Thursday, August 6, 2015
From a recent NPR piece on Knowing How Doctors Die Can Change End-of-Life Discussions:
Dr. Kendra Fleagle Gorlitsky recalls the anguish she felt performing CPR on elderly, terminally ill patients. It looks nothing like what we see on TV. In real life, ribs often break and few survive the ordeal.
"I felt like I was beating up people at the end of their life," she says. "I would be doing the CPR with tears coming down sometimes, and saying, 'I'm sorry, I'm sorry, goodbye.' Because I knew that it very likely not going to be successful. It just seemed a terrible way to end someone's life."
Gorlitsky now teaches medicine at the University of Southern California and says these early clinical experiences have stayed with her. Gorlitsky wants something different for herself and for her loved ones. And most other doctors do too: A Stanford University study shows almost 90 percent of doctors would forgo resuscitation and aggressive treatment if facing a terminal illness.
This selection also reminded me about an important essay from a few years ago, How Doctors Die, by Dr. Ken Murray. Hat tip to my Dickinson Law colleague Professor Laurel Terry for sending me this NPR piece.
[t]he ratings are based on agencies’ assessments of their own patients, which the agencies report to the government, as well as Medicare billing records. The data is adjusted to take into account how frail the patients are and other potential influences. Medicare intends to use the same or similar data sources when it eventually begins to pay bonuses and penalties to agencies based on performance, as it does for hospitals.
According to Medicare's blog, HHAs are rated in 9 categories, including wound care and prevention of bed sores, handling daily activities, controlling pain, and protecting the patient from harm. To learn more, click here to visit the HHA Compare website.
Wednesday, August 5, 2015
In recent weeks, I've been doing background research on "cross-border retirement" issues and therefore I was interested to read that ElderLawGuy Jeffrey Marshall's brother has retired to Mexico and "loves it."
For some, the reasons may include comparative costs for a range of services, including support for "independent" living, or more skilled care, as documented by the PBS News Hour program on "Why Foreign Retirees Are Flocking to Mexico." The program interviews retirees in central Mexican communities near Lake Chapala. The program compares "average cost for independent living" in U.S. retirement communities of "about $2,500 per month, with one Mexican community's prices for "rent, all utilities, connections for internet, television ... plus three meals a day" at "just a little over $1,000 a month."
But, as the program touches on (only briefly), Medicare benefits don't apply in Mexico (although, perhaps they should?). And there are also important questions about reciprocity in care for Mexican retirees who may have spent many working years in the U.S.
I was reading a blog post from Aging in Place Technology Watch which offered a roundup of tech announcements coming out of the 2015 White House Conference on Aging. I was intrigued by the UberAssist project which according to the announcement on Uber's website
Today, Uber will participate in the White House Conference on Aging and discuss Uber’s efforts to engage the senior community. At the event, we will announce the launch of a pilot program for community-based senior outreach. In cities across the country, Uber will offer free technology tutorials and free rides at select retirement communities and senior centers. Alongside public and private sector representatives, we hope to further the conversation about the way technology adoption can improve older adults’ day-to-day lives.
Uber has some projects going in Florida, for example, in Gainesville, Uber
is working with the City ... to offer on-demand transportation for residents of two senior centers as part of a six month program. Anytime a resident at a participating senior center needs a ride, he or she can request one at an even more affordable rate because of support from the city. Free technology tutorials will be available throughout, so residents of the participating centers can feel comfortable and at ease using Uber. Uber is also piloting a similar senior ride program in partnership with the Town of Miami Lakes.
a unique new collaborative research and development initiative for open innovation that will examine and share solutions for aging well. The initiative will identify new technologies, products and services, as well as provide thought leadership in collaboration with older adults, caregivers, healthcare systems, payers, policy makers, corporate innovators, entrepreneurs and academia. The AWH will also seek solutions to improve technology adoption among older adults and make aging well a reality for more people, by enabling them to better connect with their communities and healthcare providers.
You can read all of the WHCOA partner press releases and announcements here.
