the Death With Dignity Act, allowing a physician to prescribe a lethal dose of a medication that a patient voluntarily self-administers. Oregon stood alone for 14 years until Washington (2008), Vermont (2013), and now California (2015) approved similar laws. As of January 2016, the effective date of the California law, known as the End of Life Option Act, is uncertain. These laws are in general very similar, with safeguards that include requirements for a waiting period and that eligible patients be mentally competent, not mentally ill, and have a life expectancy of less than 6 months. In 2009, the Montana Supreme Court removed prohibitions against physician-assisted death for competent patients. There are no reporting requirements in Montana, so little is known about the actual practice of physician-assisted death in that state. In 2015, the Canadian Supreme Court unanimously reversed a federal law that prohibited physician-assisted death and gave the government until June 2016 to establish mechanisms for access to such assistance. (citations omitted)

A subscription is required to read the entire article.

April 27, 2016 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (0)

Tuesday, April 26, 2016

Dangers of Polypharmacy

In Elder Law world we know the dangers that may occur with taking multiple medications. The New York Times ran an article last week that focused on the topic; The Dangers of ‘Polypharmacy,’ the Ever-Mounting Pile of Pills.  "Geriatricians and researchers have warned for years about the potential hazards of polypharmacy, usually defined as taking five or more drugs concurrently. Yet it continues to rise in all age groups, reaching disturbingly high levels among older adults."

When your doctor asks you what medications you take, do you include vitamins and supplements in your answer? Many don't, according to the article, referencing a study in the Journal of American Medical Association's Journal of Internal Medicine, "A recent study in JAMA Internal Medicine, however, found that more than 42 percent of adults didn’t tell their primary care doctors about their most commonly used complementary and alternative medicines, including a quarter of those who relied most on herbs and supplements."

How many people take multiple medications?  "More than a third were taking at least five prescription medications, and almost two-thirds were using dietary supplements, including herbs and vitamins. Nearly 40 percent took over-the-counter drugs."

Don't we all take supplements and vitamins? Although there is no age-specific time when folks start doing so, there is a difference in the impact based on age.

Though drug interactions can occur in any age group, older people are more vulnerable, said Dr. Michael A. Steinman, a geriatrician at the University of California, San Francisco, who wrote an accompanying commentary. ..Most have multiple chronic diseases, so they take more drugs, putting them at higher risk for threatening interactions...The consequences can also be more threatening.

The article suggests the need to revamp our health care system so it's not fragmented and until then, ask doctors and pharmacists about medications, and include vitamins and supplements in your list of medications.

The article about the study is available here.

April 26, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care | Permalink | Comments (0)

Wednesday, April 20, 2016

Physician-aided Dying in Canada

Prime Minister Justin Trudeau was the focus of an article in the New York Times last week on physician-aided dying in Canada. Justin Trudeau Seeks to Legalize Assisted Suicide in Canada reports that a proposed law was introduced that would allow physician-aided dying  "for Canadian residents and citizens who have "a “serious and incurable illness,” which has brought them 'enduring physical or psychological suffering.'"

Under Canada’s proposed law, people who have a serious medical condition and want to die will be able to commit suicide with medication provided by their doctors or have a doctor or nurse practitioner administer the dose for them. Family members and friends will be allowed to assist patients with their death, and social workers and pharmacists will be permitted to participate in the process.

The legislation follows a ruling by the Canadian Supreme Court which eliminated a criminal ban on physician-aided dying. A copy of that decision is available here.

One striking difference in the proposed legislation in Canada compared to those states in the U.S. where physician-aided dying is legal is that "a doctor or nurse practitioner [may] administer the dose for them. Family members and friends will be allowed to assist patients with their death, and social workers and pharmacists will be permitted to participate in the process."

Not all in Canada are in favor of the legislation. CBC Canada ran a story,  Religious groups react to physician-assisted dying bill LIVE where a number of groups stated concerns about the legislation.  The video is available here.

