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."
Tuesday, March 22, 2016
Legal Service programs around the country have constant challenges in securing adequate funding for operations and I'm often struck by the ingenuity needed to keep programs afloat. I was struck by a recent "Access to Justice" panel report in Montana that highlighted the needs of rural persons, including older persons at or near the poverty line, living in isolated circumstances. Even with pro bono hours contributed by law firms, under-funding remains a serious problem. KTVQ.com from Billings, Montana reported:
One witness, identified only as Vicky, said she fought a two-year battle with Medicare before obtaining a $3,000 scooter that helps her carry on daily life while coping with cerebral palsy. “I didn’t know where to go or what to do,” she said. Vicky was among the lucky few Montanans who get legal help through the Montana Legal Services Association, said Alison Paul, director of the association....
Elderly Montanans face similar problems, said Todd Wood, director of the Area II Agency on Aging, which provides services over an area larger than West Virginia. Federal funding for the program has declined in recent years while state funding has slowly increased so that the agency now gets about two-thirds of its funds from the federal government and a third from state government.
But those sources account for only $5 million of the agency’s $9 million budget. The rest comes from contributions by clients for such services as meals and transportation. Without those contributions, the program probably would fold within five months, Wood said. He noted that many elderly residents live in deep rural areas, some without electricity or telephones. They often need help with such legal matters as wills, power of attorney and guardianship problems, he said, but they often are unaware of their rights or unable to find help.
“Their mailman might be the No. 1 contact in the course of the day,” he said.
Providing legal help for seniors is especially critical in Montana, which faces a coming tidal wave of elder care needs, said Gary Connelley, a fulltime pro bono attorney for the Crowley Fleck law firm. By 2020, Montana is expected to be third in the nation in the number of people per capita age 65 or older, he said. But even though Crowley Fleck donated nearly 5,000 hours of free legal help in 2015, Connelley said, it turns away eight or nine of every 10 requests it gets for free legal assistance.
For more read, "Legal Help for Poor, Disabled Often Hard to Come By."
For another perspective on the intense consequences for entire families from under-funding of legal services, this time on the criminal justice side of the bar, see the New York Times' recent article, "In Louisiana, the Poor Lack Legal Defense." Are you getting a tax refund this year? An opportunity to make a tax-deductible contribution to a Legal Aid or Service program near you!
Tuesday, February 23, 2016
Stakeholders and Policymakers Collaborate on Proposals for Better Approach to Financing Long-Term Care
On February 22, 2016, a diverse collection of individuals, representing a broad array of stakeholders interested in long-term care, released their report and recommendations for major changes. In the final report of the Long-Term Care Financing Collaborative (LTCFC) they propose:
•Clear private and public roles for long-term care financing
•A new universal catastrophic long-term care insurance program. This would shift today’s welfare-based system to an insurance model.
•Redefining Medicaid LTSS to empower greater autonomy and choice in services and settings.
•Encouraging private long-term care insurance initiatives to lower cost and increase enrollment.
•Increasing retirement savings and improving public education on long-term care costs and needs.
ElderLawGuy Jeff Marshall wrote to supplement this post by providing details of the report, written by Howard Glecknan of the Utban Institute. Thanks, Jeff!
Members of the Collaborative included:
Gretchen Alkema, The SCAN Foundation; Robert Blancato, Elder Justice Coalition; Sheila Burke, Harvard Kennedy School; Strategic Advisor, Baker, Donelson, Bearman, Caldwell & Berkowitz; Stuart Butler, The Brookings Institution; Marc Cohen, LifePlans, Inc.; Susan Coronel, America’s Health Insurance Plans (AHIP); John Erickson, Erickson Living; Mike Fogarty, former CEO, Oklahoma Health Care Authority; William Galston, The Brookings Institution; Howard Gleckman, Urban Institute; Lee Goldberg, The Pew Charitable Trusts; Jennie Chin Hansen, immediate past CEO, American Geriatrics Society; Ron Pollack, Families USA; Don Redfoot, Consultant; John Rother, National Coalition on Healthcare; Nelson Sabatini, The Artemis Group; Dennis G. Smith, Dentons US LLP; Ron Soloway, UJA-Federation of New York (retired); Richard Teske (1949-2014), Former U.S. Health and Human Services Official; Benjamin Veghte, National Academy of Social Insurance; Paul Van de Water, Center on Budget & Policy Priorities (CBPP); Audrey Weiner, Jewish Home Lifecare, immediate past Chair, LeadingAge; Jonathan Westin, The Jewish Federations of North America (JFNA); Gail Wilensky, Project HOPE;Caryn Hederman, Project Director, Convergence Center for Policy Resolution; Allen Schmitz, Technical Advisor to the Collaborative, Milliman, Inc.
Only Limited Authority as Health Care Agents? The Latest Grounds to Challenge Dreaded Arbitration Clauses in NH Cases
The New York Times offers another window into concerns about pre-dispute binding arbitration provisions that are routinely found in nursing home agreements. This is a long-simmering war, with many battlefronts and tactical arguments, as documented in the article. However, the article also focuses on a narrow group of cases where courts have rejected a binding effect for arbitration clauses signed by someone serving "merely" as a health care agent for the incapacitated resident. (I hope my Contracts course students this semester are reading this article!)
