Thursday, January 18, 2018

Stunning Rate Increases Likely to Continue for Owners of Long-Care Insurance Policies

The Wall Street Journal has an update article this week on the financial  health of the long-term care insurance industry, detailing recent rate increases and reminding us that even with contraction of this specialized market for sellers of new policies, there are still more than 7 million policies affected by the inadequate pricing structure issues.  

Steep rate increases that many policyholders never saw coming are confronting them with an awful choice: Come up with the money to pay more—or walk away from their coverage.

 

“Never in our wildest imagination did we consider that the company would double the premium,” says Sally Wylie, 67, a retired learning specialist who lives on Vinalhaven Island, Maine.

 

In the past two years, CNA FinancialCorp. has increased the annual long-term-care insurance bill for Ms. Wylie and her husband by more than 90% to $4,831. They bought the policies in 2008, which promise future benefits of as much as $268,275 per person. The Wylies are bracing for more increases.

Even with the rate increases, companies are looking at losses in anticipation of claims as existing policy holders are now aging into a claims mode. General Electronic Company, has attempted to reassure shareholders about the impact of its LTCI business on profits.  

Only a dozen or so insurers still sell the coverage, down from more than 100. General ElectricCo. said Tuesday it would take a pretax charge of $9.5 billion, mostly because of long-term-care policies sold in the 1980s and 1990s. Since 2007, other companies have taken $10.5 billion in pretax earnings charges to boost reserves for future claims, according to analysts at investment bank Evercore ISI. . . . 

 

Almost every insurer in the business badly underestimated how many claims would be filed and how long people would draw payments before dying. People are living and keeping their policies much longer than expected. After the financial crisis hit, nine years of ultralow interest rates also left insurers with far lower investment returns than they needed to pay those claims.

 

Long-term-care insurers barreled into the business even though their actuaries didn’t have a long record of data to draw on when setting prices. Looking back now, some executives say marketing policies on a “level premium” basis also left insurers with a disastrously slim margin of error.

 

“We never should have done it, and the regulators never should have allowed it,” Thomas McInerney, president and chief executive ofGenworth FinancialInc. since 2013, says of the pricing strategy. “That’s crazy.”

For more of this detailed article, see  Millions Brought Insurance to Cover Retirement Health Costs.  Now They Face an Awful Choice.  Our thanks to University of Illinois Law Professor Dick Kaplan and New York attorney Karen Miller for bringing this article to our attention.  

 

January 18, 2018 in Consumer Information, Current Affairs, Ethical Issues, Health Care/Long Term Care, Property Management, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Thursday, December 14, 2017

"Nursing Home Compare" Subject to Errors through Self-Reporting "Inflation"

In a new article published by Xu Han (Florida Atlantic), Niam Yaraghi (University of Connecticut) and Ram Gopal (University of Connecticut), their analysis of data used over a 4 year period for nursing home ratings  in CMS' "Nursing Home Compare" system reveals key concerns.  From the abstract:

We argue that the rating system is prone to inflation in self-reported measures, which leads to biased and misleading ratings. We use the CMS rating data over 2009–2013 and the corresponding financial data reported by Office of Statewide Health Planning and Development and patients’ complaints data reported by California Department of Public Health for 1219 nursing homes in California to empirically examine the key factors affecting the star rating of a nursing home.

 

We find a significant association between the changes in a nursing home's star rating and its profits, which points to a financial incentive for nursing homes to improve the ratings. We then demonstrate that this association does not always lead to legitimate efforts to improve service quality, but instead can induce inflation in self-reporting in the rating procedure. A prediction model is then developed to evaluate the extensiveness of inflation among the suspect population based on which 6% to 8.5% of the nursing homes are identified as likely inflators. We also summarize the key characteristics of likely inflators, which can be useful for future audit.

For more, see the full article, Winning at All Costs: Analysis of Inflation in Nursing Homes' Rating System, published November 20, 2017 in the journal Production and Operations Management.

December 14, 2017 in Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicare, Statistics | Permalink | Comments (0)

Wednesday, December 13, 2017

"Snake Oil," Tattoos & Why Some Hospice Doctors Prefer Medical Powers of Attorney

Are games and food supplements that promise to stave off the onset of dementia the modern day version of "snake oil?" I promised to write more about the Aging Brain Conference at Arizona State University's Sandra Day O'Connor College of Law on December 8, 2017.  Speaker Dr. Cynthia Stonnington, Mayo Clinic, offered an important look at ways in which law, ethics, medicine, and commerce can collide with her survey of a host of approaches receiving "popular" press treatment.  

She examined self-described "brain-training" programs, miracle diets, supplements and targeted exercise programs, noting that most studies that purport to demonstrate positive results from these items have serious flaws.  Thus, at best, programs that claim to provide "protection" against dementia are usually promising more than has been proven.  Dr. Stonnington, along with the morning keynote speaker, former U.S. Surgeon General Richard Carmona, reminded us that

  • maintaining social engagement,
  • engaging in lifelong learning,
  • getting regular exercise of any type,
  • having good blood pressure control,
  • getting adequate sleep, and
  • focusing on good nutrition (including eating plans such as the Mediterranean, DASH or MIND diets)

are  far more important than any single, magic game or exercise.