If any of our readers are from Canada, we would be very interested in hearing more about the discussion in Canada on this proposal.

April 20, 2016 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, International | Permalink | Comments (0)

Tuesday, April 19, 2016

More on Medicare LTC

After my post on an article about adding  a long term care benefit to Medicare, Professor Dick Kaplan (prolific author, elder law guru and friend) sent me an email reminding me about an article he wrote in 2004 that discussed the topic. "Cracking the Conundrum: Toward a Rational Financing of Long-Term Care,” is available from his SSRN page. Here is the abstract  

This article provides a comprehensive solution to the financing of long-term care for older Americans that balances government and family responsibility, while recognizing the different settings in which long-term care is provided. The article begins by examining the spectrum of long-term care in the United States from home health care to assisted living to nursing homes, as well as hybrids such as continuing care retirement communities. Successive sections of the article then analyze the federal government's health care program for older persons (Medicare), the joint state and federal program for poor people of any age (Medicaid), and private long-term care insurance in terms of how these mechanisms treat long-term care in each setting.

Finding serious deficiencies and inconsistencies in all three mechanisms, the article then offers a co-ordinated alternative: expand Medicare to cover long-term care in nursing homes but maintain responsibility for other long-term care settings with the affected individuals and their families. This approach recognizes that nursing home care substitutes for hospital care that Medicare would otherwise cover, while other long-term care settings substitute for family-provided care. Long-term care insurance would then be used as a means of financing long-term care in settings other than nursing homes, thereby making it more appealing. In addition, such insurance would be less expensive than presently, because it would no longer be priced to cover costly nursing home care. The article also recommends that such insurance be improved by standardizing policy options and features into a fixed set of packages that would be uniform among carriers. Other recommendations include ensuring price stability of issued policies and providing independent reviews of gatekeeper claim denials. The article concludes with some observations regarding financing of these proposals.
Professor Kaplan directs the reader to pages 82-88 for more on this topic.
Thanks Dick!

 

April 19, 2016 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Lessons About Protecting the Teenage Brain Can Resonate in Later Life

I recently caught a rebroadcast of  a Terry Gross interview -- from early 2015 and linked here -- with Dr. Frances Jensen, a neuroscientist from the University of Pennsylvania, on the "teenage brain."  It was fascinating, especially as Dr. Jensen explained the latest thinking on trauma on the younger brain, and the potential for alcohol and drug use -- both illegal and legal -- to be especially significant to the still developing teenage brain. Given that we need those brains to last for a very long time, the broadcast seems relevant to our Elder Law Prof Blog topics.  

This insulation process  [from myelin] starts in the back of the brain and heads toward the front. Brains aren't fully mature until people are in their early 20s, possibly late 20s and maybe even beyond, Jensen says.

 

"The last place to be connected — to be fully myelinated — is the front of your brain," Jensen says. "And what's in the front? Your prefrontal cortex and your frontal cortex. These are areas where we have insight, empathy, these executive functions such as impulse control, risk-taking behavior."

 

This research also explains why teenagers can be especially susceptible to addictions — including drugs, alcohol, smoking and digital devices.

And as to that last item  on the list  -- digital devices -- Dr. Jensen emphasized her concerns about constant stimulation, especially when it lasts into time meant for sleeping.  The intense light alone may be interfering with with sleep and brain development. She explains:

First of all, the artificial light can affect your brain; it decreases some chemicals in your brain that help promote sleep, such as melatonin, so we know that artificial light is not good for the brain. That's why I think there have been studies that show that reading books with a regular warm light doesn't disrupt sleep to the extent that using a Kindle does.

I'm from a generation that didn't pay much attention to closed head injuries -- indeed, I think we more or less thought of "mild concussion" as a right of passage for young athletes.  Only in the last few years are we beginning to accept the connection between such injuries and later brain degenerative processes.  Now, even as we're getting better about physical risks from sports, we need to work harder to avoid the almost round-the-clock effects of our computerized lives.

