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.
Sunday, February 14, 2016
Ever wonder if using social media helps advance the services and care for America's elders? According to a recent article in Aging Today on the website of the American Society on Aging (ASA), the answer to that question is yes. In Advocating for Aging Services in a Digital World, published on January 25, 2016, the author explains
Given all the issues that face older Americans, why is it worth the time and effort it takes to tend to a social media feed? Consider the dual nature of any effort to create social change. On every social issue, there is the “work-work” to be done—policies to be crafted, programs to be improved, risks to be reduced and funding to be secured—and then there is the “meaning-making work.” The latter involves defining the problem and its appropriate solutions, building public awareness and cultivating political will. Both efforts are essential to creating meaningful social change.
In aging policies, the author explains the importance of strategy and dissemination of the message:
So, engaging in social media is a powerful tool for shaping opinions and engaging key constituencies. But the power of this tool also means it must be handled with care. A communicator’s choices about what to emphasize and what to leave unsaid have a significant impact on how the communication is understood, interpreted and acted upon.
The article continues, offering suggestions for effective online advocacy, including how to frame a message by offering information and solutions. "[U]sing the power social media affords [the chance] to shape the public conversation. By considering the frame effects of the narratives they tell—online or elsewhere—advocates for better policies around aging can help to mature the issue of an aging America."
Friday, February 12, 2016
We've all seen it -- a family having dinner "together" while each member of the family is using a cell phone to text rather than talk. Is this likelihood to affect long-term living, and if so, how?
Stanford University's Center on Longevity has a new report on trends in three key areas usually associated with longevity -- health, financial security and social connections. The Sightlines Project: Seeing Our Way to Living Long, Living Well in 21st Century America analyzes data from studies that included more than 1.2 million Americans, and both positive and negative trends are documented.
Next will be "plans to host roundtable discussions with policymakers, private sector leaders and researchers to develop solutions to longevity problems." The goal is to better support "living long and living well." One component, therefore, is to examine the implications of "weaker social networks:"
Social engagement with individuals and communities appears weaker than 15 years ago, the research revealed. This is especially true for 55- to 64-year-olds, who exhibit notably weaker relationships with spouses, partners, family, friends and neighbors. They also are involved less in their communities than their predecessors.
"The vulnerability and disengagement in the group headed into retirement warrants further attention," Carstensen said.
The study does not address trends in the use of social media.
Amy Yotopoulos, director of the center's mind division, said, "It's too soon to tell whether asynchronous, technology-mediated forms of social engagement – texting, chat, posting and tweeting – will provide comparable social benefits to more traditional forms of interaction with family and friends."
For more on the Center's research plans, see Stanford's report on "Stanford Project Suggests Longer, Healthier Lives are Possible." My thanks to Professor Laurel Terry for sharing this article.
Tuesday, February 9, 2016
We have posted several times on how much one needs for retirement and whether folks are saving enough to have a financially secure retirement. An article in the Washington Post on January 12, 2016 features a new report from Fidelity Investments that shows savers need to get much more aggressive with saving for a financially secure retirement. How big your retirement fund should be at every age, according to one guide explains that Fidelity revised its guidelines at the end of last year using a more conservative return rate. Here is an example of their recommendation:
people save one times their salary by their 30th birthday. By the time they’re 35, savings should add up to double their annual pay. By 40, a retirement account should hold three times a person’s salary. The numbers keep growing, all the way to age 67, by which retirement savings should add up to 10 times a person’s pay.
The article notes that this guide may seem aggressive and intimidating to some, but emphasizes that it is just one guideline, and if nothing else, should be the catalyst to get people saving for retirement. Get out that piggy bank.....
