An estimated 1.5 million retirees have reentered the U.S. labor market over the past year, according to an analysis of Labor Department data by ... an economist.... That means the economy has made up most of the extra losses of retirees since February 2020, a Washington Post analysis shows.
Thursday, May 26, 2022
Yesterday I wrote a blog post about gun use that several of my friends correctly characterized as heartfelt. Of course, legal research is merited, and I find that my view echoes what is written in a key section of a very recent opinion:
Beyond these significant safety concerns, contemporary scientific research increasingly sheds light on the relative immaturity and incomplete cognitive development of young adults. California cites to evidence that young adults are less mature than older adults, which leads them to take more risks and behave more reactively than their elders. Young adults are thus quicker to anger than older adults and more vulnerable to intense mood swings and to making instinctive, rather than considered, decisions. This cognitive immaturity makes young adults more likely to use firearms in situations of significant emotional arousal or perceived threat, or other situations that require rapid, complex information processing. Other Circuits have credited similar evidence to uphold regulations on firearms affecting 18 to 20-year-olds. NRA, 700 F.3d at 208; Horsley v. Trame, 808 F.3d. 1126, 1133 (7th Cir. 2015). The semiautomatic rifle regulation helps to “ensure that access to these weapons is restricted to mature individuals who have successfully completed safety training,” such as members of law enforcement and the military, “furthering the public safety objectives and ensuring that the Founding Era balancing of Second Amendment rights with safety concerns continues today.” Jones, 498 F. Supp. 3d at 1328.
Unfortunately, this is from the dissenting opinion in Jones v. Bonta, decided by the 9th Circuit with an opinion issued less than two weeks before the shooting in Uvalde, Texas. Sigh.
Or, as the always astute Professor Naomi Cahn observes, "The irony of the timing of such a ruling is beyond distressing."
Wednesday, May 25, 2022
I suspect I'm not alone in thinking about guns this morning in the wake of the Texas shooting at a grade school in Uvalde Texas. This post reflects matters I've been thinking about for a long time. Indeed, thirty years ago I considered making gun violence a core academic research topic, until I realized how potent is the lobby supporting gun sales, and therefore gun ownership.
First, this morning I listened to a young man, David Hogg, speaking to an NPR interviewer about his own frustrations in opposing gun violence. He urged legislators at state and national levels to do at least "one thing" to move forward on gun safety legislation. My first reaction was "one thing?" How is that going to help?
Second, I heard a bit more about the background of the 18 year old shooter in Texas, as well as the background of the similarly-aged shooter in Buffalo New York. More memories. In one of my previous lives, I volunteered for a neighborhood tutoring program in New Mexico. My first two students, in high school, had been sent to the program by judges trying to help youths in crime-related incidents. One young man attended once -- and then disappeared.
I managed to have a good session with the other student, a junior in high school, who at my request wrote a short essay about what he saw as his future. The 500 word piece was quite well written, and gave us something we could definitely use to gently work to improve his reading and writing skills. The focus, however, proved to be a window into the bleak outlook of a young man who was involved in a so-called gang. To put it simply, he saw no future for himself after high school. He said with utter confidence that his high school "had" to graduate him regardless of whether he did any more work, as long as he merely attended class. I didn't want to believe that, but he had plenty of evidence to support his hypothesis. He didn't have any post graduation plans. He had equal confidence that he probably wasn't going to make it to age 21. The following week during our tutoring session, he was creative in his resistance to my role as a tutor. He turned in his next essay, but it was written entirely in what was some sort of "tagger's script," the stylized script he used when spray-painting his messages on public building. Tagging was his only crime at that moment.
I eventually decided to volunteer for younger students, and in fact I had a two-year working student-tutor relationship with a grade school boy who was in the program at his mother's insistence. Actually, I got to know the whole family, including his parents and a sister who also sometimes attended our reading sessions (and she helped turn reading into a competitive adventure). To mark the success of his "graduation" from the program, we went to a Phoenix Suns basketball game, because the opposing team that day had a player much admired by my student. At his comparatively "youthful" age, he had written about his plans for the future, including somehow, against all genetic odds, planning to "grow" tall enough to be a professional basketball player, like his idol, Nate Archibald. We talked about coaching as an alternative -- just in case.
