Monday, October 10, 2016
Will New Federal Ban on Pre-Dispute "Binding" Arbitration Clauses in LTC Agreements Survive Likely Challenges?
My colleague Becky Morgan provided prompt links and important initial commentary for CMS's recently issued final regulations that are intended to "improve the quality of life, care, and services" in Long-Term Care (LTC) facilities. As we start to digest the 700+ pages of changes and commentary, it seems clear the battle over a key section that bans pre-dispute binding arbitration agreements is already shaping up. This rule, at 40 CFR Section 483.70(n), has an implementation date of November 28, 2016.
The regulatory ban on pre-dispute binding arbitration in covered facilities raises the question of "conflict" with the Federal Arbitration Act (FAA), 9 U.S.C. Section 1 et seq. The 2012 per curium ruling by the Supreme Court in Marmet Health Care Center, Inc. v. Brown, shapes the issue, if not the result.
CMS distinguishes Marmet and presents the rule change as based on authority granted under the Social Security Act to the Secretary of Health and Human Service to issue "such rules as may be necessary to the efficient administration of the functions of the Department," which necessarily includes supervision of all providers, including LTC providers, who "participate in the Medicare and Medicaid programs." CMS points to the long history of regulatory authority over LTC including long-celebrated "patient's rights" legislation adopted in the late 1980s. CMS further explains (at page 399 of the 700 page commentary to the new rules):
Based on the comments received in response to this rulemaking, we are convinced that requiring residents to sign pre-dispute arbitration agreements is fundamentally unfair because, among other things, it is almost impossible for residents or their decision-makers to give fully informed and voluntary consent to arbitration before a dispute has arisen. We believe that LTC residents should have a right to access the court system if a dispute with a facility arises, and that any agreement to arbitrate a claim should be knowing and voluntary. . . .
We recognize that an argument could be made that Medicare and Medicaid beneficiaries can assert in Court the FAA's saving clause if they believe that a pre-dispute arbitration agreement should not be enforced. However, the comments we have received have confirmed our conclusion that predispute arbitration clauses are, by their very nature, unconscionable. As one commenter noted, it is virtually impossible for a resident or their surrogate decision-maker to give fully informed or voluntary consent to such arbitration provisions. That same commenter 402 also noted that refusing to agree to the arbitration clause, in most cases, means that care will be denied.
Furthermore, Medicare and Medicaid beneficiaries are aged or disabled and ill. Many beneficiaries lack the resources to litigate a malpractice claim, much less an initial claim seeking to invalidate an arbitration clause. Rather than requiring Medicare and Medicaid beneficiaries to incur the additional fees, expense, and delay that would be the direct cost of opposing a motion to enforce arbitration, we have concluded that this is precisely the type of situation envisioned by the Congressional grant of authority contained in sections 1819(d)(4)(B) and 1919(d)(4)(B) of the Act authorizing the Secretary to establish "such other requirements relating to the health, safety, and well-being of residents or relating to the physical facilities thereof as the Secretary may find necessary.”
By coincidence, just hours before the final LTC rules issued by CMS, the Pennsylvania Supreme Court enforced pre-dispute arbitration agreements for nursing home residents in Taylor v. Extendicare Health Facilities (decided September 28, 2016).
The LTC industry seems ready to fight, as reported by industry insiders at McKnight's News on September 29, 2016:
Both the American Health Care Association and LeadingAge expressed disappointment in the arbitration ban in statements provided to McKnight's.
“That provision clearly exceeds CMS's statutory authority and is wholly unnecessary to protect residents' health and safety,” said Mark Parkinson, president and CEO of AHCA.
LeadingAge has supported arbitration agreements that are “properly structured and allow parties to have a speedy and cost-effective alternative to traditional litigation,” but believes CMS has overstepped its boundaries with the ban, the group said.
“Arbitration agreements should be enforced if they were executed separately from the admission agreement, were not a condition of admissions, and allowed the resident to rescind the agreement within a reasonable time frame,” LeadingAge added in its statement.