One of the most lively discussions of the day came near the end, in response to presentations by Dr. Patrica Mayer of Banner Health in Phoenix, Amy McLean of Hospice of the Valley. and Life Sciences Professor Jason Robert (ASU) speaking for himself and Susan Fitzpatrick (James S. McDonnell Foundation), about end-of-life considerations for persons with dementia or other serious illnesses.  What would be the most likely response of a physician or emergency personnel confronted with a "do not resuscitate" tattoo on the chest of an emergency patient?  Dr. Mayer stressed that she is seeking reliable methods of communicating end-of-life wishes, and for her that means a preference for a written, Medical Power of Attorney.  She wants that "live" interaction whenever possible, in order to fully explore the options for care for individuals unable to communicate for themselves.  But she also noted a frequent frustration when she contacts designated  POAs about the need to make tough decisions, only to learn they were completely unaware before that moment of having been named as the designated agent.  

LSI_Aging Brain 120817 Competency_and_Incapacity_1 SPEC (1)I was part of a panel of court-connected speakers, including Arizona Superior Court Judge Jay Polk (Maricopa County), neuropsychologist  (and frequent expert witness) Elizabeth Leonard, and experienced Phoenix attorney Charles Arnold.  I was interested to hear about  -- and will pursue more information on -- the psychologists' use of evaluative tools for clients that use scenarios that would appear to test not just for loss of memory, but impaired judgment.  I was speaking on the unfortunate need for judicial inquiries into "improvident transactions" by persons with problematic cognition and I used litigation approaches from other locations -- Ireland (common law) and Maine (statutory) -- as examples.  The Arizona legal experts reminded me to take a closer look at Arizona's financial exploitation laws.

For more from this conference, see Learning to Say the Word "Die"  --  about a pilot program developed by Dr. Mayer while she was an advanced bioethics fellow at the Cleveland Clinic.  I also recommend Dr. Mayer's article on CPR & Hospice: Incompatible Goals, Irreconcilable Differences

 

December 13, 2017 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Games, Health Care/Long Term Care, Legal Practice/Practice Management, Programs/CLEs, Science, Statistics | Permalink | Comments (0)

Wednesday, December 6, 2017

Arizona State Presents Legal, Policy and Ethical Perspectives on "The Aging Brain"

On December 8, 2017, I'm excited to be participating in a conference on The Aging Brain: Legal, Policy & Ethical Perspectives, in Phoenix, Arizona.  This program is a follow-up to an interdisciplinary workshop hosted at Arizona State University's Sandra Day O'Connor School of Law in the fall of 2016. This year's presentations will take place at the the United States Courthouse in Phoenix.

The planned schedule is jam-packed with speakers I'm looking forward to hearing, including:

Welcome: Betsy Grey, Sandra Day O’Connor College of Law, ASU

Introduction: Dean Douglas Sylvester, Sandra Day O’Connor College of Law, ASU

Keynote Speaker:Richard H. Carmona, M.D., M.P.H., FACS, 17th Surgeon General of the United States, Chief of Health Innovations, Canyon Ranch, Distinguished Professor, University of Arizona

Scientific Developments in Aging and Dementia: Pre-Symptomatic Screening for Neurodegenerative Diseases

    Panel Chair: Hon. Roslyn O. Silver, U.S. District Court for the District of Arizona

  • Dr. Richard Caselli, Mayo Clinic
  • Dr. Jessica Langbaum, Banner Alzheimer's Institute
Ethical, Legal, and Social Implications
       Panel Chair:  Michael Saks, Sand Day O'Connor College of Law
  • Dr. Cynthia M. Stonnington, Mayo C;inic
  • Jalayne J. Arias, UCSF Neurology, Memory and Aging Center
  • Henry T. Greely, Stanford Law School

Aging at Home

    Panel Chair: Larry J. Cohen, The Cohen Law Firm

  • David Coon, College of Nursing & Health Solutions, ASU
  • Kent Dicks, Life365, Inc.
Competency and Incapacity: Assessment and Consent

    Panel Chair: Charles L. Arnold, Frazer Ryan Goldberg & Arnold, LLP

  • Hon. Jay M. Polk, Probate Dep’t. Associate Presiding Judge, Superior Court of Arizona for Maricopa County
  • Katherine Pearson, Dickinson School of Law, Pennsylvania State University
  • Dr. Elizabeth Leonard, Neurocognitive Associates
  • Betsy Grey, Sandra Day O’Connor College of Law, ASU

End of Life

    Panel Chair: Dr. Mitzi Krockover, Health Futures Council at ASU

  • Jason Robert, Lincoln Center for Applied Ethics, ASU
  • Amy McLean, Hospice of the Valley
  • Dr. Patricia A. Mayer, Banner Baywood & Banner Health Hospitals

Keynote:

Dr. Susan Fitzpatrick, President, James S. McDonnell Foundation
Introduction by Jason Robert, Lincoln Center for Applied Ethics, ASU

December 6, 2017 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Federal Cases, Health Care/Long Term Care, Science, Statistics | Permalink | Comments (0)

Monday, November 20, 2017

Caregiving article in the WSJ

The Wall Street Journal published an article by Maddy Dychtwald, The Surprising Benefits and Costs of Family Caregiving.  A significant number of folks are already serving as caregivers (40 million per the article) and "[a]s the massive baby-boomer generation hits their 70s, the demand for family caregiving will skyrocket—and it’s poised to become America’s biggest off-the-books industry." The author explains about a survey her company did with Merrill Lynch,  "The Journey of Caregiving: Honor, Responsibility and Financial Complexity."  The author notes one unexpected positive found in the study is the caregivers finding the act of caregiving benefitting them, perhaps as much as those receiving the care.