I remember the difference in these individuals as I listen to the troubled histories of the two "boys" who bought guns as part of their 18th birthday celebrations. I don't know what happened to most of the other the students involved in the tutoring program. The second student dropped out of the program for reasons I never learned, but I later saw his name in the newspaper when he was accused of being the driver in a car-jacking where his "friend" shot the woman who resisted having her car taken. Sadly, that student's essay was prophetic, as any true dreams for a future may have ended with that crime.
So, if we are going to do at least "one thing," could we -- should we -- focus on raising the threshold age for gun ownership? Should we give young people in their late teens more time to grow older (and "taller" or more mature) and thus to reach a point where the future seems brighter? I'm not suggesting they cannot participate in shooting sports, hunting, and the military, where we hope their use and skill building would be supervised by knowledgeable people. I am suggesting making it unlawful for them to "own" or at least to purchase guns until they are older. Research suggests that substantially more crimes of gun violence against others are committed by individuals between the ages of 17 and 21. There is research to support restricting gun ownership (and therefore gun sales) to individuals over 21 as one step forward in terms of safety.
For example, in June 1999, a "collaborative report" under the auspices of the U.S. Department of Justice noted in part:
In 1996, 26,040 people in the United States were killed with guns. In 1997, offenders age 18, 19, and 20 ranked first, second, and third in the number of gun homicides committed. Of all gun homicides where an offender was identified, 24 percent were committed by this age group, which is consistent with the historical pattern of gun homicides over the past 10 years.
Other statistics suggest that gun-related suicide death rates are highest for females age 45 to 64 and for males age 75 and older, statistics that point to another form of age-specific gun tragedies. Age matters.
That first boy who "disappeared" after the first tutoring session? I later learned he had been killed in a neighborhood shooting. Would younger adults support delayed lawful-ownership as one form of protection against gun violence? Certainly, more is needed on so many other levels including mental health supports. But could "one thing" -- at least -- include blocking gun sales to people who are still in the process of learning to plan for the future, for their futures?
Friday, May 20, 2022
Researcher Explains: Misuse of Data Can Lead to "Pariah-Tizing" the Elderly While Failing to Provide Key Information for All Ages
In September 2021, I listened to a great set of speakers at the Aging, Health, Equity and the Law Conference hosted by Touro College in New York. One session in particular captured my attention. Barbara Pfeffer Billauer, JD, MA (Occ. Health), PhD, who is currently Professor of Law and Bioethics at the University of Porto and Research Professor at the Institute of World Politics in Washington DC. spoke about the misuse of statistics regarding COVID-19 on an international scale. We exchanged emails, and it was clear she was deep into the emerging data from countries around the world.
Dr. Billauer's most recent analysis has received its first publication on May 19, 2022 by the American Council on Science and Health at ACSH.org, with the appropriate yet provocative title of Pariah-Tizing the Elderly: Another Casualty of COVID.
Here she takes on recent news media coverage, including the Washington Post, as well as some scientific community publications, to raise the significant concern that exaggerating the risk of COVID-19 stigmatizes one group -- here the elderly -- while failing to fully inform all age groups about the efficacy of vaccination. She opens with this explanation:
I call a mistaken, targeted focus and overemphasis on any population group “pariahtization.” As recent evidence demonstrates, this "pariah-tized” focus on the elderly regarding COVID-19 is certainly misplaced. It also has resulted in untoward policies that caused more deaths in both the younger segments of the population. . . .
Contrary to popular opinion . . . COVID is not a disease of the elderly—like dementia, or cataracts, or osteoarthritis. Indeed, older people are less likely to die of COVID than heart disease or cancer. This is not so for the younger cohort, for whom during several months last year COVID was the leading cause of death.
For six months of 2021—half the year, COVID was the leading cause of death in those 45-54. In three months of the year, COVID was the leading cause of deaths forages 55-64, but only in two months was it the leading cause of death for those 65-74, the same as for those 35-44; and only in one month was COVID the leading cause of death for those over 75. . . .
The misplaced focus [of the media] on the aged being especially vulnerable has led younger people to unwisely eschew vaccination on the grounds that the disease is not generous to them.
Dr. Billhauer clearly has a way with words and she makes effective use of data and charts to explain important data concerns. The implications of her findings go beyond the problem of the current crisis.