Stay tuned -- but don't hold your breath as the next round is likely to take some time. My special thanks to Megan Armstrong, Class of 2018 at Dickinson Law, for sharing key links with me for our research on this important development.
October 10, 2016 in Consumer Information, Ethical Issues, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare, State Statutes/Regulations, Statistics | Permalink | Comments (0)
Thursday, September 1, 2016
A recent report about Boomers and voting made be stop for a moment and go "hmmmm". Pew Research Center's latest FactTank offered that this may be the last presidential election where the Greatest Generation, the Silents and the Boomers have a significant impact at the polls.
This may be the last presidential election dominated by Boomers and prior generations explains that although these demographic groups have dominated at the polls, that may no longer be true; "their election reign may end this November, according to a new Pew Research Center analysis of census data."
[T]he ranks of Millennial and Generation X eligible voters have been growing, thanks to the aging-in of Millennials and naturalizations among foreign-born adults. These generations matched Boomers and previous generations as a share of eligible voters in 2012 and are now estimated to outnumber them. As of July, an estimated 126 million Millennial and Gen X adults were eligible to vote (56% of eligible voters), compared with only 98 million Boomers and other adults from prior generations, or 44% of the voting-eligible population.
However, keep in mind that eligible and actual are not synonymous. In fact, the article reminds us what ultimately matters is who casts ballots. Looking at the data and focusing on actual votes, the report offers that the Boomers and prior generations voted at a rate of about 70% of eligible voters. The younger generations percentage turnout was lower, according to the article.
Not that the generations are in competition or anything. It's just interesting to think about the changing demographics at the ballot box and wonder at the impact on laws and policies as a result.
Among those in the oldest living generation, the Greatest Generation, turnout crested in the 1984 election at 76% before declining. Similarly, turnout among eligible voters in the Silent Generation peaked at 76% in the 1992 election. The Millennial and Gen X generations are likely still on the upswing in terms of their turnout rates, so it is a reasonable guess that at least 54.5% of these adults will vote, and perhaps more.
We won’t know until after November if Boomers and their elders will pass the torch to Gen X and Millennials as a share of voters, but all the available data suggest that the 2016 election will mark the beginning of a new era for U.S. presidential elections.
Wednesday, August 24, 2016
Dickinson Law Professor Laurel Terry sent me a timely link to an NPR story about Japanese convenience stores. I was already thinking about how retail shopping has changed over the years. For example, on the corner of 7th Avenue and Indian School Road in Phoenix, there used to be a high-end Scandinavian furniture store. I'd only been in it once, and that was to use a gift certificate for what seemed like a huge amount of money at the time as a wedding present. My husband and I realized the most we could afford in the store was a wooden bowl. A very nice wooden bowl, mind you, but still, it was a wooden bowl.
Yesterday, as I passed that corner, I realized there was still a big, fancy sign out front, but the store is now a Goodwill franchise store.
So, with that change in mind, I enjoyed the NPR story, captioned Beyond Slurpees: Many Japanese MiniMarts Now Cater to Elders. From the written account:
Case in point is a Lawson convenience store in the city of Kawaguchi, north of Tokyo. It sells products that an American consumer would never find tucked between the aspirin and the candy bars. For example, there's a whole rack of ready-to-heat meals in colorful pouches. They're rated at levels from 1 to 5, based on how hard it is to chew what's inside.
Or, as the store's manager, Masahiko Terada, puts it, "the higher the level, the less need for you to chew. In the end it's porridge."
This Lawson store in Kawaguchi is one of six in a special line called Care Lawson. The company plans to expand to 30 by early next year. And these Care Lawson stores have another special feature: staff like Mika Kojima.
She's a nursing care manager and she's stationed at this Lawson store. In fact the franchise owner of this store is actually a nursing services company. Anyone who comes in can ask for Kojima's help. For example, she'll go to an older client's home to make sure it's set up so they can live there safely. And she'll connect families with adult day care services.