Tuesday, August 4, 2015
I, along with many academics, have appreciated the opportunity to travel more easily to Cuba (my first working visit was in June). It will be fascinating to see what academic programs emerge, including opportunities for comparative law studies. Along this line, it was was interesting to read a Washington Post article about plans of several colleges and universities, including University of District of Columbia Law School's announcement of a week-long session in January 2016 for study of "issues around aging," including, apparently, the dean's interest in filial support enforcement in Cuba.
My thanks to Kate Manni, an administrator from Penn State's Office of Global Programs, for sharing the Post's article.
The New York Times ran a story on July 17, 2015 on how scammers are targeting older individuals on internet dating sites. Swindlers Target Older Women on Dating Websites tells the stories of several elders who ended up sending significant sums of money to scammers who had developed virtual relationships with these elders. This high-tech version of the "romance con" has resulted in the legislature in at least one state, Vermont, to consider "pass[ing] a law requiring online dating sites to notify members quickly when there is suspicious activity on their accounts or when another member has been barred on suspicion of financial fraud." As well, the story explains, the proliferation of the virtual version of the romance con was the impetus for action from AARP.
Despite warnings, the digital version of the romance con is now sufficiently widespread that AARP’s Fraud Watch Network in June urged online dating sites to institute more safeguards to protect against such fraud. The safeguards it suggests include using computer algorithms to detect suspicious language patterns, searching for fake profiles, alerting members who have been in contact with someone using a fake profile and providing more education so members are aware of romance cons.
The AARP network recommends that from the beginning, dating site members use Google’s “search by image” to see if the suitor’s picture appears on other sites with different names. If an email from “a potential suitor seems suspicious, cut and paste it into Google and see if the words pop up on any romance scam sites,” the network advised.
On AARP's site, individuals can learn more about these digital romance cons, sign an on-line petition to dating sites to adopt safety measures, and learn 10 tips on how to spot a romance scammer and 5 tips to protect oneself from this "virtual heartbreak".
Monday, August 3, 2015
The Arizona Republic recently reported on Arizona legislation affecting home care agencies that will become effective in 2015, after a similar bill was vetoed in 2014 by a previous governor. According to news reports, the new law requires agencies to disclose to consumers whether they do background checks on employees, what type of training they use for employees, the costs of services and their hiring and firing practices.
In my experience, such a "disclosure" focus is different than setting minimum substantive standards for home care, and puts a great deal of responsibility for evaluation of "disclosed" information on consumers, who when it comes to long-term care, may already be under stress.
"We want to help the consumer understand better and make an educated decision," said Mark Young, president of the Arizona In-Home Care Association (AZNHA) who helped press for passage of the bill. "A lot of times, clients get in crisis mode when they need to make these decisions because they don't know about the industry."
The bill, sponsored by Sen. Nancy Barto, R-Phoenix, passed unanimously in the Senate and by a 51-8 margin in the House. Gov. Doug Ducey signed the bill into law April 1.
Home-care service owners could be charged with a misdemeanor if their company does not comply with the new regulations, the attorney general's office said. But the law does not apply to volunteer caregivers and home-care service organizations already licensed by the state or federal government.
The Administration for Community Living (ACL) has posted a new report on its website. The July 2015 report was prepared by RTI International pursuant to a contract with ACL. The report is titled IDD and Dementia. The executive summary explains in part:
The National Plan to Address Alzheimer’s Disease (2014) calls for a coordinated effort to develop workforces in aging, public health, and intellectual and developmental disabilities that are dementia-capable and culturally-competent. In response to this directive, the U.S. Administration on Community Living presents the findings and resources in this white paper to community of providers who primarily serve older adults. It provides a broad overview of the services and support system for persons with intellectual and developmental disabilities (IDD) affected by dementia and their caregivers, examples of cross-network initiatives, and resources for improving dementia care across agencies and organizations that serve this population.
This white paper presents the current state of services and support system for persons with IDD who have dementia. There is recognition in the aging and IDD networks that states are in a transition period where the future of services will be more person-centered and focused on integration in the community (see Appendix A).