The majority of respondents (65%) also said that caregiving has brought meaning and purpose to their life. Most (77%) went so far as to say they would gladly take on the role of caregiver for another loved one. More than half (61%) told us the biggest benefit of being a caregiver is feeling that they’re doing the right thing. And often, caregivers begin to take better care of their own health as a result of their caregiving experience (86%).

The article discusses the obstacles encountered in caregiving, including the role reversals that can make the relationship difficult. "Nearly half (45%) of all caregivers say they are struggling with this, while trying to meet what they tell us are their top three goals: preserving the dignity of their loved one, providing the best care possible, and keeping their loved one out of an institution. Many caregivers also believe part of their role is to make sure the recipient does not feel like a burden, even when they might be."

The article stresses the importance of a family conversation--and early. The talk needs to include financial caregiving, which may end up being a big part of the need.

As it turns out, financial caregiving is a critical part of the picture—but one that’s not often discussed. Financial caregivers in our study are contributing to the cost of care, coordinating and managing finances for their loved one, or both. More than half (52%) of respondents have no idea what they have spent on caregiving-related expenses. In fact, many contribute financially to the care of their loved one even when it’s detrimental to their own financial future.

The cost of caregiving is not easy or comfortable to talk about, but finances are an integral piece of the puzzle. Seventy-five percent of family caregivers have never discussed their financial role with their care recipient. It could be that talking about money is taboo, especially in the face of grave illness, or that the care recipient does not have the mental acuity to discuss finances. But the financial burden and emotional toll can be minimized if families talk it through and plan appropriately.

It’s important to get our heads around the costs and benefits of caregiving now, because it’s likely to be in each of our futures. As founder of the Rosalynn Carter Institute for Caregiving, former First Lady Rosalynn Carter once said: “There are only four kinds of people in this world: those who have been caregivers; those who currently are caregivers; those who will be caregivers; and those who will need caregivers.”

November 20, 2017 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other, Statistics | Permalink | Comments (1)

Thursday, November 16, 2017

Pennsylvania's Secretary of Aging Talks about Demographic-Driven Challenges in Aging

Pennsylvania's Secretary of Aging, Teresa Osborne  was interviewed on Smart Talk, a Public Radio program in central Pennsylvania on November 16, 2017.  Secretary Osborne is well-spoken, and using the fact that Pennsylvania has one of the fastest growing "older old" populations in the country (usually defined as age 85+), she reports on some of the ways that Pennsylvania is attempting to assist healthy aging, including making available resources better available to age-in-place at home through a program called Community Choice.  One of her observations?  While everyone "hopes" to stay in one's own home, "'hope' is not a plan."  Active steps to make that happen safely are needed -- and one of the boomers interviewed  talked about his own periodic, "five year review" plan.   You can listen to a podcast of the approximately 30 minute interview here.  

The radio interview also introduced a segment from a public television Health Smart series on The Aging Boom-The 2030 Problem, scheduled to be aired for the first time on WITF-TV on November 16 at 8 p.m. (with additional broadcasts planned for various times of day on November 17 and 18). 

November 16, 2017 in Consumer Information, Current Affairs, Ethical Issues, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Thursday, November 9, 2017

Mom Does Have a Favorite!

I grew up watching the Smothers Brothers and vividly recall their sibling rivalry...."mom always liked you best."  For elder law attorneys, the idea of the parent having a favorite child can be an important bit of information in the representation of the client. I've written about family matters beyond this blog.  I was interested in the recent article in Huffington Post covering family favoritism. Parents Really Do Have Favorite Child, No Matter What They Say. Finally, ANSWERS. opens with an amusing observation that if your parents have told you all along they don't have favorites, they weren't being truthful to you. "[S]cience tells a different story. In research that will vindicate self-pitying siblings everywhere, sociologist Katherine Conger’s recently resurfaced longitudinal study found what many have suspected all along: Parents totally have a favorite child."  The article discusses the study's hypothesis regarding birth order and who would feel favored. "The research also found that no matter a child’s birth order, every single one was suspicious of their parents liking another better. “Everyone feels their brother or sister is getting a better deal,” Conger said... So what do we make of all of this? For one, siblings have it tough. Always competing for their parents’ love, never knowing who’s ahead. But the good news for brothers and sisters is that the relationship serves tons of benefits: Having a sibling may make you more intelligent, more likely to have a stable marriage as an adult and can serve as a built-in support system. " The study referenced in the article is available for purchase.   

November 9, 2017 in Consumer Information, Current Affairs, Estates and Trusts, Other, Statistics | Permalink | Comments (0)

Tuesday, November 7, 2017

Boomer Trends and the Coming Caregiving Crunch

The Future of Caregiving: The Coming Caregiving Crunch  is a report released in October 2917 by Merrill Lynch and Age Wave that  provides interesting data points to identify challenges and action items tied to aging in the U.S.  The information in the report was generated by surveys of more than 2,200 individuals, including "nonprofessional" caregivers.  

While perhaps it is tempting to assume we are already feeling the effects of retirement for the Boomer generation, this report reminds us that we still haven't had the "first" boomer hit 80 years of age, which is when the likelihood of needing care or assistance increases.