Convenience stories should be just that, convenient, right? With adults over age-65 making up nearly 27 percent of Japan's population, it just makes sense for retailers to provide customer-specific merchandise that is easily accessible, especially for people who might prefer to avoid large supermarkets. The Lawson chain also offers home deliveries.
The story made me wonder more about Lawson. How was it that the Japanese chain came to have such a non-Japanese name? It turns out Lawson began back to 1939 in Ohio, in the United States, where J. J. Lawson ran a dairy milk store. "'Mr. Lawson's milk store' was locally renowned for its fresh and delicious milk and many customers came to buy milk there every morning." The first Lawson convenience store opened in Japan in 1975 and sold "party food," very different from the model of today.
Friday, August 19, 2016
I'm always just a bit suspicious of books that promise to make me laugh. I think it is because I like to be surprised by humorous moments, rather than feel duty-bound to chuckle, guffaw or giggle.
Nonetheless, I succumbed to the promise in the blurb for Michael Kinsley's 2016 book, Old Age: A Beginner's Guide, that it was a "surprisingly cheerful book ... and a frequently funny account of one man's journey to the finish line."
And I'm glad I did. I did indeed laugh, and at the most surprising of moments, as when he described the need to avoid the doors of his refrigerator because of the magnets that might interfere with the technology in his brain used to keep symptom of Parkinson's Disease at bay. He has the knack of making wry observations about his own mortal state to think broadly about what it is for all of us to age. I can see the short essays that make up this book being useful in a class on elder law or estate planning.
His words are perhaps most poignantly relevant to boomers. For example, on a goal of living longer, he writes:
Even before you're dead, you may want to ask yourself whether this is what you really want. Is being alive all that desirable if you're alive only in the technical sense? Millions of boomers are watching their parents fade until they are no longer there. As they approach their seventies, they start observing their own peer group losing their collective marbles, one at a time. And they reasonably conclude that the real competition should not be about longevity. It should be about cognition.
But he doesn't stop there, exploring other, potentially more important goals for the competitive boomer generation to consider.
This is a short, deep book. And I recommend it, not least of all because it gives readers welcome opportunities to smile.
Wednesday, July 6, 2016
Not everyone retires. Some don't retire because they love the work they do. Others can't afford to retire. Still others change professions, but keep working. What will you do?
The Pew Research Center released a new FactTank report on June 20, 2016 about elders and work, More older Americans are working, and working more, than they used to. Using data from the Bureau of Labor Statistics, the Pew report explains
More older Americans – those ages 65 and older – are working than at any time since the turn of the century, and today’s older workers are spending more time on the job than did their peers in previous years ... In May, 18.8% of Americans ages 65 and older, or nearly 9 million people, reported being employed full- or part-time, continuing a steady increase that dates to at least 2000 (which is as far back as we took our analysis). In May of that year, just 12.8% of 65-and-older Americans, or about 4 million people, said they were working.
The report shows that the increase in elders working is steady across the age ranges (65-69, 70-74, and 75+) but with a slightly greater percentage of elder men over women. And when I say working, I mean they are working. "Not only are more older Americans working, more of them are working full-time. In May 2000, 46.1% of workers ages 65 and older were working fewer than 35 hours a week (the BLS’ cutoff for full-time status). The part-time share has fallen steadily, so that by last month only 36.1% of 65-and-older workers were part-time."
The jobs elders hold fall across a spectrum of mainly white-collar type jobs, "older workers are more likely to be in management, legal and community/social service occupations than the overall workforce, and less likely to be in computer and mathematical, food preparation, and construction-related occupations."
Tuesday, June 14, 2016
We often write here about end-of-life decisions. But, recently a friend shared with me one of the more remarkable accounts of decision-making I have seen, by a couple in their 80s.
I'm not even going to attempt to summarize this story, but I do recommend reading all the way to the end of the Gainesville Sun's report on "After nearly 59 years of marriage, Joe and Jean Subers die together."