Dr. Jensen closed the interview with sound advice for everyone:

GROSS: We are out of time, but I just want to ask you if there's any quick tip you can give us to preserve our brain health - something that you would suggest that adults do?

 

JENSEN: I think [take] time to reflect on what you've done every day, to underscore for yourself the most important things that happen to you that day and to not respond to conflict - to try to not respond to conflict in the midst of your working environment, for instance, because it will color your efficacy.

For more, look for Dr. Jensen's book: The Teenage Brain: A Neuroscientist's Survival Guide to Raising Adolescents and Young Adults.

 

April 19, 2016 in Cognitive Impairment, Consumer Information, Dementia/Alzheimer’s, Health Care/Long Term Care, Science | Permalink | Comments (0)

Monday, April 18, 2016

Arizona State University Announces Preliminary Plans for Affiliated CCRC

Arizona State University is considering plans to develop a Continuing Care Retirement Community (CCRC) near its main campus, working with Pacific Retirement Services (based in Oregon) as a co-developer and operator.  From the announcement:

ASU is working with the ASU Foundation, who has hired Pacific Retirement Services to co-develop and operate the project. Artistic renderings depict a gleaming a 20-story building with 291 independent, assisted, memory care and skilled nursing units....

 

ASU is currently in discussion with Mayo Clinic, Osher Lifelong Learning Institute and ASU’s nursing, health, innovation, nutrition, arts and design and teaching programs as potential partners. Other amenities include casual dining, health club, game room, estate planning, concierge service, classroom and intergenerational childcare programming....

 

ASU is currently conducting a marketing and feasibility study about the facility, which would ground lease approval from the Arizona Board of Regents. If approved, construction could begin in 2018 and begin accepting residents in 2020. 

For more, read Arizona State University to Build CCRC on Campus, from Senior Living publication.  

My thanks to Karen Miller, J.D., who lives in a successful CCRC affiliated with the University of Florida.

Addendum:  After posting the above information about ASU's possible project, I noticed that Arizona State University is a named co-sponsor of what appears to be three-day education and business development forum called the ASU-GSV Summit. Bill Gates is a keynote speaker.  What struck me as interesting is the summit, from April 18-20, is being held in California -- San Diego to be exact -- and not in ASU's home state. As someone who grew up in the Valley of the Sun, I've been watching the increasingly entrepreneurial spirit of ASU for some time, and this is more evidence.

 

April 18, 2016 in Health Care/Long Term Care, Housing, Property Management | Permalink | Comments (0)

Sunday, April 17, 2016

Time for Medicare Part LTC?

Periodically we will see observations about whether Medicare should offer a long term care benefit as part of Medicare coverage (would this be Part E or maybe Part LTC?).  It isn't a secret that many often think Medicare has a long term nursing home benefit, confusing what Medicare covers with what Medicaid does. Health Affairs Blog ran a story recently about  Medicare and long term care. Medicare Help At Home offers some sobering data

Nine million community-dwelling Medicare beneficiaries—about one-fifth of all beneficiaries—have serious physical or cognitive limitations and require long-term services and supports (LTSS) that are not covered by Medicare. Nearly all have chronic conditions that require ongoing medical attention, including three-fourths who have three or more chronic conditions and are high-need, high-risk users of Medicare covered services.

Gaps in Medicare coverage and the lack of integration of medical care and LTSS have serious consequences. Beneficiaries are exposed to potentially high out-of-pocket expenses. Medicaid covers LTSS for very low-income Medicare beneficiaries, but only one-fourth of Medicare beneficiaries with serious physical or cognitive limitations are covered by Medicaid.

The authors offer a 3-part proposal that would expand Medicare coverage to include home and community-based coverages:

  1. A Medicare home and community-based benefit for those with two or more functional limitations, Alzheimer’s, or severe cognitive impairment, according to an individualized care plan based on beneficiary goals. This would cover up to 20 hours a week of personal service worker care or equivalent dollar amount for a range of home and community-based LTSS.
  2. Creation of new Integrated Care Organizations (ICOs) accountable for the delivery and coordination of both medical care and LTSS that meet quality standards, honor beneficiary preferences, and support care partners.
  3. Innovative models of health care delivery including a team approach to care in the home building on promising models of service delivery that improve patient outcomes, reduce emergency department use, prevent avoidable hospitalization, and delay or reduce long-term institutional care.