Wednesday, May 18, 2022
I get a lot of fun calls, both from attorneys and from law students, looking for the right employment match in "elder law." For lawyers who are looking for "new attorneys" to help staff their growing law practices, the calls sometimes come just after the law school year is over in early May, when the students have already scattered to the winds or to their homes to study for July Bar Exams. Law Schools' Career Services offices welcome these calls year-round, but we can often be of more help to both sides of the employment equation when people reach out early in the spring or fall semesters.
Nonetheless, one of my favorite "secret" ways for students and attorneys to find each other is through Bar Association programming and Continuing Legal Ed programs. While students usually roll their eyes when, for example, I suggest attending an "educational" program such as Pennsylvania's Elder Law Institute (July 21-22, 2022), most of the students who do attend soon realize that these offer multiple opportunities to get to knew great practitioners and to network. I often "sponsor" my own summer research assistants to attend at least one full day of programming, especially if there is a meet-and-greet lunch or reception at the end of the day. Elder Law attorneys are just plain friendly. This is a win-win for students and prospective employers.
But even beyond elder law, I also recommend that law students reach out during the summers to potential "employers" via State and County Bar organizations in the area of the country where they hope to practice. For example, I recently noticed that in Arizona, the Maricopa County (Phoenix area) Bar Association is hosting a 2022 Diversity Summer Social on June 9, 2022 expressly for "interns, externs, summer and first year associates." I'm sure that "prospective" interns, externs, summer and first-year associates would also be welcome to "mingle with other summer associates, local judges and bar leaders."
I know that one of Pennsylvania's very respected "young" Elder Law attorneys is someone I first got to know as a student because we were both attending a State Bar Association meeting while he was "just" a first year law student. That's the kind of smart networking that can take people very far.
Monday, May 9, 2022
The Washington Post recently published Millions retired early during the pandemic. Many are now returning to work, new data shows. Although a significant number of folks retired early,
Many retirees are being pulled back to jobs by a combination of diminishing covid concerns and more flexible work arrangements at a time when employers are desperate for workers. In some cases, workers say rising costs — and the inability to keep up while on a fixed income — are factoring heavily into their decisions as well.
But those reentering the work force are not just those who retired during the pandemic.
The percentage of retirees returning to work has picked up momentum in recent months, hitting a pandemic high of 3.2 percent in March, according to Indeed. In interviews with nearly a dozen workers who recently “un-retired," many said they felt comfortable returning to work now that they’ve gotten the coronavirus vaccine and booster shots. Almost all said they’d taken on jobs that were more accommodating of their needs, whether that meant being able to work remotely, travel less or set their own hours.
The article provides a number of interesting examples of individuals who are "unretiring" and why they chose to do so.
Sunday, May 8, 2022
The Inspector General of HHS recently released this report, Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care.
Here's the OIG explanation why they did the study:
A central concern about the capitated payment model used in Medicare Advantage is the potential incentive for Medicare Advantage Organizations (MAOs) to deny beneficiary access to services and deny payments to providers in an attempt to increase profits. Although MAOs approve the vast majority of requests for services and payment, they issue millions of denials each year, and CMS annual audits of MAOs have highlighted widespread and persistent problems related to inappropriate denials of services and payment. As Medicare Advantage enrollment continues to grow, MAOs play an increasingly critical role in ensuring that Medicare beneficiaries have access to medically necessary covered services and that providers are reimbursed appropriately.
What the OIG found shows that "MAOs sometimes delayed or denied Medicare Advantage beneficiaries' access to services, even though the requests met Medicare coverage rules. MAOs also denied payments to providers for some services that met both Medicare coverage rules and MAO billing rules." They also found that 13% of denied prior authorizations met the coverage rules and that additionally some denials were made based on lack of documentation but OIG found sufficient documentation had been provided. 18% of payment request denials met the Medicare coverage rules.
Here are their recommendations
Our findings about the causes and circumstances under which MAOs denied prior authorization or payment for requests that met Medicare coverage and MAO billing rules provide an opportunity for improvement to ensure that Medicare Advantage beneficiaries have timely access to all necessary health care services, and that providers are paid appropriately. Therefore, we recommend that CMS:
issue new guidance on the appropriate use of MAO clinical criteria in medical necessity reviews;
update its audit protocols to address the issues identified in this report, such as MAO use of clinical criteria and/or examining particular service types; and
direct MAOs to take additional steps to identify and address vulnerabilities that can lead to manual review errors and system errors.