Monday, June 13, 2016
Professor Laura L. Carstensen, PhD, who is the director of the Stanford Center on Longevity, has an intriguing essay in a recent issue of Time magazine, focusing on research on social engagement among the Boomer generation. She writes
The 55-to-65-year olds just about to join the ranks of the elderly are far less socially engaged now than their predecessors were at the same age 20 years ago. And this pattern emerged across all traditional measures of social engagement: Boomers are less likely to participate in community or religious organizations than were their counterparts 20 years ago. They are less likely to be married. They talk with their neighbors less frequently. And it doesn't stop with participation in communities and neighborhoods: boomers report fewer meaningful interactions with their spouses and partners than did previous generations, and they report weaker ties to family and friends.
She asks, "Should we be worried about these trends?" For her answers, read "Baby Boomers are Isolating Themselves as They Age." (Hint, the subtitle says: "That's bad -- for everyone.")
Friday, June 10, 2016
How long do you plan to work, if you are a Baby Boomer? According to one survey from the Center for State and Local Government Excellence, we are facing a "brain drain" in local governments. The 'Silver Tsunami' Has Arrived in Government explains the survey "indicates that governments are experiencing an uptick in retirements. More than half -- 54 percent -- of surveyed governments reported an increase in retirements last year from 2014, while just 10 percent reported a decrease." Here's where the "brain drain" comes in. According to the story "[b]aby boomers at or near retirement age make up a large share of senior-level managers in many agencies. Compared to the private sector, public-sector workers tend to be older and possess higher levels of education."
The article explores reasons why there seem to be so many retirements these days, including the expiration of union contracts, retirement benefits reductions , etc. And since not all Boomers have hit retirement age yet, the "silver tsunami" is expected to continue "over a number of years given that the youngest baby boomers just turned 52 years old."
The article explains that the survey shows not just retirements but an increase in individuals quitting their jobs.
The survey, 7 pages long with 19 questions and results, is available here as a pdf.
Wednesday, June 8, 2016
The Office of Inspector General issues regular reports to Congress, and the most recent report indicates that for the period of October 1, 2016 to March 31, 2016, the total amount of expected recoveries arising from allegations of healthcare fraud was $2.77 billion. That number is "up" by a billion dollars over the first half of fiscal year 2016.
Tuesday, June 7, 2016
John Oliver, in his typically over-the-top, but still informative manner, focuses on the industry of debt collection and how it can be especially troublesome for older adults. Indeed, when I was running an Elder Protection Clinic for Dickinson Law, a significant percentage of our clients were struggling with "old" debts, often connected to health care costs, and were dealing with aggressive attempts to recover what has come to be known as "zombie debt." One woman interviewed about $80k in debt arising out of denial for insurance coverage for her elderly husband's hospitalization for breathing problems, describes her fear and frustration after a lifetime of working and saving. She asks, "Is this how my life is going to end?"
Our thanks to Karen Miller, Esq., in Florida, for sending this link.
Friday, June 3, 2016
The Pew Research Center reports that for the first time in the modern era, more adult children ages 18 through 34 are living with their parents than living in other arrangements:
Broad demographic shifts in marital status, educational attainment and employment have transformed the way young adults in the U.S. are living, and a new Pew Research Center analysis of census data highlights the implications of these changes for the most basic element of their lives – where they call home. In 2014, for the first time in more than 130 years, adults ages 18 to 34 were slightly more likely to be living in their parents’ home than they were to be living with a spouse or partner in their own household.
It seems likely that this trend has long-range significance for both young adults and aging families.