The report suggests that "denial" is a huge problem.  While 7 in 10 Americans turning 65 today will need "care for prolonged periods" in their later years, only 4 in 10 Americans believe they personally are likely to "ever" need such care.  Certainly Merrill Lynch has a goal to increase consumer awareness of a need for realistic financial planning, some of the most interesting parts of the report addressed not just the need for adequate savings, but the likelihood that families could benefit from "financial coordinators."  The report used this term for people with the skills to handle (or monitor/oversee) such tasks as:

  • paying bills from proper accounts
  • monitoring bank accounts and access to accounts
  • handling insurance claims
  • filing taxes
  • managing invested assets 

The writers observe:  

Financial caregiving is nearly uncharted territory, with little research identifying the flow and pace of transactions that individuals and their families experience as they navigate the caregiving journey. Similarly, little has been studied about the ways in which caregivers and care recipients need help financially. As Boomers age, the need for assistance in tracking, managing and paying for care-related expenses in complex relationships is destined to grow.

The writers warn that family members are frequently unprepared for the responsibilities that caring for an elder may involve, especially given the fact that Boomers are much more unlikely than previous generations to living near their own children.  

November 7, 2017 in Current Affairs, Ethical Issues, Health Care/Long Term Care, Statistics | Permalink | Comments (0)

Monday, November 6, 2017

Unpartnered Americans-New Report from Pew

Pew Research Center issued a new FactTank report, The share of Americans living without a partner has increased, especially among young adults.  The article starts off with these statistics "[i]n the past 10 years, the share of U.S. adults living without a spouse or partner has climbed to 42%, up from 39% in 2007, when the Census Bureau began collecting detailed data on cohabitation."  So you are wondering, what does this report have to do with elder law? Well, here you go. "The rise in adults living without a spouse or partner has also occurred against the backdrop of a third important demographic shift: the aging of American adults. Older adults (55 and older) are more likely to have a spouse or partner than younger adults. So it is surprising that the share of adults who are unpartnered has risen even though relatively more Americans are older." The article explains the financial implications of being "unpartnered", not unsurprising to those of us in the field of elder law. This can be an important implication in terms of retirement security as well. The infographic breaking down the data by age is available here.

 

November 6, 2017 in Consumer Information, Current Affairs, Other, Statistics | Permalink | Comments (0)

Monday, October 23, 2017

The Latest in Off-Label Prescriptions for Dementia Patients: "The Little Red Pill"

My thanks to my colleague Dermot Groome for pointing me to the CNN investigative series on "The Little Red Pill Being Pushed on the Elderly." The prescription drug in questions is Nuedexta, approved to treat PseudoBulbar Affect or PBA, a "disorder marked by sudden and uncontrollable laughing or crying." (Perhaps you have seen commercials for treatment of PBA with actor Danny Glover effectively portraying the disorder).   

According to the CNN report:

Since 2012, more than half of all Nuedexta pills have gone to long-term care facilities. The number of pills rose to roughly 14 million in 2016, a jump of nearly 400% in just four years, according to data obtained from QuintilesIMS, which tracks pharmaceutical sales. Total sales of Nuedexta reached almost $300 million that year.
 
Concerns about unnecessary prescription, side effects (including a higher incidence of falls), and federal reimbursements for cost are raised by critics:
 
Nuedexta is approved by the Food and Drug Administration (FDA) to treat anyone with PBA, including those with a variety of neurological conditions such as dementia. But geriatric physicians, dementia researchers and other medical experts told CNN that PBA is extremely rare in dementia patients; several said it affects 5% or less. And state regulators have found doctors inappropriately diagnosing nursing home residents with PBA to justify using Nuedexta to treat patients whose confusion, agitation and unruly behavior make them difficult to manage.
 
 
"There has to be a diagnosis for every drug prescribed, and that diagnosis has to be real ... it cannot be simply made up by a doctor," said Kathryn Locatell, a geriatric physician who helps the California Department of Justice investigate cases of elder abuse in nursing homes. "There is little to no medical literature to support the drug's use in nursing home residents (with dementia) -- the population apparently being targeted."
The article notes that Medicare pays for much of the use of this drug in the nursing home setting, and as we've been reported before on other off label prescriptions of  medications, federal regulators have the power to investigate and sanction improper use (not just off-label use) under the False Claims Act and similar anti-fraud regulations.  

October 23, 2017 in Cognitive Impairment, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Medicare, Science, Statistics | Permalink | Comments (0)

Thursday, October 19, 2017

Fountains of Youth (Or Just Spending?): A Positive Take on "Anti-Aging" Industries

Every day I fight with my email in-box, trying to delete the stuff that just isn't necessary to open, much less read.  For example, I know more or less which emails -- no matter how tempting the regarding line -- are what I call "junk science" emails that claw their way past my spam filter.  A lot of them involve "anti-aging" theories that promote foods, exercises, vitamins or minerals that "May" prevent cognitive or physical decline.  "May" with a capital "M."  

But United States District Judge Roslyn Silver, from Arizona, recently shared an article she's using with a class she is teaching at Arizona State's law school. In the June 2017 issue of Smithsonian Magazine, the subtitle for the article explains: "Backed by digital fortunes of Silicon Valley, biotech companies are brazenly setting out to 'cure' aging."  The author profiles the work of controversial author Aubrey de Grey and "Chief Science Officer" from SENS, a biotech research enterprise in California.  The author summarizes:  

The basic vision behind SENS is that aging isn’t an inevitable process by which your body just happens to wear out over time. Rather, it’s the result of specific biological mechanisms that damage molecules or cells. Some elements of this idea date back to 1972, when the biogerontologist Denham Harman noted that free radicals (atoms or molecules with a single unpaired electron) cause chemical reactions, and that these reactions can damage the mitochondria, the powerhouses within cells. Since then, studies have linked free radicals to all sorts of age-related ailments, from heart disease to Alzheimer’s.