The article goes on to explain eligibility, beneficiary cost-sharing, financing, care delivery and coverage. The article concludes, offering that with the Baby Boomers " the Medicare program ... was not designed to support their [boomers] preferences for independent living and functioning.

Moving forward, adoption of a home and community based benefit in Medicare would constitute an important first step to helping beneficiaries afford the services and support they need to continue living independently. Adoption of innovative models of care emphasizing care at home or in independent living settings would reduce the difficulty and risk of obtaining services in traditional health care settings such as physician offices and hospitals. It would also reduce beneficiary reliance on Medicaid’s safety-net coverage of institutional care. It is a policy proposal worthy of serious consideration as the nation grapples with Medicare redesign to meet the needs of an aging population.

 

 

 

April 17, 2016 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (2)

Friday, April 15, 2016

Multigenerational Housing-The Hot New Thing!

The New York Times ran a story recently about a new trend in housing for elders---multigenerational homes.  Multigenerational Homes That Fit Just Right are homes that, as the name implies, are designed for multiple generations of a family that live in the same house.  "[A] growing number of families ... are seeking specially designed homes that can accommodate aging parents, grown children and even boomerang children under the same roof. The number of Americans living in multigenerational households — defined, generally, as homes with more than one adult generation — rose to 56.8 million in 2012, or about 18.1 percent of the total population, from 46.6 million, or 15.5 percent of the population in 2007, according to the latest data from Pew Research. By comparison, an estimated 28 million, or 12 percent, lived in such households in 1980."

But how does one accommodate family dynamics when living together under one roof? In fact, the story notes, many of the multigenerational households do live in an "ordinary" home. But, it appears that the building industry has developed an option that is catching on, "responding quickly to this shifting demand by creating homes specifically intended for such families."  For example, one builder's homes "don’t offer just a spare bedroom suite or a “granny hut” that sits separately on the property or a room above a garage. The NextGen designs provide a separate entranceway, bedroom, living space, bathroom, kitchenette, laundry facilities and, in some cases, even separate temperature controls and separate garages with a lockable entrance to the main house. Family members can live under the same roof and not see one another for days if they so choose."

The article explains the drivers for the trend, baby boomers (of course), the 2008 recession, tough job market and higher rents facing millenials, the boomerang children and again, those baby boomers, "[m]any [of whom] are planning ahead in hopes that they can devote more attention to their children and grandchildren — and spend little, if any, time in a nursing home."

Expect to see more of these multigenerational homes over the next years. From a legal perspective, it seems that ground rules, a family contract and a care  would be important to the success of the venture (whose turn is it to cut the grass this week? No loud music after 11 p.m. as a couple of an examples).  What an interesting concept of the market changing to accommodate demand.

April 15, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Property Management, Retirement | Permalink | Comments (1)

Wednesday, April 13, 2016

Hoarding-More Prevalent Than You May Think.

I ran across a couple of articles recently about hoarding.  We all have "stuff" and the older we get, the more "stuff" we may have as we accumulate a lifetime of memories. Does that mean we are hoarders? According to the article in the Washington Post, Hoarding is a serious disorder — and it’s only getting worse in the U.S.,

While the stockpiling of stuff is often pinned on America’s culture of mass consumption, hoarding is nothing new. But it’s only in recent years that the subject has received the attention of researchers, social workers, psychologists, fire marshals and public-health officials.

They call it an emerging issue that is certain to grow with an aging population. That’s because, while the first signs often arise in adolescence, they typically worsen with age, usually after a divorce, the death of a spouse or another crisis.