Friday, May 20, 2016
I had mentioned previously that I was looking at the Genworth annual cost of care survey. As a corollary, Genworth has information about who provides care, referred to as The Expanding Circle of Care. The website mentions the caregivers, with "[t]he Beyond Dollars Research reveal[ing] 5 key insights on the true impact of long term care." The Expanding Circle of Care Beyond Dollars 2015 explains the 5 "key insights" in the executive summary. The circle of care is explained as:
The financial, physical and emotional demands of providing care for a loved one can sometimes be more than a single caregiver can handle. The good news is that more family members are helping provide care. The opportunity to plan for the likelihood of needing long term care before a crisis situation occurs remains large. Our research has shown that a "Circle of Care" often forms around the care recipient, involving people who provide different levels and types of support.
The second insight is that although caregivers are positive about their role of caregivers, they note that "[c]aregiving can negatively impact health & well-being", including familial relationships and interactions with friends. The third insight is instructive regarding the future: "Caregivers’ savings and retirement funds are at risk"
Caregivers who help provide financial assistance for the care of their loved ones estimate that they pay, on average, a total of about $10,000 in out-of-pocket expenses.
That’s up from an average of $7,285 in 2010. Those financial expenses can include everything from household expenses, personal items, or transportation services, to payment of informal caregivers or long term care facilities.
Most caregivers did not anticipate or plan for this expenditure. In many cases, they are cutting back on personal spending and savings. More significantly, some may be jeopardizing their own financial futures.
It follows logically then that the fourth insight builds from the third one: "Caregivers’ careers and livelihoods are impacted by providing care." The caregivers who work reported a definite impact on their jobs, which in turn impacts the caregiver's bottom line. "Absences, reduced hours and chronic tardiness can translate into a significant reduction in a caregiver’s paycheck."
The executive summary is available here.
Sunday, April 24, 2016
Pew Research Center issued a recent Fact Tank on Centenarians worldwide. World's Centenarian Population Projected to Grow Eightfold by 2050 explains the number of centenarians is growing rapidly. Check this out: "[t]he world was home to nearly half a million centenarians (people ages 100 and older) in 2015, more than four times as many as in 1990, according to United Nations estimates. And this growth is expected to accelerate: Projections suggest there will be 3.7 million centenarians across the globe in 2050." We know that the oldest-old have been the fastest growing for some time, so it makes sense that the number of centenarians is growing as well. The report discusses the difficulty in verification of ages for this group for various reasons.
Who has the most centenarians? "[T]he available data suggest that the U.S. leads the world in terms of the sheer number of centenarians, followed by Japan, China, India and Italy." The U.S. population isn't aging as fast as other countries, according to the report, and is "aging at a slower rate than Japan and Italy, partly due to its higher fertility and immigration rates – there are now 2.2 centenarians per 10,000 people." By 2050, China will have the greatest number of centenarians, and "[t]he centenarian share of the populations of the U.S. ... will grow less rapidly. There will be 9.7 centenarians per 10,000 people in the U.S. ..."
Thursday, April 21, 2016
All of us who use social media, raise your hands. Ok, so that is a lot of us. And social media isn't just the province of the young, even though some of us may be digital immigrants. The New York Times ran a recent article about elders on Facebook. Why Do Older People Love Facebook? Let’s Ask My Dad explains about a recent survey done by Penn State.
The press release about the study, Sorry kids, seniors want to connect and communicate on Facebook, too explains "[o]lder adults, who are Facebook's fastest growing demographic, are joining the social network to stay connected and make new connections, just like college kids who joined the site decades ago, according to Penn State researchers." The study looks at the reasons why elders would be drawn to use Facebook, including curiosity, keeping in touch with friends, and connecting with family, as well as communicating with those with shared interests, what the authors refer to as social bonding, social bridging and social surveillance.
The authors suggest that the social media designers need to look at making the media more elder-friendly, and "emphasize simple and convenient interface tools to attract older adult users and motivate them to stay on the site longer." The volume of elder users is growing, so "[d]evelopers may be interested in creating tools for seniors because that age group is the fastest growing demographic among social media users. In 2013, 27 percent of adults aged 65 and older belonged to a social network, such as Facebook or LinkedIn, according to the researchers. Now, the number is 35 percent and is continuing to show an upward trend."