The full report is available here.
It is Sunday, and I'm looking at a long list of things to do next week, with grading exams at the top of my list. Significantly, however, in the last six to eight months, at increasing rates, I'm hearing from current and prospective residents of Continuing Care Retirement Communities (CCRCs, also sometimes called Life Plan Communities). Here are examples of some of the most often asked questions:
- "The company that runs my CCRC is about to engage in development of a new CCRC. Is the money I've already paid in the form of an admission fee, or the money I continue to pay as monthly service fees, going to support this new development?"
- "During the lock-down associated with protecting residents and the public from COVID-19, we were asked to give up services that were the very reason we choose this community. But now that we are no longer locked down, the services either are not returning or the fees we are charged are actually increasing. Is there some effective way to object to this disconnect between the promises and the delivery of services?"
- "My parents are thinking about moving into a CCRC. On the one hand, I like the idea of the active community they are choosing. But on the other hand, the amount they are expected to pay in the form of an admission fee is astounding. Why are some communities calling this a refundable fee and others are saying it isn't a refundable fee? What are the protections for the 'refundable' fee?"
- "We have just learned that our nonprofit CCRC is being transferred to a for-profit company as the owner-operator. How is this likely to impact my wife and I as residents?"
Answers to many of these questions depend on the state's laws governing this form of senior living operation and, even more, on the particular contracts between the resident and the provider. State regulators have concerns here too. For those looking for legal assistance in their particular community, I sometimes recommend looking for attorneys in the caller's home state, someone who understands CCRCs from a resident perspective. I first wrote about the need for attorneys who understand resident perspectives in 2006.
Sometimes "elder law" attorneys have this expertise, but not always. Plus, it can be important to consult with an attorney who understands consumer protection laws, and not "just" CCRC law. Finally, if litigation is actually on the horizon, the choice for legal advice can depend on whether the attorneys have expertise in litigation or dispute resolution and not "just" contract law.
So, all of this is a short way of saying that even though, as an legal academic, I often write about the importance of resident rights in CCRCs, and even though I believe the future of CCRCs is very much tied to the answers, I'm not in a position to respond to individual questions. The very fact that I'm writing this Blog Post is a potential indication that something important could be going on in the industry. Perhaps that "something" should be addressed by the industry itself, especially if it wants the CCRC concept not just to survive, but thrive. In my opinion, it is not enough for the industry to say that "every CCRC is different."
Tuesday, May 3, 2022
RFP: Washington State Seeks Expert Consultation to Develop CCRC Regulations with Heightened Consumer Protections
I'm always interested when I start getting lots of calls or emails about a certain topic in aging. Today I was hearing from a lot of people wanting to talk about Continuing Care Retirement Communities (CCRCs, sometimes also called Life Plan Communities or LPCs). It is safe to say that all forms of senior living operations are facing new challenges after being hit hard by the lockdowns and staffing problems of the last two years with COVID-19.
But one of the most interesting set of calls was from the State of Washington, where residents have been using their time together during COVID to think carefully about the need for certain key protections for consumers who put their money and trust into CCRCs. The Washington Continuing Care Residents Association (WACCRA) has worked carefully, calmly and diligently to reach the ears of legislators and regulators in the state. I had the pleasure of hearing from members and residents of CCRCs in Washington last October and speaking at their annual meeting.
Today, I heard that the Office of Insurance Commissioner in Washington has initiated a Request for Proposals for a time-sensitive research project:
This project is designed to assess federal and state authorities regulating continuing care retirement communities (CCRCs) and provide a report with recommendations on creating a legal framework for shared regulatory oversight of CCRC products under Chapter 18.390 RCW, which may achieve heightened consumer protections.
Interested researchers -- with background in regulatory systems for CCRCS -- should act quickly as the deadline for submissions is May 23, 2022.
Last month, the Washington Post ran this article, Caring for aging parents, sick spouses is keeping millions out of work.