The report is divided into 9 sections with section 4 looking at screening, diagnosis and treatment; section 5 looking at services and financing; and section 6 looking at efforts to improve community-based services. Section 7, the conclusion, includes a brief discussion of 5 issues:
Is dementia awareness education available to the IDD population and service providers?
Do the information and assistance services in both the aging and IDD networks identify those individuals with IDD and dementia and their caregivers who contact them?
Are persons with IDD and dementia being referred for appropriate diagnosis?
Are program eligibility and resource allocations taking into account the impact of cognitive disabilities on an aging population of persons with IDD?
Are the dementia-capable home and community-based services available to the general population capable of serving persons with IDD and dementia?
The report is available here.
Friday, July 31, 2015
Which is More Terrifying? "Dying Early" or "Living Long" (and Doing Financial Planning Necessary for the Latter)?
The New York Times recently carried a column that probably hit home with many -- if, that is, one could bring oneself to read it. While some people keep postponing "the conversation" discussion about how they want to die, there is plenty of evidence many people are also avoidant of conversations about financial planning for a long life.
Educating consumers to be better purchasers seems a sensible idea, but an example from recent history illustrates the problem with that. For a long time, the simple investment advice given to consumers has been “buy an index fund.” Index funds are such standardized products — mirroring the Standard & Poor’s 500-stock index does not require much management — that just about all of them were initially low cost while offering wonderful diversification.
Consumers have been buying index funds, and the market has responded by providing hundreds of them. Nearly all E.T.F.s are index funds.
But the market has also responded by charging high fees for this standardized product. In 2004, Ali Hortacsu and Chad Syverson, economists at the University of Chicago, found that index funds had as much variability in fees as their more labor-intensive actively managed counterparts. And these fees are nothing to be scoffed at — paying 1 percent more every single year in fees can compound over a lifetime to noticeably lower returns.
For more on the problem with financial advice -- with encouragement to "face up to something [you too] may have been dreading," read Why Investing Is So Complicated, and How to Make it Simpler, by Sendhil Mullainathan.
My thanks to Prof. Laurel Terry and Jack Bennett, Esq. for sharing this column.
AARP''s Public Policy Institute has released a new report that provides an update on the topic of family caregivers. Valuing the Invaluable 2015 Update: Undeniable Progress, but Big Gaps Remain is 25 pages long and available as a pdf. As the introduction notes:
In 2013, about 40 million family caregivers in the United States provided an estimated 37 billion hours of care to an adult with limitations in daily activities. The estimated economic value of their unpaid contributions was approximately$470 billion in 2013, up from an estimated $450 billion in 2009.
This report also explains the key challenges facing family caregivers…The report highlights the growing importance of family caregiving on the public policy agenda. It lists key policy developments for family caregivers since the last Valuing the Invaluable report was released in 2011. Finally, the report recommends ways to better recognize and explicitly support caregiving families through public policies, private sector initiatives, and research.
The report reviews progress in policies, programs and services at the federal and state levels since the previous report and makes over 20 policy recommendations in a number of categories.
To both address the growing care gap as the population ages and lessen the strain in the daily lives of caregiving families, more meaningful public policies and private sector initiatives are needed now. Better strategies will assist those who need care and their families struggling to find and afford the supportive services to live in their homes and communities—where they want to stay. It is essential to the well-being of our health care and LTSS systems, our economy, our workplaces, our families, and ourselves.
Thursday, July 30, 2015
The legislation carrying the name Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act, that has now passed both the House and Senate, goes to President Obama for signature. If signed by the president, it will still be another year before its official effective date.
Sadly, it doesn't actually fix the problem for the patients with the fact that hospitals frequently attempt to hold patients on a fictional "observation only" status. Money is still the issue. Hospitals want to avoid harsh potential Medicare penalties associated with readmissions of "admitted" patients. At the same time, the lack of "admitted status" reduces the ability of patients to seek Medicare coverage for rehabilitation care post-hospitalization. But now the patients get better "notice" of their status -- and the potential for it to affect Medicare coverage and therefor out-of-pocket expense for the patients.