Returning to the New York Times article, the author asked her dad about his Facebook use; "he wanted to be better at keeping in touch with family and with the friends he remembers from my childhood. He told me over Facebook chat (naturally) that his curiosity about what others were up to was his main motivator in finally learning to navigate Facebook." The author quotes one of the co-authors of the study: "[a]s Facebook continues to be a bigger part of American life, the ever-growing population of older Americans is figuring out how to adapt. As people grow older, peer communication through chatting, status updates and commenting will become more important ... and Facebook will need to adapt tools that are suited for an aging audience."
Tuesday, April 12, 2016
As law profs, that title doesn't surprise us. Learning is something we continually do (and so too, hopefully, our students). The Pew Research Center released a new report, Lifelong Learning and Technology. The report looks at learning from a variety of points, including learners who learn for employment and learners who learn for personal reasons.
As far as age for the personal learners, the report provides a breakdown for the percentage "of adults in each group who participated in at least one of a variety of activities in the past 12 months related to personal growth and enrichment...." for those age 65 and older, the percentage engaged in personal learning was 72%. For professional learners ("[a]mong employed adults, % of those who took a course or got extra training in the past 12 months for job-related reasons...") the percentage for those 65 and older was 47%.
The study doesn't just look at age of the learner, but looks at a number of variables, including education, income, ethnicity, race, access to and ownership of tech devices and internet, etc. A pdf of the report is available here.
Thursday, April 7, 2016
The Journal of American Medical Association (JAMA) Network, JAMA Psychiatry ran an article about a study looking at depression and dementia. Trajectories of Depressive Symptoms in Older Adults and Risk of Dementia considers that "[d]epression has been identified as a risk factor for dementia. However, most studies have measured depressive symptoms at only one time point, and older adults may show different patterns of depressive symptoms over time." The study came to the conclusion that a time line of consideration of a patient's depression may give a better picture of the patient's future potential for dementia ("Older adults with a longitudinal pattern of high and increasing depressive symptoms are at high risk for dementia. Individuals’ trajectory of depressive symptoms may inform dementia risk more accurately than one-time assessment of depressive symptoms.")
Sunday, April 3, 2016
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.
Monday, March 28, 2016
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.
Wednesday, March 23, 2016
My colleague Becky Morgan shared a good item this week on statistics about the number of elderly inmates, with growth of needy inmates increasing the burden on state prisons.
Another perspective on the issue comes this week via the San Jose Mercury News, reporting on California's Elderly Parole Program:
The Elderly Parole Program was instituted by a federal three-judge panel after a 2013 class-action lawsuit successfully argued that conditions in California's overcrowded prisons, including poor health care, amounted to cruel and unusual punishment. As a result, the court ordered California to reduce its inmate population. The Elderly Parole Program and a realignment program to move nonviolent convicted felons back to county jails are among the solutions. The Elderly Parole Program will be in effect at least until California meets its prison population targets.
In Sacramento, prosecutors and victims rights groups have been working to prevent this temporary program from becoming state law. They scored a small victory last week when, after a call from this newspaper, state Sen. Mark Leno, D-San Francisco, gutted Senate Bill 1310, which he introduced last month. The original bill would not only make the Elderly Parole Program state law, but it would also lower the eligibility age to 50 and the time in prison to 15 years.
The withdrawal was unexpected and came with little explanation. Leno said in a statement Thursday that the bill would be used as a place holder for "other criminal justice reforms" and that "the bill will not deal with the issue of elder parole."
The article reports that since the Elderly Parole Program began in February 2014, more than 1,000 inmates have had parole hearings, with 371 granted parole, 89 deemed "not ready," and 781 denied release. In the article, the reality of the hearings is seen through the eyes of one victim, who faced the trauma of attending a parole hearing to argue that the man who sexually assaulted her and others some 30 years ago, should serve his full sentence or die in prison -- 141 years.
No easy answers here. For more read, "California's Elderly Parole Program Forcing Victims to Face Attackers Decades Later."