So you have a lot of stuff. And maybe you are disorganized (I once had someone tell me people do two kinds of organizing, some are "pilers" and others are "filers").  Does that mean you are a hoarder? Not necessarily, according to the article, because "[h]oarding is different from merely living amid clutter, experts note. It’s possible to have a messy house and be a pack rat without qualifying for a diagnosis of hoarding behavior. The difference is one of degree. Hoarding disorder is present when the behavior causes distress to the individual or interferes with emotional, physical, social, financial or legal well-being." 

The article offers some interesting insights into hoarding and the research (such as it runs in families) but it isn't until recently that it's been thought of as a brain disorder.  Not only may hoarding have lacked attention in the past, it's one of those situations where the person may not know to seek treatment and the response requires a multi-disciplinary approach. The article has a lot of good information and is insightful in covering the issues.

Then look at this article in Huffington Post's Post 50, 5 Signs That Someone You Love May Be A Hoarder where one expert is quoted as predicting about 4 million people in the U.S. are hoarders. "Hoarding ...  is associated with a number of things including difficulty processing information, the inability to make decisions when confronted with a large amount of information and a failure to categorize things — meaning you can’t see the commonality of objects and they instead all look unique to you." This article offers 5 signs that someone is a hoarder, including constant attendance at garage sales and swap meets, never inviting visitors to the person's home, never giving anything away, keeping every scrap of paper and getting upset at the suggestion of discarding possessions.  Sound like anyone you may know?

 

April 13, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Health Care/Long Term Care, Other | Permalink | Comments (0)

Monday, April 11, 2016

Is Aging Something to Be Cured?

We have all seen advertisements for "anti-aging" products and claims of products and research to defeat aging, reverse the effects of aging or at least slow down time.  Last month Fortune ran the article, The Obsession With 'Curing' Aging Is Now Big Business. Opening with statistics about Baby Boomers, the article next notes that "[i]t comes as little surprise, then, that finding ways to extend a healthy life has become big business, attracting many tens of millions in investment dollars from the likes of Google ...  and numerous biotechnology companies."  The article looks at six "tech titans" who are financing research for "longevity solutions," including the co-founder of the Methuselah Foundation who explains "[t]he Methuselah Prize has been credited for encouraging scientists to work on anti-aging research and treat aging as a "medical condition...." The research is fascinating. Check out the article and consider including this topic in a class discussion.

April 11, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Science | Permalink | Comments (0)

Friday, April 8, 2016

DOL Guidance Available for Families on Wage Payments to Home Care Workers

U.S. Department of Labor has a new guide book, "Paying Minimum Wage and Overtime to Home Care Workers," to assist families in understanding updated rules for payment of home care workers. These rules became fully effective on January 1, 2016.

The goal of the recently finalized  "Home Care Final Rule" is to "make sure that home care workers have the same basic wage protections as most U.S. workers, including those who perform the same jobs in nursing homes and group homes."   The rule applies "if you hire the worker directly, and no agency or other organization is involved," but may also apply if you hired the worker through an agency.  

Employers must keep certain basic records for home care workers, and these records will be key to determining proper payment, especially for overtime:

1. Full name;

2. Social security number;

3. Home address;

4. Hours worked each day and total hours worked each workweek;

5. Total cash wages paid each week to the employee by employer, including any overtime pay; and

6. Any weekly amounts claimed by the employer as part of wages for housing or food provided to the employee/.

The guide explains special rules that apply if the paid care provider is a family member or  if the paid worker is "living in."

In addition, the guideline explains the "narrow" exemption from minimum wage and overtime rules that applies for home care workers who provide only "companionship services."  The key here is that the the worker can be spending no more than 20% of his or her working time on tasks such as assisting with personal care (bathing, dressing, cooking, cleaning, etc.) and the worker is not performing any medically related tasks.  