As detailed in new stories in Southern California media, an important suit by University of California San Diego (UCSD) against University of Southern California (USC) highlights a battle between public and private research enterprises. Control over millions of dollars is stake for Alzheimer's-related research. From the San Diego Union-Tribune in a Sunday feature article by Larry Gordon, Gary Robbins and Bradley Fikes:
In the lawsuit, U.C. San Diego alleges that USC, [Alzheimer's researcher Paul] Aisen and eight colleagues conspired to take research data involving more than 1,000 patients and other assets, including an estimated $100 million in federal and private funding to a new Alzheimer's study center in the San Diego Area. Aisen and USC deny any wrongdoing and contend that UC San Diego is trying to inhibit the freedom to move jobs and is threatening the data's security.
A Superior Court judge in San Diego last week denied USC's request to block UC San Diego's access to that data.
Richard Seligman, the associate vice president for research administration at Caltech who has more than four decades of experience dealing with grants, said he had never heard of such a lawsuit even though competition for grants and noted faculty has gotten more fierce.
Stakeholders interested in the outcome of the research are reported to be taking note of the suit, with Mary Carrillo, the chief science officer for the Alzheimer's Association quoted as saying the association wants a "speedy resolution" of the lawsuit to keep research going forward.
Left in an uncomfortable middle ground are the National Institutes of Health and its subsidiary National Institute on Aging, which provides about $11 million per year to the UC Alzheimer's Center. While confirming that UC San Diego still holds that grant, officials at those agencies said they must approve whether funding like that stays put or moves to another school with a principal investigator like Aisen.
For additional background on the lawsuit, see a related Los Angeles Times piece here. Reporters from the Los Angeles Times and the San Diego Union-Tribune have collaborated on these stories.
On Friday, July 24, a California trial court ruled that the key research data must be returned to UCSD and therefore does not go "with" the faculty member, Aisen, recruited away from San Diego by USC. Details here.
As further evidence of the battle for primacy in southern California medical research, USC and UCSD have each courted the La Jolla Institute for Allergy and Immunology, with University of California-San Diego energing as the winning suitor for "affiliation." Details here.
Wednesday, July 29, 2015
Ever wonder how your neighborhood would measure up as a "livable community"? AARP has released an interactive tool. The Livability Index: Great Neighborhoods for All Ages explains: this is "[a]n interactive, easily navigated website, the Livability Index allows users to compare communities, adjust scores based on personal preferences and learn how to take action to make their own communities move livable." The tool is easy to use and gives results quickly. The index rates communities in seven categories, including environment, health, engagement, transportation, housing, neighborhoods and opportunity. Try it!
Sally Hurme, J.D., adds another useful book to her long list of consumer-friendly publications. In Checklist for Family Caregivers, published and marketed jointly by AARP and the American Bar Association, offers "to do" and "action" checklists to guide family members as key providers of care and assistance for seniors. Each topic is introduced by brief narratives of explanation, often with an emphasis on legal implications of decision-making. For example Chapter 6 is on "Deciphering Contracts," and describes different components of family caregiver agreements, home care service agreements (whether directly or through an agency), assisted living agreements, and skilled nursing care contracts, plus a few points about long-term care insurance policies.
Think of this book as the starting place -- and a wonderful opportunity to organize thoughts for meetings with doctors, agencies, social workers or lawyers. More information about the book is available on the ABA webpages (with a member discount, and "bulk discounts are available"), on AARP's webpage, or directly through Amazon.
Tuesday, July 28, 2015
Twenty-five years ago, through the Americans with Disabilities Act (ADA), our nation committed itself to eliminating discrimination against people with disabilities. The U.S. Department of Justice’s Civil Rights Division is proud to play a critical role in enforcing the ADA, working towards a future in which all the doors are open to equality of opportunity, full participation, independent living, integration and economic self-sufficiency for persons with disabilities. In honor of the 25th anniversary of the ADA, each month the Department of Justice will spotlight efforts that are opening gateways to full participation and opportunity for people with disabilities.
The efforts that are spotlighted can be accessed here. Concomitant with the anniversary, the Social Security Administration's July 27, 2015 blog, Supporting the Americans with Disabilities Act, focused on the ADA's anniversary.