 

De Grey takes this concept further than most scientists are willing to go. His 1999 book argued that there could be a way to obviate mitochondrial damage, slowing the process of aging itself. Now SENS is working to prove this. Its scientists are also studying other potential aging culprits, such as the cross-links that form between proteins and cause problems like arteriosclerosis. They’re looking at damage to chromosomal DNA, and at “junk” materials that accumulate inside and outside cells (such as the plaques found in the brains of Alzheimer’s patients).

Despite the controversies associated with the work of de Grey and other anti-aging proponents, the article points to a "mini-boom of private investment in Silicon Valley, where a handful of labs have sprung up in SENS' shadow, funded most notably by tech magnates."

One of the early critics of de Gray concedes that anti-aging theorists have attracted needed money and energy into age-related research beyond "just" the 1,000-year-old human goal:

More than a decade later, [University of Massachusetts Medical School Professor] Tissenbaum now sees SENS in a more positive light. “Kudos to Aubrey,” she says diplomatically. “The more people talking about aging research, the better. I give him a lot of credit for bringing attention and money to the field. When we wrote that paper, it was just him and his ideas, no research, nothing. But now they are doing a lot of basic, fundamental research, like any other lab.”

I can definitely see how this article would be useful in a law school class on aging, elder law, or estate planning.  It raises fundamental questions in governance, economics and human rights, including implications from disparities in life expectancy that already exist and are increasing,  associated with comparative wealth.  

For the full article, see Can Human Mortality Really be Hacked? by Elmo Keep.

October 19, 2017 in Cognitive Impairment, Consumer Information, Current Affairs, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, Statistics | Permalink | Comments (0)

Wednesday, October 11, 2017

Are Guardianship Court "Oversight" Problems Pervasive?

 During the last several years, I've received calls from around the country about possible guardianship "oversight" concerns. And since The New Yorker article came out last week focusing on guardianship issues in Las Vegas Nevada, I've been getting more calls. The question arises: Is there a pervasive problem with court-appointed guardians for older adults in the United States?  

In my opinion, the answer is "no, not pervasive."  At least, that's my answer if the definition of pervasive is "universal," or omnipresent, or rife, or widespread. In the 20+ years I've been working in elder law, I've unfortunately reviewed a lot of cases of exploitation, but it is comparatively rare that I've been asked to examine a court-monitored guardianship where there was a problem created by inadequate attention by the courts, much less active misconduct by the court or agency. Granted, that is just one law professor's experience.

Still, in my opinion, the oversight problems that do exist within the U.S. are significant, periodic, sometimes recurring or persistent, and often have common elements.  The issues can exist in any county court or fiduciary administrative system. Historically, these courts -- sometimes called probate courts, fiduciary courts, surrogate courts, or orphans courts -- depended on the guardians for management of all issues, once the appointments were made. The judges trusted their appointees to take their fiduciary responsibilities seriously. But, as is sometimes said in international relations, the problem can be how best to "trust, but verify" proper behavior. With more elder boomers, there can be increased need for guardians, and thus more potential for guardians to be monitored.

  • For example, in Maricopa County, Arizona, an investigative news series, that began in 2008 with the reporting of Laurie Roberts for the Arizona Republic, described a number of mishandled older adult guardianships.  In some instances, the family members were so busy arguing about money, that the incapacitated elder was ignored, while his or her estate was diminished to pay fees.  Sometimes the question was whether a "full" guardianship was even necessary.  The problems, once investigated not just by journalists but by the courts, resulted in changes in Arizona guardianship law.
  • In Palm Beach County, Florida, complaints about appointment of a particular individual as guardian in a large number of cases, focused on conflict of interest and claims of favoritism by the court, complaints that came from a number of families. Eventually, in one case challenging the system,  a jury reportedly awarded more than  $16 million against two West Palm Beach attorneys for "breach of fiduciary duties."  The complaints also led to state investigations of Florida's entire oversight systems, and brought three years of legislative changes to Florida guardianship laws.
  • Most recently, two co-founders of a nonprofit guardianship company, Ayudando Guardianship, in Bernalillo County, New Mexico were indicted in federal court in July 2017 with criminal charges including conspiracy, mail fraud, aggravated identity theft, and money laundering.  The company was the appointed fiduciary in hundreds of cases. 

Especially when the Clark County, Nevada cases are included in this list of recent challenges to guardianship oversight systems, concerns about proper and objective oversight are real; without a equally real commitment to more careful selection, training, monitoring and accountability for guardians, the problems can be predicted to increase as the baby boomer generation of seniors get to their 70s, 80s, or 90s.  In 2016, the GAO for the United States responded to a U.S. Senate Special Committee on Aging's request for data on "the extent of abuse by guardians," and concluded that "courts lack comprehensive data on older adults in guardianships and elder abuse by guardians, but some courts have limited information."  Unreliable data certainly leaves open the potential for the occasional problems to become pervasive problems.    

Continue reading

October 11, 2017 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (2)

Friday, October 6, 2017

Guns, Aging & Suicide

The last few weeks have been very tough, haven't they?  As have the last few months, and perhaps even the last few years.  

Many seem to be trying to understand why a 64-year-old "retired" man in the U.S. would assemble an arsenal of weaponry, unleash it on a crowd of innocents enjoying a last few weekend hours of music, and then take his own life.  While it is, on a comparative scale, unusual for a 60+ individual to be involved in a mass shooting, "older men" apparently have a comparatively high suicide-by-gun rate.  While there may be no way to understand the motivation for the most recent murders, there are still reasons to ask whether aging and deteriorating cognitive health can be factors in gun-related deaths.  