April 8, 2016 in Current Affairs, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (0)

Tuesday, April 5, 2016

2016 Alzheimers Facts and Figures

The Alzheimer's Association has issued the 2016 Facts and Figures report.   2016 Alzheimer's Disease Facts and Figures  is

a statistical resource for U.S. data related to Alzheimer’s disease, the most common cause of dementia, as well as other dementias. Background and context for interpretation of the data are contained in the Overview. This information includes descriptions of the various causes of dementia and a summary of current knowledge about Alzheimer’s disease. Additional sections address prevalence, mortality and morbidity, caregiving, and use and costs of health care, long-term care and hospice. The Special Report discusses the personal financial impact of Alzheimer’s disease on families.

 

Check out the quick facts here which is great for use in classes. A pdf of the report is available here. An infographic accompanying the report is available here. As the conclusion notes

The costs of caring for a relative or friend with Alzheimer’s disease or another dementia can have striking effects on a household. These costs can jeopardize the ability to buy food, leading to food insecurity and increasing the risks of poor nutrition and hunger. In addition, the costs can make it more difficult for individuals and families to maintain their own health and financial security. Lack of knowledge about the roles of government assistance programs for older people and those with low income is common, leaving many families vulnerable to unexpected expenses associated with chronic conditions such as Alzheimer’s and other dementias. Better solutions are needed to ensure that relatives and friends of people with dementia are not jeopardizing their own health and financial security to help pay for dementia-related costs.

 

 

April 5, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care | Permalink | Comments (0)

Sunday, April 3, 2016

Take a Mortgage for Expensive Healthcare?

Kaiser Health News (KHN) published a story on March 29, 2016 that caught my attention. Mortgages For Expensive Health Care? Some Experts Think It Can Work reports on a recent report from "[a] Massachusetts Institute of Technology economist and Harvard oncologist have a proposal to get highly effective but prohibitively expensive drugs into consumers’ hands: health care installment loans."  The article was published in Science Translational Medicine and is available here. The abstract explains

A crisis is building over the prices of new transformative therapies for cancer, hepatitis C virus infection, and rare diseases. The clinical imperative is to offer these therapies as broadly and rapidly as possible. We propose a practical way to increase drug affordability through health care loans (HCLs)—the equivalent of mortgages for large health care expenses. HCLs allow patients in both multipayer and single-payer markets to access a broader set of therapeutics, including expensive short-duration treatments that are curative. HCLs also link payment to clinical benefit and should help lower per-patient cost while incentivizing the development of transformative therapies rather than those that offer small incremental advances. Moreover, we propose the use of securitization—a well-known financial engineering method—to finance a large diversified pool of HCLs through both debt and equity. Numerical simulations suggest that securitization is viable for a wide range of economic environments and cost parameters, allowing a much broader patient population to access transformative therapies while also aligning the interests of patients, payers, and the pharmaceutical industry.

The KHN article explains that this proposal is "not designed to pay for maintenance drugs that help people deal with chronic illness. It’s easier for insurers to cover maintenance drugs because they’re purchased over an extended period of time...." The KHN article offers comments from those with opposing views and discusses how outcomes effect the loan.

April 3, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care | Permalink | Comments (0)

An Aging World -- Trends by the Numbers

The U.S. Census Bureau recently released it's updated international population report, An Aging World: 2015. Lots of interesting numbers in this 135 page report (plus tables), with analysis indicating trends. To highlight a few:

  • Growth of world's older population will continue to outpace that of younger population over the next 35 years
  • Asia leads world regions in speed of aging and size of older population
  • Africa is exceptionally young in 2015 and will remain so in the foreseeable future
  • World's oldest countries are mostly in Europe, but some Asian and Latin American countries are quickly catching up
  • Some countries will experience a quadrupling of their older population from 2015 to 2050

The document compares India and China as two "population giants" that are on "drastically different paths of population aging."  

In 2015, the total population of China stands at 1.4 billion, with India close behind at 1.3 billion. It is projected that 10 years from now, by 2025, India will surpass China and become the most populous country in the world. . . . Although both China and India introduced family planning programs decades ago [graphic available in report], the fertility level in India has remained well above the level in China since the 1970s. By 2030, after India is projected to have overtaken China in terms of total population, 8.8 percent of India’s population will be aged 65 and older, or 128.9 million people. In contrast, in the same year, China will have nearly twice the number and share of older population (238.8 million and 17.2 percent).