Even as the job market rapidly approaches the levels last seen before the coronavirus pandemic, a lack of affordable care for older and disabled adults is keeping many out of the workforce. At least 6.6 million people who weren’t working in early March said it was because they were caring for someone else, according the most recent Household Pulse Survey from the Census Bureau.Whether — and when — they return to work will play a role in the continued recovery and could reshape the post-covid labor force.
Read these next two paragraphs from the article very carefully:
For all the attention on parents — and mothers in particular — who stopped working to care for children during the pandemic, four times as many people are out of the work force, caring for spouses, siblings, aging parents and grandchildren, according to the Federal Reserve’s latest Monetary Policy Report.
Caregiving is the second-largest factor keeping people out of work, behind early retirements, at a time when job openings continue to outnumber potential workers. That mismatch is contributing to labor shortages around the country and playing a role in overall inflation. Roughly one-quarter of the workers missing from pre-pandemic levels are on the sidelines for caregiving reasons, according to the report. Overall, the economy is still short 1.6 million workers, two-thirds of them women, from early 2020.
Did you catch those numbers? 4x as many folks are not working because of caregiving responsibilities, and caregiving is the 2nd most common reason why folks aren't working.
Read the article. It's important!
Monday, May 2, 2022
- Medicaid beneficiaries should make sure their Medicaid agency has their current contact information. They should check their mail and be sure to mail back any Medicaid forms they receive.
- All renewal forms and notices must be accessible to people with limited English proficiency and people with disabilities.
- Many people who are no longer eligible for Medicaid will have other coverage options.
- If someone is disenrolled or their Medicaid coverage changes and they disagree with their state Medicaid agency’s decision, they can appeal.
- The end of the Public Health Emergency may lead to an increase in utilization of services provided by Older Americans Act programs, Centers for Independent Living, Assistive Technology Act programs, and other ACL grantees.
The fact sheet contains useful explanations and is available for download.
Friday, April 29, 2022
Earlier this month, Forbes ran this article, American Elders Are Short-Changed 5 Years Of Healthy Retirement, which explains that
America’s elders die sooner and are sicker than their counterparts in other rich nations. American elders also must work longer than their cohort abroad. These trends mean that Americans get fewer years of healthy retirement life than elders in comparable wealthy nations—five years less, in fact.
One reason for this big gap in healthy retirement is the pressure for American elders to work longer. Among major rich nations, Americans work longer than anyone except the Japanese, who retire at age 67.9 while Americans work until age 65 on average; but the Japanese live longer, so experience more healthy retirement time.
Consider this from the author: "It's sad to know that America’s de facto plan for retirement is working longer and dying sooner. This inequality of retirement time is caused by the crossing of two swords: the growing inequality of retirement wealth and the growing inequality of longevity. These inequities are deeply connected. If people who die younger could retire earlier than those with longer and healthier lives, retirement time could at least be distributed more equally."
The full article discussing life expectancy in the U.S. and abroad, as well as work histories, is available here.
As is true with several U.S. states, Virginia has a filial support statute that can obligate adult children to support their parents. The key language of VA Code Ann. Section 20-88 provides:
It shall be the joint and several duty of all persons eighteen years of age or over, of sufficient earning capacity or income, after reasonably providing for his or her own immediate family, to assist in providing for the support and maintenance of his or her mother or father, he or she being then and there in necessitous circumstances.
If there be more than one person bound to support the same parent or parents, the persons so bound to support shall jointly and severally share equitably in the discharge of such duty. . . .
This section shall not apply if there is substantial evidence of desertion, neglect, abuse or willful failure to support any such child by the father or mother, as the case may be, prior to the child's emancipation or, except as provided hereafter in this section, if a parent is otherwise eligible for and is receiving public assistance or services under a federal or state program. . . .
There are few modern cases applying this law. In Peyton v. Peyton, an "unreported" Virginia chancery court decision from 40 years ago, the court applies the law to obligate one brother to reimburse another brother $8,000, representing half of the past out-of-pocket expenses for their mother's care in a nursing home. A careful reading of the Peyton case reveals one of the challenges of applying filial support laws when used to collect "back" expenses; here the second son was willing to pay a portion of their mother's monthly costs going forward but he was not successful in arguing a statute of limitations should apply to prevent liability for multiple years of back claims.