Tuesday, January 26, 2016
As we (finally) get to the early primary and caucus stages of this Presidential election year, I'm struck by how much the pundits are talking about changing demographics, including the potential impact of growing diversity of race and national origin among potential voters. At the same time, it will be interesting to see whether "aging" of the population, including the growing share of older voters, will play an equally significant role. At least one early evaluation of swing state voting compares growing diversity of the Sun Belt states with aging in Rust Belt states:
Diversity is also spreading, but much more slowly, in the six Rust Belt swing states (Iowa, Michigan, New Hampshire, Ohio, Pennsylvania, and Wisconsin). Compared with 2008, the model projects that by 2016 the white eligible voter share will drop in a range from Pennsylvania at the high end (3.1 percentage points), to New Hampshire at the low end (1.2 points). Behind strong Obama turnout efforts, from 2008 to 2012, minorities in Ohio and Pennsylvania grew even faster as a share of actual voters than as eligible voters. That helped Obama win Ohio in 2012, despite attracting exactly the same share of the white vote (41 percent) that Gore did and less than Kerry did (44 percent) when each lost the state in 2000 and 2004 respectively. (Obama also held Pennsylvania, despite winning considerably less of the white vote than either Gore or Kerry, who both carried the state.) But, overall, racial change is not nearly as big a factor in these brawny battlegrounds as in the Sun Belt swing states.
In those critical Rust Belt states, the key demographic change is the one captured in the second chart: the population’s aging. In all six Rust Belt swing states, the model projects that adults 50 and older will constitute at least 45 percent of eligible voters by 2016; for each state except Pennsylvania, that would be an increase of at least 2.3 percentage points since 2008. New Hampshire leads the list with an increase of 3.6 percentage points in the over-50 share of eligible voters; the model projects Pennsylvania, which started with the oldest eligible population, to increase the least at 1.8 percentage points. (The Sun Belt swing states are also aging, but generally not quite as fast as the Rust Belt battlegrounds.)
My own sense is there is at least one major commonality among many older voters and younger non-white voters: fear that they haven't earned enough -- or won't be able to earn enough -- to survive or thrive in a constricted economy. Is it easier for the candidates to talk about terrorism or national security than it is to talk about social security through the lifespan?
Friday, January 22, 2016
In South Korea, "filial duty" is apparently a hot topic, as reflected by a recent Korean Supreme Court ruling and a public survey. And it is more than a theoretical concept or moral obligation, with "contract" law principles now coming into play. As reported in English by the Korea Herald, published on December 30, 2015:
More than 75 percent of South Koreans surveyed by a local pollster think “filial duty contracts” -- a legal document that makes it mandatory for all grown children to financially and emotionally care for their aged parents -- are necessary should they receive any gifts such as real estate or stocks from them.
The survey results were released two days after the Supreme Court ruled in favor of an elderly father who filed a suit against his son, who, in spite of signing a filial duty contract, did not care for his ill mother as promised after receiving a personal estate. The court acknowledged the legality of the document and ruled the son must return the property to his father, as the property was gifted in exchange for his support.
Although "filial duty" has long been considered an important, traditional value in Korea, "the nation's changing family structure" and high costs for housing and education apparently have made it more difficult for elderly Koreans to rely on their children for voluntary care. The survey, of 567 Koreans, showed strong support for greater enforcement of "filial duty contracts."
Under the current law, a donor may rescind a gift contract if the recipient committed an act of crime against the donor, or if “the beneficiary is obliged to support the donor but does not do so.” However, the law also states that rescinding a gift contract does not have any effect once the gift has already been given to the beneficiary.
For more details, including a report on a pending bill that would give "Korean parents the right to sue their children in case of mistreatment and to ask them to return any gifts," read "77% of South Koreans See Need for 'Filial Duty Contracts.'"
Friday, January 15, 2016
I recently ran into an article published in December of 2015 that I thought was interesting. Fighting Ageism in the Twitter Era (Getting Old Isn't All That Bad) was published in the Arizona Republic/New America Media. The December article followed up a late November opinion piece titled, Valdez: Getting old isn't all that bad by Linda Valdez that opened with this:
The baby boomers, AKA the nation’s silver tsunami, had better pay as much attention to changing attitudes about aging as they did to shaking up all those previous social norms.
In our culture, old things get replaced with something nice and new. Like the latest smart phone.
Apply the concept to people, and it’s called ageism.