There were a number of articles highlighting the ADA's anniversary. For example, the New York Times ran a Room for Debate on the ADA, The Americans With Disabilities Act, 25 Years Later. NPR did a story on the ADA's influence on other countries, How A Law To Protect Disabled Americans Became Imitated Around The World and the Washington Post ran an article by Professor Robert L. Burgdorf Jr., Why I Wrote the Americans with Disabilities Act. President Obama spoke about the anniversary of the ADA and the White House website has a page devoted to issues facing Americans with disabilities.
If you cover the ADA in your classes, there are many more useful articles and stories released as a result of the ADA's 25th anniversary.
I'm visiting family in the Southwest as I type this entry. To say that I come from a family of pack rat readers is an understatement. Every room in my parents' three story old house has stashes of books, even the bathrooms. In one room, I think the bed is entirely supported by books stacked neatly underneath it. (And this is a looooong family tradition; I can remember vacations in Wisconsin where the prized activity was digging through old books and ancient Saturday Evening Posts in a cousin's attic, to find the perfect text for reading on the screened- in porch on a rainy summer day).
This week's discovery was an article in the Winter issue of the Journal of the Southwest, a refereed journal published quarterly at the University of Arizona. "The Eclipse of the Century," tells the story of married scientists Cecile DeWitt-Morette and Bryce Seligman Dewitt, who pursued greater understanding of Einstein's theory of relativity. A goal was to observe one of the longest total eclipses of the sun, taking the highest-quality possible photographs in order to measure and document "bending" of light caused by the pull of gravity. The opening paragraph of the article by University of Texas PhD candidate David Conrad hooked me:
Cécile DeWitt-Morette sat on a roof in a sandstorm in the Sahara Desert. It was 10:30 a.m. on June 30, 1973, and nearly 100 degrees Fahrenheit. If the storm did not let up soon, all was lost. A year and a half of preparation and approximately $100,000 in grants would be for naught, and a similar opportunity would not come for another 18 years. But Cécile had no power over the wind or sand or time. She could only wait. Beneath her feet, inside the structure she and her colleagues from the University of Texas (UT) McDonald Observatory built, her husband Bryce DeWitt—head of the expedition—and five other men waited for the storm to abate. The clock ticked off the seconds, and still the sand blew. All the money and effort spent to send these people here, to the oasis of Chinguetti in the Islamic Republic of Mauritania, could not alter the forces of nature.
You may be asking, "How on earth is this a topic for the Elder Law Prof Blog," right? The answer comes from the fascinating start to UT's decision to develop a top-flight team of academic researchers. It began with a "will." The article continues...
Professor Cynthia Bond at John Marshall Law is doing a survey on how law profs use pop culture in their classrooms. Here is her email providing more info and requesting responses to her survey:
Greetings Law Teacher Colleagues:
I am working on an article this summer on uses of popular culture in the law school classroom. I am defining popular culture broadly to include mass culture texts like movies, TV shows, popular music, images which circulate on the internet, etc, and also any current events that you may reference in the classroom which are not purely legal in nature (i.e. not simply a recent court decision).
To support this article, I am doing a rather unscientific survey to get a sense of what law professors are doing in this area. If you are a law professor and you use popular culture in your class, I would be most grateful if you could answer this quick, anonymous survey I have put together:
Thanks in advance for your time and have a wonderful rest of summer!
The John Marshall Law School
Monday, July 27, 2015
Law Reform: A Proposed Remedy for "Deeply Toxic" Damage to Higher Ed Caused by Abolition of Mandatory Retirement
Bentley University Professors Beverley Earle and Marianne Delbo Kulow have a nicely provocative article in the Spring 2015 issue of the Southern California Interdisciplinary Law Journal, titled The "Deeply Toxic" Damage Caused by the Abolition of Mandatory Retirement and its Collision with Tenure in Higher Education: A Proposal for Statutory Repair. From the introduction:
There are very few positions that offer the level of protection that tenure does. One such position is a federal judgeship, which is distinguishable because of the very public nature of the work. If a judge performs inadequately, community backlash may quickly develop that could usher in a publicly coerced retirement. For example, a state judge, who recently gave a lenient sentence to a convicted rapist of a minor who committed suicide, has announced his retirement following pubic outrage.Tenured faculty members, unlike judges, labor in the relative isolation of the classroom, where feedback comes at the end of the semester and then only via student evaluations. This creates the first of two problems for higher education in the United States stemming from the abolition of mandatory retirement: the difficulty of removing a tenured professor for poor performance.