As with other American states that have had forms of filial support laws, Virginia's law was enacted as an alternative to public welfare laws because the common law generally found no legal duty for adult children to support indigent parents. But, in Virginia, again as in most American states, the filial support laws are largely dormant, misunderstood or ignored, especially after Social Security, Medicare, and Medicaid laws were enacted on a federal level beginning in the 1960s.
Virginia's statute was amended decades ago to restrict use of the law by the state to seek reimbursement for its costs in providing public services (such as "medical assistance" a/k/a Medicaid). However, unlike the filial laws of most states, Virginia's law permits criminal prosecution as a misdemeanor for "any person violating the provisions of an order" of support under this statute, with a fine not exceeding $500 or imprisonment in jail for up to 12 months. I find no reported cases of criminal enforcement actions.
Recognizing that other states (including neighboring Maryland in 2017) had recently taken formal action to repeal filial support laws as outdated or impractical, Virginia Senator Adam Ebbin introduced 2022 Senate Bill 389 to repeal Virginia's law. Senator Ebbin's bill passed with no dissenting votes in the Virginia Senate. The final vote in the Virginia House, on March 11, 2022, supported repeal with 81 voting in favor, and only 16 members voting in opposition to repeal. In other words, repeal was not a controversial measure; rather it appeared to be part of an attempt to clean-up hoary laws, and it attracted strong bipartisan support.
Nonetheless, Virginia Governor Glenn Youngkin (sworn into office in January 2022) vetoed the repeal on April 11, 2022. His reasoning for preserving filial support laws is unique, at least in my 20-some years of experience researching filial support laws (see e.g., Filial Support Laws in the Modern Era: Domestic and International and International Comparison of Enforcement Practices for Laws Requiring Adult Children to Support Indigent Parents, 20 Elder Law Journal 269 (2013)).
The governor's veto statement explains:
"Primarily, the Commonwealth's filial responsibility law supports those who care for their elderly parents. In establishing a bankruptcy budget, the court allows for necessary and reasonable expenditures and the repeal of Section 20-88 could prevent an individual from covering these expenses within the budget of their debtor. For those undergoing bankruptcy proceedings, there is a grave risk of unforeseeable and unintended consequences, which may harm people going through some of the most difficult times in their lives."
On the one hand, in today's torn asunder political scene, no one should be surprised that a newly elected governor of one party would be vetoing legislation sponsored by a member of the other party -- and that is true here, with a Republican governor vetoing a bill proposed by a Democrat.
But what about the proffered reason for the veto? Virginia's law does not "primarily" support those who care for their elderly parents. Rather, it creates an obligation for adult children. Is there any precedent for a theory that Virginia's filial support law permits some type of sheltering of assets for a debtor in bankruptcy court, to provide a means of financial support for the (also) destitute parent? Certainly I find no modern cases on Lexis or Westlaw suggesting such use or even a need for such use.
There is a reported case from 1938 in Virginia. In Mitchell-Powers Hardware Co. v. Eaton, 198 S.E. 496 (Supreme Court of Appeals, VA 1938), the court addressed a question of whether a transfer of valuable stock by a debtor to his sister was voidable as an invalid gift. Was this an invalid attempt to defeat a legitimate creditor's lien against the asset? The court recognized that under Virginia's predecessor version of Statute 20-88, the debtor "could" have an obligation to assist his sister in the care of their elderly mother. The appellate court remanded the case for a jury determination of whether the mother was actually destitute and in need of the son's financial support. (The sister had further transferred the stock in question onward to the debtor's son). This hardly seems a persuasive case for characterizing filial support laws as necessary "support for those who care for their elderly parents."
April 29, 2022 in Crimes, Current Affairs, Estates and Trusts, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare, State Cases, State Statutes/Regulations | Permalink | Comments (0)
Thursday, April 28, 2022
PHI has released a new report, State Policy Strategies for Strengthening the Direct Care Workforce.
Recognizing the urgency of the crisis in direct care, states are taking action—collaborating with diverse stakeholders to tackle entrenched workforce challenges in bold, innovative ways. To leverage this historic moment, PHI has compiled 24 specific policy strategies—with concrete examples—for improving direct care job quality and stabilizing the workforce. The strategies are organized according to the eight comprehensive solutions outlined in PHI’s signature report, Caring for the Future: The Power and Potential of America’s Direct Care Workforce.