It’s as current as Twitter.
A team of researchers at Oregon State University took a look at tweets about people with Alzheimer’s disease and found ridicule, stigma and stereotypes.
In the December article, the author, reporting on the Gerontological Society of America's annual scientific meeting in November, was in attendance as a Journalist in Aging Fellowship. After generally reviewing topics covered in the conference, the author notes that the Boomers wish to age in place, yet many may not be physically able to do so and blame themselves for their own inability to do so. Enter negative thoughts about aging:
Meanwhile, society does its best to accent the negative.
Asked to characterize the aging, some people recorded during on-the-street interviews dredged up cliches about spry retirees on vacation, but most talked about decline, disease, dependency.
“Society isn’t betting on them,” said one man.
These interviews were done as a result of a project with 8 of the national aging organizations, who were looking for metaphors for aging because how we look at something is crucial to how we apply information about it. The article concludes
[T]he way information is framed has an impact on how people use the information, which should come as no surprise to those who reframed cultural norms about race, gender, sex, the environment and entertainment.
The baby boomers have a lot at stake, and that includes [the author] me. I’m no fan of euphemisms, but I’m all for promoting a fine-wine view of life. It should get better with age. We should feel better about aging.
If some creative wordsmithing and mass marketing helps our society recognize that aging doesn’t diminish value or humanity, it would be a real contribution to our collective understanding of who we boomers are.
Turning to the researchers at Oregon State U who did the analysis of tweets, their article, Portrayal of Alzheimer's Disease on Twitter is available in volume 55 of the Gerontologist, the publication of the Gerontological Society of America.
Recently, several attorneys pointed me to an interesting report on "Marital Biography, Social Security Receipt and Poverty," by sociology researchers at Bowling Green State University. The abstract explains:
Increasingly, older adults are unmarried, which could mean a larger share is at risk of economic disadvantage. Using data from the 2010 Health and Retirement Study, we chart the diverse range of marital biographies, capturing marital sequences and timing, of adults who are age eligible for Social Security and examine three indicators of economic well-being: Social Security receipt, Social Security benefit levels, and poverty status. . . . Among singles, economic well-being varies by marital biography and gender. Gray divorced and never-married women face considerable economic insecurity.
From the body of body of the study more information emerges about the phenomenon of "gray divorce," those occurring after age 50, which has "doubled since 1990 even though the overall U.S. divorce rate remains stable." The authors continue (with citations omitted here):
The timing of marital dissolution in the adult life course may have implications for postdivorce adjustment, including late life economic well-being. Divorce tends to be more normative at younger ages whereas widowhood becomes increasingly likely with age. From a life course perspective, the timing of an event can magnify or reduce its influence on well-being. Off-time events are associated with poorer outcomes than on-time events. Thus, divorce prior to age 50 may be less detrimental to economic well-being than divorce after age 50. Those who divorce earlier in adulthood have more time to recoup the financial losses divorce usually entails. In contrast, those who divorce later have fewer years of working life remaining and may not be able to fully recover economically from a gray divorce. Indeed, gray divorce appears to diminish wealth more than an earlier divorce. Similarly, widowhood prior to age 50 is an off-time event that is not a normative life course experience. Young widows are more likely to become poor compared with older widows. Couples tend to be overly optimistic about the likelihood they both will survive to an old age. Thus they may not have adequately planned for this unlikely possibility and ultimately may be less able to recover fully.
Ultimately, from their research it appears that comparatively higher rates of poverty are associated with unmarried status as you age, but, particularly for women, late-in-life divorce may further increase the likelihood of poverty.
Tuesday, January 5, 2016
Over the holidays in December, I spent time with family in a hospital, responding to an emergency health situation. One of the staff told me it is "always" busier at the holidays, and she attributed this to family members gathering together and "realizing" that a loved one's health was declining. However, there may be more to it than that. Former New York Administrative Law Judge Karen Miller shared a very interesting Wall Street Journal article reporting on the trends in deaths at the holidays. While some of the information is, perhaps, expected, as you think about stress and weather contributing to health risks, the spike in deaths in early 2015 was unusual, when "nearly a third more senior citizens died than normal in the first two weeks of the new year." For more data, read "Why Death Doesn't Take a Holiday This Time of Year."