The report also introduced me to a new acronym - HALE - for "healthy life expectancy," as an important measurement of population health across the life span.  For example, while among European countries France has the longest life expectancy, Norway has significantly better projections for healthy life expectancy, the number of years older adults can be expected to live without activity limitations. 

April 3, 2016 in Health Care/Long Term Care, International, Statistics | Permalink | Comments (0)

Thursday, March 31, 2016

More Resources on Dementia

A friend sent me several recent resources about elders with dementia.  The Hospice and Nursing Home Blog published a video on Doctors’ End-of-Life Language, Impact on Patient-Caregiver Decisions.  The Agency on Healthcare Research and Quality published Nonpharmacologic Interventions for Agitation and Aggression in DementiaThe pdf of the article is available here. Finally, in February, 2016, this article, Palliative care of patients with advanced dementia was published in UpToDate (which is "an evidence-based, physician-authored clinical decision support resource....")

Thanks to my friend Pamela Burdett for sending me the links to these 3 publications.

March 31, 2016 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care | Permalink | Comments (0)

Tuesday, March 29, 2016

Caregiver Shortage or a Caregiver Crisis?

We have written several posts about the need for caregivers, so this article in the Washington Post is particularly relevant to our classes. I needed to find care for my elderly aunt. What I found was an eldercare crisis ran on March 22, 2013.  The article opens wit h a story about an elder relative who had fallen, again, not a too unfamiliar a story, unfortunately.

It’s true that aging isn’t exactly what it used to be. Thanks to Botox and Viagra and other medical innovations, anyone with some money can look and act 30 at 50 or 50 at 70. Many boomers are working past 65. Mick Jagger is still strutting around. Age is just a number!

But this approach to aging, however empowering, is a lie. Most of us won’t keep going strong until we’re felled by a painless heart attack in our sleep. Life is seldom so kind.

The story continues, the relative was sent home but needing assistance with multiple ADLs, struggled, and ultimately fell again.  "[W]hat happened after showed me how difficult it is for the elderly and their families to navigate health care in this country. Once she got home, [the relative] struggled with everything from eating to dressing to washing. Four days later, I got another call: She’d fallen again, trying to get out of the armchair she was sleeping in because lying flat in bed was too uncomfortable." The author discusses the options explored, but to no avail-no Medicare rehab coverage, LTC insurance wouldn't yet kick in, and no option of living with relatives.  Finding the right home health agency required effort and research to find the right fit of agency that provided the right level of services the relative needed.

The author then learned some reasons why caregivers may be hard to find: "[d]espite the critical need for eldercare, getting the workers to do it is not easy. Sharona Hoffman, author of “Aging with a plan: How a Little Thought Today Can Vastly Improve Your Tomorrow,” (note-we had previously blogged about Professor Hoffman's work)  explained ... that the tedious work of caring for people at home carries risks, such as back injuries from lifting a patient after a bath or dealing with a patient who gets violent or handsy due to dementia. The pay isn’t great; the night caregiver we found for [the relative] confided in her that her take-home pay was about $10 an hour, or minimum wage in California. (We paid the agency who oversaw her $16 an hour.) Unsurprisingly, turnover among these workers is as high as 60 percent."

The article turns to the issue of workers' rights, noting some efforts in California.  There is a balancing act occurring here-workers' rights and affordable care. An Hawaiian state senator has introduced a bill for "universal home care" and some of the presidential candidates have at least acknowledged the issue.

The author's relative has improved and the author acknowledges she's learned some lessons along the way. The relative "no longer needs night care, though we have a plan in place when she does.Even with all the problems that have plagued her in the last 18 months, she remains the woman I hope to be should I make it, mostly unscathed, into my 90s. I may even buy a hat or two. And I’ll definitely have a number of home care agencies on speed dial."