Here are 3 takeaways from the report:
This guide provides 24 specific policy strategies for improving direct care job quality and stabilizing the workforce.
State leaders around the country are taking action to tackle entrenched workforce challenges in direct care.
By implementing a tailored combination of strategies, state leaders will help resolve the direct care workforce crisis in their own states.
The full report is available here.
Wednesday, April 27, 2022
On April 11, CMS announced it was proposing a decrease in Medicare funding to SNFs, according to an article in Skilled Nursing News. CMS’s Proposed $320M Decrease in Nursing Home Medicare Funding Could Be ‘Ruinous’ for Struggling Operators
The federal government on Monday proposed its payment rate update to nursing home reimbursements for fiscal 2023, which includes a 4.6% cut related to the Patient-Driven Payment Model.
That cut from the Centers for Medicare & Medicaid Services (CMS) amounts to a total loss of $320 million, according to the agency.
CMS – in its SNF Prospective Payment System proposed rule – recommended a 3.9%, or $1.4 billion, payment increase to the industry. The government agency arrived at that number by raising the market basket rate for skilled nursing facilities by 2.8%, a 1.5 percentage point forecast error adjustment and a 0.4-percentage-point multifactor productivity adjustment.
The article goes into detail about the CMS position, what is driving it and the impact it would have on the industry. The CMS release about their proposal and the comment period is available here: Fiscal Year (FY) 2023 Skilled Nursing Facility Prospective Payment System Proposed Rule (CMS 1765-P).
The Skilled Nursing News article also notes that CMS is looking for feedback on the issue of staffing standards. For more info on the staffing standards, see the CMS news release, HHS Takes Actions to Promote Safety and Quality in Nursing Homes.
Tuesday, April 26, 2022
I'm working on a book chapter about filial support laws, where families (usually adult children) may be surprised to learn that their state or their country has a seldom-used law that mandates financial support or maintenance for indigent family members. In working on this chapter, I was considering using the concept of "scarecrow laws" as a metaphor. This label can apply to laws which are seldom enforced but legislators resist repeal because the very existence of the law might serve as a warning -- a scarecrow -- about the consequences of bad behavior.
While working on the metaphor, I came across an interesting application from Shakespeare's play, Measure for Measure. In Act 2, Scene 1, we hear a harshly ambitious deputy administrator calling for the ultimate punishment -- beheading -- of Claudio, a man convicted of a crime. But the law in question, prohibiting sexual relations outside of sanctioned marriage, is "rarely enforced." One of Angelo's subordinates objects to the harsh sentence. Angelo responds:
We must not make a scarecrow of the law,
Settling it up to fear the birds of prey,
And let it keep one shape, till custom make it
Their perch and not their terror.
The irony is that Angelo also seeks to violate the same law with a woman who has attracted his attention, but he discounts his own admission as, so far, mere temptation.
Shakespeare's use of the scarecrow characterization raises a legitimate question. Should laws, little known and rarely enforced, be removed from the books, or allowed to remain, perhaps on the justification they serve as moral guidance?
showcases the highlights of the Fourth National Guardianship Summit and the 22 recommendations to reform and improve state guardianship systems. The video also addresses the history of these national summits, the importance of the Fourth Summit and the main topics discussed during the Summit:
Rights of Persons Subject to Guardianship
Limited Guardianship, Protective Arrangements, and Guardianship Pipelines
Rethinking Monitoring and Addressing Abuse by Guardians
Fiduciary Responsibilities and Tensions
Developing a Guardianship Court Improvement Program
To view the video, click here.
Monday, April 25, 2022
The sandwich generation, those who are raising kids and caring for their parents, continues on, as noted in the data from a recent Pew Research Fact Tank report, More than half of Americans in their 40s are ‘sandwiched’ between an aging parent and their own children.
As people are living longer and many young adults are struggling to gain financial independence, about a quarter of U.S. adults (23%) are now part of the so-called “sandwich generation,” according to a Pew Research Center survey conducted in October 2021. These are adults who have a parent age 65 or older and are either raising at least one child younger than 18 or providing financial support to an adult child.