Thankfully, in our family we weren't dealing with a death! Thanks for sharing this article, Karen.
Tuesday, December 15, 2015
JP Morgan Chase & Co. Institute released a December 2015 report, Profiles of Local Consumer Commerce, Insights from 12 Billion Transactions in 15 U.S. Metro Areas. The report reviews "how the growth of local consumer commerce is shaped by the age and income of the consumer, the products sold by the business and its size, and the residence of the consumer relative to the business." Age is addressed in Finding One. The executive summary explains Finding One: "[m]iddle- and high-income consumers, and consumers ages 65 and older, were responsible for most of the slowdown in growth, while low-income consumers and those under 35 maintained relatively stable spending growth."
The report expands on the findings, explaining with Finding One
We first explore the simultaneous impact of consumer age and income on local consumer commercial spending. Spending is largely driven by income, which for many consumers is strongly related to their age. We define five age and income segments that best explain this pattern (see Data and Methodology for details of this segmentation). Based on these segments, our analyses show that middle-income and high-income consumers ages 35 to 64, and consumers 65 and older, were responsible for most of the slowdown in growth, while low-income consumers 35 to 64 and those under 35 maintained relatively stable spending growth.
Pages 10 - 11 of the report discuss Finding One, along with graphs and charts that accompany the discussion. This 32 page report is heavily data driven and provides good visual aids to accompany each finding.
Sunday, December 13, 2015
I don't know whether the issue of elder abuse is just getting more coverage or whether cases of elder abuse are increasing. We all know that elder abuse is a global issue. I ran across a few recent articles about elder abuse that I wanted to share in this post.
First, The Conversation published Why are we abusing our parents? The ugly facts of family violence and ageism . The article opens with the story of Gwen, who was being abused by her son. The article suggests that "[o]lder people experiencing abuse from family members share the same experience as women suffering intimate partner violence in having someone close to them, whom they ought to be able to trust, perniciously erode their sense of safety and wellbeing through excessive use of power and control." But, when its a child who is the perpetrator, "feelings of parental love and responsibility coupled with shame and guilt for having “failed” as a parent often stop the parent from seeking help and protecting themselves." Turning to Australia, the article examines the prevalence and frequency of multiple abuses of a victim. "For example, financial abuse was coupled with another form of abuse in 65% of cases." Linking abuse and ageism, the article offers that "[promoting the dignity and inherent value of older people is a crucial component of elder abuse prevention." The article calls for educating professionals, elders and society about the issues.
Next, a newspaper in Bend, Oregon ran the story, Financial exploitation hits close. Report: Most financial exploitation done by someone the victim trusts. "A report by Oregon’s Office of Adult Abuse Prevention and Investigations found nearly three-fourths of Central Oregon’s financial-exploitation cases involved someone known or trusted by the victim." The cases in Oregon are similar to what is happening across the country:"[s]tate investigators recorded 1,059 cases in which people 65 or older, who lived on their own or with a loved a one, were victims of theft or someone had misused their money, medication or property...Financial exploitation for seniors living outside of a long-term care facility was the most common type of elder abuse for the third year running in 2014."
Finally (but finally only for this post; I have no doubt that there will be more posts on elder abuse, unfortunately) CNBC ran a story on elder abuse with a headline that caused me to do a double-take. Why seniors don't fear elder financial abuse discusses a new report from Allianz Life that "queried over 1,200 seniors and more than 1,000 people ages 40 to 64 about seniors' finances and found that among the seniors, 89 percent were confident they could handle their money on their own. At the same time, 22 percent of the younger group said they were not confident in their own ability to recognize elder financial abuse, or were not sure."