In the search for some understanding I read Leah Libresco's opinion piece in the Washington Post:  "I used to think gun control was the answer.  My research told me otherwise." 

In that article, her research on the annual 33,000+ gun deaths in America, led her to several interesting observations and conclusions.  She writes, for example, that the statistics showed her:

  • "Two-thirds of gun deaths in the United States every year are suicides."
  • "Older men, who make up the largest share of gun suicides, need better access to people who could care for them and get help."

Libresco's essay sent me in turn to a feature story, part of a FiveThirtyEight series analyzing annual gun deaths, on "Surviving Suicide in Wyoming," by Anna Maria Barry-Jester.  She writes in greater detail about warning signs of deteriorating mental health, especially among older men: isolation, sometimes self-imposed; sleeplessness; depression; anxiety; and unresolved physical health problems. 

As these articles point out, limiting access to guns is appropriate for individuals with suicidal thoughts. That's different than "gun control laws."  And while guns may too often be the means to effectuate "rash desperate decisions," these researchers also suggest the greatest need is for better public awareness and response to warning signs, and for improved diagnosis and access to effective care, including social, mental and physical health care.    

October 6, 2017 in Advance Directives/End-of-Life, Crimes, Current Affairs, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Science, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Wednesday, July 26, 2017

Dementia Prospects Down?

Good news for all of us!  The July 2017 issue of Today's Research on Aging from the Population Reference Bureau reports a proportional decline in dementia. Dementia Trends: Implications for an Aging America explains that

While the absolute number of older Americans with dementia is increasing, the proportion of the population with dementia may have fallen over the past 25 years, according to a recent U.S. study (Langa et al. 2017). Researchers say this downward trend may be the result of better brain health—possibly related to higher levels of education and more aggressive treatment of cardiovascular risk factors such as high blood pressure and diabetes.

After discussing the research, the research report also notes this

The decline in dementia prevalence coupled with longer life expectancy may be contributing to another change: A growing share of older Americans are spending less of their lifetimes with cognitive impairments, another recent study based on HRS data and vital statistics shows (Crimmins, Saito, and Kim 2016). The gains in life expectancy between 2000 and 2010 represent more time older Americans spend cognitively intact, the researchers report. The share of Americans 65 and older without cognitive problems increased by 4.5 percentage points for men and 3.4 percentage points for women during the decade. At the same time, the average time older people spent with dementia or cognitive impairment shortened slightly.

The report discusses the various theories and work done to help  with "brain training", the correlations (if any) between certain diseases and dementia, and policy and budgetary implications. The report concludes:

Improvements in understanding, diagnosing, preventing, and treating Alzheimer’s disease and other dementias are top NIA priorities. The 2011 National Alzheimer’s Project Act and related legislation lay the foundation and provide new funding for “an aggressive and coordinated national plan to accelerate research.” This initiative includes research designed to better answer the following questions:

•What roles do education and intellectual stimulation play in delaying or preventing dementia?

•What are the connections among dementia, cardiovascular disease, obesity, and diabetes?

•What are the best ways to reduce the dementia risks that minority group members face?

Refining our understanding of the answers to these questions can enable policymakers and

planners to design and test prevention strategies that can contribute to continued future decline

in dementia prevalence.

 

July 26, 2017 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Science, Statistics | Permalink | Comments (0)

Thursday, July 13, 2017

If 60 is the new "40" is 70 the new 60?

The Stony Brook U newsroom released a story recently, New Measures of Aging May Show 70 is the New 60.

Here are some excerpts from the story about the study:


new measures of aging with probabilistic projections from the United Nations to scientifically illustrate that one’s actual age is not necessarily the best measure of human aging itself, but rather aging should be based on the number of years people are likely to live in a given country in the 21st Century.

The study also predicts an end to population aging in the U.S. and other countries before the end of the century. Population aging – when the median age rises in a country because of increasing life expectancy and lower fertility rates – is a concern for countries because of the perception that population aging leads to declining numbers of working age people and additional social burdens.

You'll recall the three cohorts of "old" 65-74, the "young old", 75-84, the old, and 85+ the old-old.  According to this study, "[t]raditional population projections categorize “old age” as a simple cutoff at age 65. But as life expectancies have increased, so too have the years that people remain healthy, active, and productive. In the last decade, IIASA researchers have published a large body of research showing that the very boundary of “old age” should shift with changes in life expectancy, and have introduced new measures of aging that are based on population characteristics, giving a more comprehensive view of population aging."

The study focuses on the US, China, Iran and Germany.  The study is available here.

July 13, 2017 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other, Statistics | Permalink | Comments (0)

Monday, July 10, 2017

New Report: Restoration of Rights: Adult Guardianship

The ABA Commission on Law & Aging and the Virginia Tech Center for Gerontology have released a report, Restoration of Rights in Adult Guardianship: Research & Recommendations. The report is divided into four parts: (1) introduction & background,  (2) research on restoration of rights, (3) discussion & recommendations on key issues to restoration, and (4) conclusion.   The report runs 69 pages and is available for download as a pdf. Section 3 covers a number of topics, including lack of knowledge of the availability of restoration, review by courts re: continuing need for guardianship, court access, attorney representation (and the attorney's role),  the guardian's role, supports available to the person, evidence and evidentiary standards, and data and research.  Here is the conclusion

The time is ripe for restoration of rights to be become a viable option for people subject to guardianship. In the context of the emergent paradigm of supported decision-making, restoration can be a path to self-determination and choice. For courts, attention to restoration can weed out unnecessary cases from dockets, allowing a stronger focus on problems needing judicial intervention, and saving administrative costs of carrying unnecessary cases.