The article offers an additional opportunity to consider the tensions between public policies on either side of the debate over "fairness" of arbitration as a forum for consumer claims:
Arbitration clauses have proliferated over the last 10 years as companies have added them to tens of millions of contracts for things as diverse as cellphone service, credit cards and student loans.. Nursing homes in particular have embraced the clauses, which are often buried in complex contracts that are difficult to navigate, especially for elderly people with dwindling mental acuity or their relatives, who can be emotionally vulnerable when admitting a parent to a home.
State regulators are concerned because the secretive nature of arbitration can obscure patterns of wrongdoing from prospective residents and their families. Recently, officials in 16 states and the District of Columbia urged the federal government to deny Medicaid and Medicare money to nursing homes that use the clauses. Between 2010 and 2014, hundreds of cases of elder abuse, neglect and wrongful death ended up in arbitration, according to an examination by The New York Times of 25,000 arbitration records and interviews with arbitrators, judges and plaintiffs.
Judges have consistently upheld the clauses, The Times found, regardless of whether the people signing them understood what they were forfeiting. It is the most basic principle of contract law: Once a contract is signed, judges have ruled, it is legally binding.
Mr. Barrow’s case [set for trial in Massachusetts] is pivotal because, with the help of his lawyers, he has overcome an arbitration clause by using the fundamentals of contract law to fight back. As is often the case when elderly people are admitted to nursing homes, Mr. Barrow signed the admissions paperwork containing the arbitration clause on his mother’s behalf.
Although his mother had designated Mr. Barrow as her health care proxy — someone who was authorized to make decisions about her medical treatment — his lawyers argued that he did not have the authority to bind his mother to arbitration.
Our thanks to attorneys Karen Miller in Florida and Morris Klein in Maryland, plus Dickinson Law students Joe Carroll, Corey Kysor and Kadeem Morris in Pennsylvania for sending us the link to the NYT coverage.
February 23, 2016 in Cognitive Impairment, Consumer Information, Crimes, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare, Statistics | Permalink | Comments (0)
Monday, February 22, 2016
A John A. Hartford Foundation-sponsored study released this month uses Medicare data to examine health care for older Americans, with a self-described "emphasis on the patient's perspective." Both the methodology and the conclusions are intriguing. The researchers report:
For the first time, we measure the intensity of care in terms of how many days per year the average Medicare beneficiary is in contact with the health care system. We can see that beneficiaries in some regions see twice as many unique clinicians for ambulatory care than in others. We also can see in which regions beneficiaries are more likely than not to have a primary care physician as their predominant provider of care.
We also examine the adoption of new evidence-based practices to show that, while some regions showed substantial progress, others still fall short. For example, in some regions, fewer seniors are being prescribed inappropriate high-risk medications, and in others, thirty-day readmission rates are falling. Yet screening tests for prostate cancer and breast cancer among beneficiaries 75 and older remain unnecessarily high, and the data in this report suggest that we are still waiting too long to refer patients to hospice care.
On the one hand, the report demonstrates wide regional variation in the percentage of patients enrolled in "hospice" during the last three days of an individual's life. The researchers conclude: "Referrals to hospice care that are done too late ... adversely affect the quality of care, the reported experiences of patients and families, and their satisfaction with the health care system."
On the other hand, the report cites "clinical evidence" that shows that "feeding tube placement" in patients with advanced dementia "does not prolong life or improve outcomes, and in fact leads to further complications and adverse effects such as the increased use of restraints." Nonetheless, the report shows that in some regions of the country, 12% to 14% of patients with dementia may be on feeding tubes, pointing to locations such as southern California, Lake Charles, Louisiana, and Dearborn, Michigan.
For the full report, see the Dartmouth Atlas project report, "Our Patients, Ourselves: Health Care for an Aging Population."
Further, for an region-specific analysis of the report findings, see iNewsource's "Care for San Diego's Dying Patients Needs to Improve, Study Finds."
Monday, February 15, 2016
My friend, colleague and renaissance guy, Mark Bauer, keeps an eye out for interesting articles for me, including those that focus on a community's livability for elders. He sent me this great article that looks at how a vibrant, walkable community can increase one's longevity once one reaches 80. The article, Land use mix and five-year mortality in later life: Results from the Cognitive Function and Ageing Study, appears in volume 36 of Health and Place at pages 54-60 (Mar. 2016). Here's the abstract
This study explores the potential modifying effect of age and mediation effect of co-morbidity on the association between land use mix, a measure of neighbourhood walkability, and five-year mortality among the 2424 individuals participating in the year-10 follow-up of the Cognitive Function and Ageing Study in England. Postcodes of participants were mapped onto Lower-layer Super Output Areas, a small area level geographical unit in the UK, and linked to Generalised Land Use data. Cox regression models were fitted to investigate the association. For the younger older age group (75–79 years), the effect of high land use mix on an elevated risk of mortality was mediated by co-morbidity. For older old age groups (80–84, 85+ years), a higher land use mix was directly associated with a 10% lower risk of five-year mortality. The findings suggest differential impacts of land use mix on the health of the younger and older old.
I thought this quote from the implications/future research section persuasive: "[P]olicy planning should take note of such variation within older populations, and in particular the needs of the middle and oldest old cohorts. This observation is particularly relevant to the recent movement toward age-friendly environments, which have been advocated worldwide to create inclusive and supportive living environments for active ageing... improving the mix of land uses in local areas may be a potential approach to reduce limitations in activity of daily life and support active ageing for these older age groups."
A pdf of the article is available here.