The CNBC story indicates that family members worry more about the elder being a victim than the elder does. "The confidence of the seniors may make them even more vulnerable to financial scams or financial abuse by friends or family members, said Walter White, president and CEO of Allianz Life. ..."Everything we understand about the prevalence of the issue would suggest that confidence is misplaced," he said." The CNBC story cites some other reports that provide good statistics and discusses the connection between financial exploitation and ultimately a nursing home placement.
That kind of loss can devastate a person's finances, and elder financial abuse is often a major reason why seniors wind up in nursing homes and assisted living facilities on public assistance. Dr. Mark Lachs, co-chief of the division of geriatrics and gerontology at Weill Medical College, has studied the issue and found that an older person who falls victim to abuse, including financial exploitation, is four times more likely to be placed in a nursing home, after adjusting for other known risk factors for nursing home placement.
Discussing the reasons a victim may fail to report financial exploitation, the story adds overconfidence as a reason, citing to the Allianz report. The CNBC story concludes with some links to resources to help fight elder abuse.
December 13, 2015 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care, Property Management, Retirement, Statistics | Permalink | Comments (0)
Monday, December 7, 2015
During my recent visit in England, I had the fortunate experience of having lunch with Bernard Casey, Associate Professor at the Personal Social Services Research Unit at the London School of Economics and Principal Research Fellow at the University of Warwick. He has deep interest and experience as a social economist in evaluation of the economic implications of societal ageing. We could have talked for hours -- so much so that I almost missed my train from London to Leeds.
Bernard introduced me to a fascinating network of academics and policy makers with related interests, the International Long Term Care Policy Network. I encourage you to check out their website, and especially to browse the short interviews with international experts who are following long-term care system developments around the world.
Mark Your Calendars: The ILP Network is hosting its 4th International Conference on Evidence-based Policy in Long-term Care at the London School of Economics and Political Science (LSE) in London from the 4th to the 7th of September in 2016. Key themes of the conference will include: care models, case management, economics of long-term care, equity and efficiency, funding systems, health and social care integration, housing, institutional dynamics, local vs. central policy interactions, personalization of the care system, policy implications of dementia, technology and long-term care, unpaid carers, and workforce and migrant workers. More information about registration and submission of abstracts will be available in the near future.
Wednesday, November 11, 2015
I was reading a recent article in the New York Times on estimating longevity in the context of the Social Security Trust Fund. Your Kids Will Live Longer Than You Thought ran in the NY Times on November 10, 2015. The article discusses statistics and probabilities, explaining how life expectancies are calculated. Looking at the Social Security projections of life expectancy, the article notes that SSA is likely too conservative in their longevity projections.
The Technical Panel on Assumptions and Methods established by the Social Security Advisory Board, an independent government agency that advises Social Security’s trustees on matters including actuarial assumptions, says Social Security is systematically underestimating future declines in mortality rates, and therefore underestimating the likely life spans of young Americans.
So this is a good news-bad news scenario. Good news for those who get more years of life, bad news for Social Security. "[O]ne quirk of Social Security is that a piece of obvious good news (People will live longer than we thought!) is bad news from the narrow perspective of paying for retirement benefits (The government will have to pay benefits longer!)." So how to handle Social Security's too conservative projections? The Congressional Budget Office "tweaked" them by increasing them.
Sunday, November 1, 2015
The four-day annual meeting for LeadingAge, a trade association for providers of senior services with "6,000+ members and partners including not-for-profit organizations representing the entire field of aging services, 39 state partners, hundreds of businesses, consumer groups, foundations and research partners," starts today, November 1, in Boston The program offerings are impressive with as many as two dozen choices per educational session and keynote addresses by high profile individuals, such as Monday's speaker, Dr. Atul Gawande, famed author of a best selling and much discussed book that challenges thinking on end-of-life case, Being Mortal.
I find LeadingAge as an organization to be fascinating, not least of all because of the scope of providers under its umbrella, but also because it has proven itself to be very responsive to changes in the market place. It was once known as AAHSA or American Association of Homes and Services, but voted to change its name to LeadingAge in 2010.