To make restoration work:

State legislation must ensure sufficient notice that the option exists, provide for regular court review of the continuing need for guardianship, afford the right to counsel, and set workable evidentiary standards.

Courts must assess cases for possible restoration, find ways to make individuals and families more aware of the option, make the process more accessible, take into account available supports in making determinations, and track data on restoration.

Guardians must perceive their role as enhancing self-determination and working toward termination of guardianship with sufficient support – more as "supporters" guided by the person’s expressed wishes if possible. There must be sufficient legal decision-making tools, family supports, technological supports, and community supports readily available to bolster functional abilities.

Lawyers must recognize and act on the potential of restoration in guardianship cases.

This study has set the stage for such actions, bringing to life the possibility that guardianship is not automatically an end but can be "a way station and not a final destination."

 

 

July 10, 2017 in Cognitive Impairment, Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Thursday, July 6, 2017

How Much Care do Family Caregivers Provide?

We have blogged on several occasions about the important role adult children play in family caregiving. Ever wonder just how much care the kids are providing? The Center for Retirement Research at Boston College looked at that specific question.

How Much Long-Term Care Do Adult Children Provide?, an issue brief, offered these key findings:

  • As people age and their health deteriorates, they begin to need more help with daily activities.
  • While many formal long-term care services are available, cost concerns and personal preferences lead many to rely on informal care from adult children.
  • At any given point, 6 percent of adult children serve as caregivers, and 17 percent will take on this role at some point in their lives.
  • Those who do provide care devote an average of 77 hours per month, which can take a toll on both the finances and health of the caregiver.
  • The caregiving burden on adult children is likely to become a bigger concern as baby boomers move into their 80s.

Look again at the numbers. Seventeen percent of adult kids will be caregivers at some point and at almost 80 hours a month, it's almost like working half-time. Here is the conclusion to the brief:

At any point in time, few adult children are taking care of their parents. But, over the course of their lives, about 17 percent of adults end up providing care for their parents. And when children do care for par- ents, the commitment is large – 77 hours per month. As baby boomers enter their 80s, a large increase in the demand for long-term care is likely, with a commensurate rise in the reliance on care from their children. Since boomers had fewer children per household than the previous generation, this develop- ment will place an unprecedented burden on their children, with implications for their physical, mental, and nancial well-being. However, research also suggests that the issue may be more challenging than just the relative sizes of the generations. After all, divorced parents need more support from children, and those children are more likely to provide support if they live nearby. For a generation characterized by low fertility, unstable marriages, and far- ung children, this situation sug- gests that the informal care the boomers will need may not be there – and demand for formal care will soon increase beyond its historical levels. Policymakers and the private sector must confront this prospect, with its attendant burdens on the long-term care sector and insurers of long-term care – the largest of which by far is an already overburdened Medicaid system.

Consider the last sentence of the conclusion in light of  the debated Congressional action on the Affordable Care Act.

The full brief is available here.

July 6, 2017 in Consumer Information, Current Affairs, Health Care/Long Term Care, Retirement, Statistics | Permalink

Friday, May 12, 2017

Preventative "Support Visits" Starting at Age 75 under Consideration in Northern Ireland

On May 10, 2017, my research colleagues Gavin Davidson (Queens University Belfast) and Subhajit Basu (University of Leeds) participated in a policy briefing at Stormont, the Northern Ireland Assembly in Belfast.  They appeared in support of recommendations by the Commissioner of Older People (COPNI) Eddie Lynch on a major plan for modernization of social care programs for vulnerable adults (of any age).

Professors Davidson and Basu focused on three key recommendations:

  1. Northern Ireland should have a single legislative framework for adult social care with accompanying guidance for implementation. This could either be new or consolidated legislation, based on human rights principles, bringing existing social care law together into one coherent framework.
  1. All older people in Northern Ireland, once they reach the age of 75 years, should be offered a Support Visit by an appropriately trained professional. This will be based on principles of choice and self-determination and is aimed at helping older people to be aware of the support and preventative services that are available to them.
  1. Increasing demands for health and social care reinforce the importance of considering how these services should be funded. All future funding arrangements must be equitable and not discriminate against any group who may have higher levels of need.

The audience, which included researchers, social service program administrators and elected officials (not only from Northern Ireland, but elsewhere, including the Isle of Man), reportedly responded strongly to the recommendations, especially to the concept of specially-trained "support visitors," offered to persons age 75 or older. The intent is to provide individuals with planning support and, where needed, medical assessment.  Guidance and information is often needed for pre-crisis planning, thus moving in the direction of prevention of crises and reduction of need for last-minute response. The support visitor concept has been used successfully in Denmark and other locations in Europe.  The next step for Northern Ireland would likely be a pilot or test project.  

As a co-author of the research reports that led to the COPNI recommendations, working with Professors Gavin Davidson and Subhajit Basu as part of a team headed by Dr. Joe Duffy of Queens University Belfast, I found it an interesting coincidence that at almost the same time as the Northern Ireland government session, I was addressing similar interests in "preventative" planning while speaking on elder abuse in a "Day on the Hill" program at the Capitol in Pennsylvania, hosted by the Alzheimer's Association.  It is clear that on both sides of the Atlantic, we are interested in cost-effective, proactive measures to help people stay in their homes safely.   