Americans in their 40s are the most likely to be sandwiched between their children and an aging parent. More than half in this age group (54%) have a living parent age 65 or older and are either raising a child younger than 18 or have an adult child they helped financially in the past year. By comparison, 36% of those in their 50s, 27% of those in their 30s, and fewer than one-in-ten of those younger than 30 (6%) or 60 and older (7%) are in this situation.
The full report is available here.
Friday, April 22, 2022
The Washington Post recently published this article, Aging in place can be so much easier with smart home technology. "Supporting health, safety and security are important components of successfully aging in place. So are home management systems that maintain a comfortable environment, and communication and recreation systems that enable social engagement, stimulation and entertainment." As the article notes, the type and amount of tech is vast, ranging from pretty simple types that do just a little, to more comprehensive setups that integrate into much of every day life. The article focuses on two couples who added tech to their homes. It also looks at the pros and cons, as well as advances and includes a list of recommendations. The article also mentions concerns about privacy and how to mitigate that. I would also add the topic of consent, when family want to install the tech in the home of the elder. Lots of good info in the article.
Thursday, April 21, 2022
Yesterday I blogged about Dr. Levy's new book on ageism. Now, continuing that theme, I wanted to be sure you saw this article in Healthline, Do We Become Invisible As We Age? Mentioning Dr. Levy's book as well as other factors, the article explains that
"Ageism — prejudice, discrimination, and stereotyping based on age — is sometimes called society’s last acceptable “ism.” It happens at work, to celebrities, and in everyday ways. And it can make people feel invisible as they get older... A 2020 University of Michigan National Poll on Healthy Aging found that 82 percent of adults 50 to 80 surveyed reported regularly experiencing at least one form of “everyday ageism.” ... And, according to the World Health OrganizationTrusted Source, “Every second person in the world is believed to hold ageist attitudes, leading to poorer physical and mental health and reduced quality of life for older persons.” ... Plus, the pandemic has only made ageism worse, by increasing the physical isolation and accordant invisibility of older adults... So, where exactly do we see ageism and what can we do about it?
The article addresses ageism by where it occurs: in the workplace, in health care, in popular culture, and exams ageism's impact on people. The article discusses why some folks have ageist views and quotes one expert who identifies two types of folks who have ageist views: "The first type are “egoistic ageists” who fear aging and consider old people both repulsive and irrelevant... The other type, ..., “compassionate ageists,” view old people as “pathetic and needy” and believe that they must be served and protected." As far as kids and young adults, yep it happens there, according to the article, noting "that ageism 'starts in childhood and is reinforced over time.'"
The article discusses the respect for elders, the importance of self-perception, the work being done to fight ageism, and what still needs to be done. This is a great article to assign to students!
Wednesday, April 20, 2022
Professor Richard Kaplan sent me a link to a recent book review in the Wall Street Journal ‘Breaking the Age Code’ Review: Riding High Into the Sunset.
Social psychologist Becca Levy spends much of “Breaking the Age Code” doing exactly that, weaving together case studies and her own research to demonstrate that old age doesn’t have to suck at all. The expectation that aging means decay, Ms. Levy shows, is actually a major reason it so often does—our negative view of aging is literally killing us. Chipping away at this widespread and deeply ingrained conviction has a measurable effect on health after just 10 minutes. ... n 2002 Ms. Levy combined results from the Ohio Longitudinal Study on Aging and Retirement with data from the National Death Index to reveal that, on average, people with the most positive views of aging were outliving those with the most negative views by 7½ years—an extraordinary 10% of current life expectancy in the United States.
The author discusses factors that make us prone to negative views of aging, and in particular, the prevalence of ageism. However, the author goes on to address how to change our thinking to "break the age code."
Ms. Levy finishes with a vision of paradise: “A place where ageism does not exist.” But this is no idle fantasy, it’s Greensboro, Vt. She stops for homemade lemonade with an 81-year-old writer for the local paper and swims at Caspian Lake with a real-estate agent in her 80s. When older people and society around them are “harmonized in a productive way,” Ms. Levy continues, it shows how “aging can become a homecoming, a rediscovery, a feast of life.” Or—as Grandpa Eddie puts it after his adventure has left him closer to Spencer than ever before—“Getting old is a gift.”
I'm ordering the book!