In most universities, only egregiously poor performance by a tenured professor is flagged for termination; outdated, boring, or barely adequate, teaching may not sufficiently stand out to warrant a more intense review. There is also a slow feedback loopdue to minimal, if any, post-tenure peer classroom evaluations and skepticism about student evaluations of teaching. Therefore, often many semesters pass before there is sufficient evidence to persuade a professor or her superiors that the tenured professor's employment status should be reevaluated. Inadequacies in scholarship can be even more difficult to discern, given the common time lag between research and publication, as well as the variations between disciplines in frequency, length, and format of publications.
The second distinct challenge faced by higher education caused by the coupling of the abolition of mandatory retirement with the institution of tenure is the prospect of stagnant departments: no new faculty may be hired because there are no vacancies....
The authors' proposed reforms include "expiration" of tenure for professors reaching age 70, while permitting continued employment opportunities on the same evaluative standards as non-tenured faculty.
Sunday, July 26, 2015
Many common nursing home practices are, in fact, illegal. In order to receive the best possible quality of care, a resident or resident’s family member should be familiar with the protections of the federal Nursing Home Reform Law, and understand how to use the law effectively.
This free webinar, with Directing Attorney Eric Carlson, will detail the most common problems that crop up—from evictions to excessive medication—and provide practical, clear tips to help family members and advocates navigate solutions.
This webinar complements the re-release of an updated version of our popular guide, 20 Common Nursing Home Problems and How to Resolve Them. Look for it on our website starting on Thursday, July 23, 2015.
The webinar is set for August 4, 2015 at 2 p.m. EDT. To register, click here.
With just a few weeks left before law school classes start again, I hope your summer writing and research projects are well underway, giving you time to relax a bit with a good beach read. I've got one to recommend, too. It's Dry Bones in the Valley by Tom Bouman.
The mystery is set in northeastern Pennsylvania, where old time music haunts the air, mixing with the off and on whine of modern day fracking. One of my favorite authors is Tana French, whose Dublin-based "police procedural mysteries" are an excuse for deep exploration of the human condition. Tom's debut novel is in that tradition, even bringing to bear an Irish spirit or two. I like it best when I can see, hear and "feel" the settings in a novel, as in this passage, where bone-tired Henry Farrell struggles to find balance while carrying out his official duties as the rural township's investigator:
I knew I wouldn't sleep and likely shouldn't with my head the way it was. Went back inside, got out my fiddle, and rosined the bow....
I needed something I could rip into. "Bonaparte's Retreat" found me. . . . By the time I got to the modified part B Copland had made so famous, I had to stop and breathe. I thought of George Ellis. Got a piece of paper and curled it into a funnel, poured the rest of my whiskey back into the bottle, and went to bed, but never to sleep.
It's not hard to get up if you never go down. Dawn brought a hint that the weather might get clearer. With enough pain pills, my head would too. The eastern sky was bright as a wild rose as I walked stiff-backed from my woodpile with an armload for the stove. The snow had melted, and my boots left prints on a field that, newly bared, crackled underfoot and shimmered silver; it was a beauty that would not last another ten minutes, so I dropped the firewood and stood and watched the night's frost dissolve into morning mist. Somewhere in the tree line, a bluebird burbled a tune, but I couldn't pick him out. It was the first songbird I'd heard that spring....
Strong writing, yes? But, how does this particular book relate to the Elder Law Prof Blog? Well, as you may have come to expect from me by now, one reason is a central character in the mystery, ol' Aub, may -- or may not -- be too old to remember the truths of what happened.
Another reason is the author is a current Penn State Dickinson law student, and his new book has already earned a 2015 Edgar Award for best first novel and a 2015 Los Angeles Times Book Award for best mystery/thriller.