May 12, 2017 in Consumer Information, Crimes, Ethical Issues, Health Care/Long Term Care, International, Retirement, Social Security, Statistics | Permalink | Comments (1)

Wednesday, April 12, 2017

Elders with Depression & who Self-Neglect

NAPSA and NCPEA have released a research to practice brief on Correlates of Depression in Self-Neglecting Older Adults: A Cross-Sectional Study Examining the Role of Alcohol Abuse & Pain in Increasing Vulnerability Here is the summary from this one page brief:

Older adults with confirmed self-neglect report high rates of depressive symptoms. It has been estimated that between 50-62% of older adults with confirmed self-neglect suffer from at least sub-clinical levels of depressive symptomatology. Depressive symptoms in this population have been linked to untreated medical conditions. Further study is needed to understand the association between elder self-neglect and depressive symptoms, including studies determining potential correlates of depression in this population. Identifying such correlates could inform clinical social work and other mental health approaches for reducing depressive symptoms and self-neglect behaviors in this population. The cur-rent cross-sectional study reviewed a host of self-reported cognitive, functional, demo-graphic and clinical measures and identified a positive history of alcohol abuse, low self-rated health and pain as significant correlates of depressive symptomatology in older adults with Adult Protective Services (APS) validated self-neglect. Those with a positive screen for prior alcohol abuse were approximately 3 times more likely to have at least sub-clinical depression (Geriatric Depression Scale-15 >4). Having lower self-rated health was associated with a 53% increase in the likelihood of reporting at least sub-clinical depression. Reporting pain was associated with a 37% increase in the likelihood of reporting at least sub-clinical depression. These findings did not allow for establishing a temporal direction between depression, history of alcohol abuse, low self-rated health or pain. Nevertheless, they do provide insight into possible targets for improving out-comes in elder self-neglect populations given their evidence-based associations with both depression and self-management activities including accessing healthcare and completing activities critical for safety and protection.

April 12, 2017 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care, Statistics | Permalink | Comments (0)

Thursday, March 23, 2017

Profile of Older Americans 2016

The Administration on Aging has released the 2016 Profile of Older Americans.  Here are the highlights:

Highlights*

  • Over the past 10 years, the population 65 and over increased from 36.6 million in 2005 to 47.8 million in 2015 (a 30% increase) and is projected to more than double to 98 million in 2060.
  • Between 2005 and 2015 the population age 60 and over increased 34% from 49.8 million to 66.8 million.
  • The 85+ population is projected to triple from 6.3 million in 2015 to 14.6 million in 2040.
  • Racial and ethnic minority populations have increased from 6.7 million in 2005 (18% of the older adult population) to 10.6 million in 2015 (22% of older adults) and are projected to increase to 21.1 million in 2030 (28% of older adults).
  • The number of Americans aged 45-64 – who will reach 65 over the next two decades – increased by 14.9% between 2005 and 2015.
  • About one in every seven, or 14.9%, of the population is an older American.
  • Persons reaching age 65 have an average life expectancy of an additional 19.4 years (20.6 years for females and 18 years for males).
  • There were 76,974 persons aged 100 or more in 2015 (0.2% of the total 65+ population).
  • Older women outnumber older men at 26.7 million older women to 21.1 million older men.
  • In 2015, 22% of persons 65+ were members of racial or ethnic minority populations--9% were African-Americans (not Hispanic), 4% were Asian or Pacific Islander (not Hispanic), 0.5% were Native American (not Hispanic), 0.1% were Native Hawaiian/Pacific Islander, (not Hispanic), and 0.7% of persons 65+ identified themselves as being of two or more races. Persons of Hispanic origin (who may be of any race) represented 8% of the older population.
  • Older men were much more likely to be married than older women---70% of men, 45% of women. In 2016, 34% older women were widows.
  • About 29% (13.6 million) of noninstitutionalized older persons live alone (9.3 million women, 4.3 million men).
  • Almost half of older women (46%) age 75+ live alone.
  • The median income of older persons in 2015 was $31,372 for males and $18,250 for females. Median money income (after adjusting for inflation) of all households headed by older people increased by 4.3% (which was statistically significant) between 2014 and 2015. Households containing families headed by persons 65+ reported a median income in 2015 of $57,360.
  • The major sources of income as reported by older persons in 2014 were Social Security (reported by 84% of older persons), income from assets (reported by 62%), earnings (reported by 29%), private pensions (reported by 37%), and government employee pensions (reported by 16%).
  • Social Security constituted 90% or more of the income received by 33% of beneficiaries in 2014 (21% of married couples and 43% of non-married beneficiaries).
  • Over 4.2 million older adults (8.8%) were below the poverty level in 2015. This poverty rate is statistically different from the poverty rate in 2014 (10.0%). In 2011, the U.S. Census Bureau also released a new Supplemental Poverty Measure (SPM) which takes into account regional variations in living costs, non-cash benefits received, and non-discretionary expenditures but does not replace the official poverty measure.   In 2015, the SPM shows a poverty level for older persons of 13.7% (almost 5 percentage points higher than the official rate of 8.8%). This increase is mainly due to including medical out-of-pocket expenses in the poverty calculations. 

*Principal sources of data for the Profile are the U.S. Census Bureau, the National Center for Health Statistics, and the Bureau of Labor Statistics. The Profile incorporates the latest data available but not all items are updated on an annual basis.

The report is available as a word document or a spread sheet with tables.

March 23, 2017 in Consumer Information, Current Affairs, Other, Statistics | Permalink | Comments (0)