More changes are in the works, as long-time and much respected Larry Minnix is retiring as the head honcho of LeadingAge. Nonprofit Continuing Care Retirement Communities (CCRCs) were once a major (perhaps even the most dominate) part of the membership, but as the senior care and services market is changing that is less and less true, especially with trends in favor of mergers and acquisitions, including not infrequent transitions to for-profit operations. Interestingly, during this year's meeting, LeadingAge is announcing a new for name for CCRCs. Stay tuned!
This organization clearly understands the need for change to stay attractive to consumers. At the same time, name changes can also complicate understanding by consumers of the choices available to them -- and can complicate state efforts to evaluate and, where appropriate, regulate different models of senior and adult housing and care services.
Monday, October 26, 2015
Recently I witnessed a nighttime accident on Interstate-81 in Cumberland County, Pennsylvania. There was an unmistakable "boom" signaling a rear-end collision. One truck (that appeared to be a large rental truck) had rear-ended an 18-wheeler behind me -- and I watched the faster moving rental truck continue past me on the road with heavy damage on its right side, before eventually veering to a shaky halt in the median. As far as I could tell, both drivers were alive, but at the first safe spot, I called 911.
I got off of I-81 at the next exit. I paused both for gas and to take a breath of crisp night air, before taking a back road the rest of the way home. While I was fueling, an older man in the car next to me, a car with West Virginia license plates, pointed to the I-81 overpass where traffic was crawling through more flashing lights. He asked, "Is it safe for us to get on the road to get home? We live about 75 miles from here." Frankly, I had no way to answer that with any confidence. He shook his head and said to his companion, "I think we should stay in a motel tonight."
Monday, October 19, 2015
Oregon Health & Science University (OHSU) announced the forthcoming publication of a report on elders and depression and the differences when they had in-person interactions vs. virtual interactions. Research: Face-to-face socializing more powerful than phone calls, emails in guarding against depression in older adults is published in the Journal of the American Geriatrics Society (free to members). The release on the study described the findings: "Study participants who regularly met in person with family and friends were less likely to report symptoms of depression, compared with participants who emailed or spoke on the phone. The gains people derived from face-to-face socializing endured even years later."
Here are some more details about the study from the news release:
Researchers examined the frequency of in-person, telephone and written social contact, including email. Then they looked at the risk of depression symptoms two years later, adjusting for potential confounding factors including health status, how close people lived from family and preexisting depression.
The researchers found that having little face-to-face social contact nearly doubles your risk of having depression two years later. They also reported that having more or fewer phone conversations, or written or email contact, had no effect on depression.
Study participants who met up with family and friends at least three times a week had the lowest level of depressive symptoms two years later – 6.5 percent – than those who had less frequent contact. Individuals who met up just once every few months or less frequently had an 11.5 percent chance of depressive symptoms.
Wednesday, September 2, 2015
UCLA's Center for Health Policy Research has issued its August 2015 report on "The Hidden Poor," using county-by-county data to demonstrate that "federal" definitions of poverty are not a sufficient measure of true poverty for seniors. What are the "hidden poor?" The UCLA report explains: "The Hidden Poor are defined as those who have incomes above 100 percent of the Federal Poverty Level (FPL), but who do not have enough income to make ends meet as calculated by the Elder Index."
A recent article in the Sacramento Bee highlights key components of the analysis:
More than 300,000 elderly Californians are officially poor, as measured by the federal government, but their numbers triple to more than 1 million when the “hidden poor” are counted, according to a new study from UCLA’s Center for Health Policy Research.
National poverty guidelines say that for a single elderly adult living alone, the poverty line is $10,890 a year, but UCLA’s “elder index” puts it at $23,364 in California.
Those “hidden poor” Californians over 65 tend to be Latino or black. Their greatest concentrations are found in rural counties with overall low income levels, topped by Imperial County, where more than 40 percent of the elderly are the hidden poor....
The study said population groups with especially large proportions of the hidden poor include grandparents raising grandchildren, elderly with adult children living at home, and single elders.
Accurate measurements of poverty are core to planning of resources for any age group, including seniors. How does your state account for needy seniors?