Thanks to my colleague Professor Bauer for sending me the article.

 

March 29, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care | Permalink | Comments (0)

Family Finances, POAs, and Telephone Help Lines in the Third Age

Roz Chast's memoir of life with her parents as they aged, Can't We Talk About Something More Pleasant?, uses humor to explore the complicated issues that can arise when aging parents and their adult children try to address physical frailty and financial complexities in the "third age" of life.   Another look, equally realistic and also ruefully humorous, comes from William Power, writing for the Wall Street Journal in "The Difficult, Delicate Untangling of Our Parents' Financial Lives."   Thanks to the WSJ for making this an  unlocked article for digital access! 

Power begins with that ever-humbling attempt to use "help lines" to solve problems by phone:

“No, no, no, don’t transfer me to her again,” pleads my wife.  It is a typically frustrating moment in our family crisis, one that many grown children will have to face, ready or not: We are people in our 50s who are unraveling the finances of parents who can no longer do it themselves.

 

My wife, Julie, is on the phone with the company where her 82-year-old dad had once worked, trying to change the direct deposit of his pension checks to a bank closer to the assisted-living home where he and his wife now live, which is near us in Pennsylvania. Again and again, she is transferred to the person in charge, “Rose.” And every time, the same recording: “This number has been disconnected.”

Power's account is punctuated by practical advice for others, including the importance of teamwork, involving both family members and others, in tackling the issues, as well as the use of key document-based tools, including Powers of Attorney, or as he stresses, "Repeat after Me: POA, POA, POA."  

My thanks to Amy Bartylla, a long-time friend, for this article referral.

 

March 29, 2016 in Advance Directives/End-of-Life, Consumer Information, Dementia/Alzheimer’s, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, Property Management | Permalink | Comments (0)

Monday, March 28, 2016

Medicare Part D Co-Insurance as Percentage?

Kaiser Health News ran a story on March 18, 2016 about co-insurance trends in drug coverages. Coinsurance Trend Means Seniors Likely To Face Higher Out-Of-Pocket Drug Costs, Report Says explains that a new report shows that "Medicare beneficiaries may get dinged with higher prescription drug bills this year because more than half of covered drugs in standalone plans require them to pay a percentage of the cost rather than a flat fee...." This report notes that over half of the Part D covered drugs have a coinsurance payment rather than a fixed copayment. This means greater out of pocket costs for Medicare beneficiaries.  As a result, predicting a beneficiary's out of pocket costs is more difficult.

The report, Majority of Drugs Now Subject to Coinsurance in Medicare Part D Plans is available here.  A pdf of the report is available here.

March 28, 2016 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare, Statistics | Permalink | Comments (0)

Creativity -- Thy Name is Senior Living!

From the New York Times, courtesy of reader and Bethesda, Maryland Elder Law Attorney Morris Klein, comes a demonstration of just how "clued in" the world of senior living has become.  A recent article begins with the background of ShantiNiketan in Florida, and continues with other descriptions of creatively-designed assisted living, nursing facilities and day programs serving ethnic communities around the country, including Chinese-Americans:

 

Indian immigrants who came to the United States in the 1960s and ’70s for educational and work opportunities have begun to downsize and contemplate their postcareer years, said Iggy Ignatius, 60, ShantiNiketan’s chairman. “Many people were thinking they’d go back to India, but pragmatically it’s not possible,” he said. “Our children are here. Our grandchildren are here.”

 

In Florida, from the architecture that reminds Dr. Chandran of Chennai, India, to the vegetarian meals and Bollywood dance classes, “we have created a mini-India, a piece of India,” Mr. Ignatius said. The Chandrans moved into their three-bedroom condominium in 2011, paying $250,000, and now they lead yoga classes in ShantiNiketan’s meditation room.

For more, read the always interesting Paula Span's full article,  A New Spin on Senior Living.

March 28, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing | Permalink | Comments (0)