Thursday, February 21, 2019
Kiplinger published a slide show that focuses on reasons why folks may outlive their retirement savings. 15 Reasons You'll Go Broke in Retirement include explanations, some of which are out of an individual's control but most are not. These explanations include: abandoning stocks or investing too heavily into stocks, not saving enough for your anticipated life span, living beyond your means, only having one source of income, not working long enough, getting sick, failing to take state taxes into account, financially supporting the kids, being under-insured, falling victim to a consumer scam, using retirement savings as collateral and lacking a rainy day fund.
Wednesday, February 20, 2019
Recently the New York Times ran an opinion piece about the amount of debt from social programs. Your Grandchildren Are Already in Debt focuses on some of the new social programs being proposed by presidential candidates. But how will we pay for these programs, as well as existing programs? "On present course and speed, the United States is on track to experience the highest deficits in its history, reaching more than $2 trillion a year by 2029. Those annual gaps are projected to bring America’s total debt to nearly $33 trillion by that date, according to the Committee for a Responsible Budget. That’s double today’s level and more than the size of our economy, a peacetime record."
Here are some thoughts from the author about the situation and its impact
[M]y principal fear is that all this irresponsible borrowing amounts to intergenerational theft. America is simultaneously indulging in two deficit-busting desires: for lower taxes and for robust government programs. Eventually, the interest on all the debt will force the governments of future generations to reverse those fiscally imprudent policies in order to pay for today’s profligacy.
It’s like a couple in their 40s deciding to borrow money to sustain a lavish lifestyle and then leaving the debts for their kids to pay off after they’re gone.
But that’s not all. The generally accepted measure of America’s national debt doesn’t include obligations for future retirement and health care benefits.
Tuesday, February 19, 2019
Kaiser Health News ran a story recently, Seniors Aging In Place Turn To Devices And Helpers, But Unmet Needs Are Common details the use of caregivers and assistive devices to help them age in place. Reporting on a new study, the article notes that there are a substantial majority of elders with insufficient help and adapt their living in order to get by. The study, published in the Commonwealth Fund, Are Older Americans Getting the Long-Term Services and Supports They Need? explains this issue "[o]lder adults’ needs have evolved and are no longer met by the Medicare program. With the recent passage of the Bipartisan Budget Act of 2018 (BBA), Medicare Advantage (MA) plans can now provide beneficiaries with nonmedical benefits, such as long-term services and supports (LTSS), which Medicare does not cover."
The key findings and the conclusion from the study abstract show:
Two-thirds of older adults living in the community use some degree of LTSS. Reliance on assistive devices and environmental modifications is high; however many adults, particularly dual-eligible beneficiaries, experience adverse consequences of not receiving care. Although the recent policy change allowing MA plans to offer LTSS benefits is an important step toward meeting the medical and nonmedical needs of Medicare beneficiaries, only the one-third of Medicare beneficiaries enrolled in MA plans stand to benefit. Accountable care organizations operating in traditional Medicare also should have the increased flexibility to provide nonmedical services. from the study.
Monday, February 18, 2019
MedicalXPress ran a story about a New tool for documenting injuries may provide better evidence for elder abuse cases. which opens noting that "[a]n estimated 10 percent of older adults experience some form of abuse each year. However, the link between injuries and possible elder abuse may take months or years to establish and is often difficult to investigate due to poor documentation during prior medical visits." To improve the process, Dr. Laura Mosqueda and her team have created "the Geriatric Injury Documentation Tool (Geri-IDT)." The tool was a result of a study done by her team, the results of which were recently published in the Journal for General Internal Medicine, Developing the Geriatric Injury Documentation Tool (Geri-IDT) to Improve Documentation of Physical Findings in Injured Older Adults.
An excerpt of the abstract offers this insight
Experts agreed that medical providers’ documentation of geriatric injuries is usually inadequate for investigating alleged elder abuse/neglect. They highlighted elements needed for forensic investigation: initial appearance before treatment is initiated, complete head-to-toe evaluation, documentation of all injuries (even minor ones), and documentation of pertinent negatives. Several noted the value of photographs to supplement written documentation. End users identified practical challenges to utilizing a tool, including the burden of additional or parallel documentation in a busy clinical setting, and how to integrate it into existing electronic medical records.
A practical tool to improve medical documentation of geriatric injuries for potential forensic use would be valuable. Practical challenges to utilization must be overcome.
Wednesday, February 6, 2019
AARP's research has an update on tech use among older adults. Older Americans’ Technology Usage Keeps Climbing shows adoption of technology by a fair number of older adults. "Today, 91 percent of those age 50+ report using a computer and 94 percent say technology helps them keep in touch with friends and family. And notably, the assumption that older individuals rely less on technology than others may be increasingly inaccurate. More than 80 percent of Americans age 50 to 64 have smartphones, which is about the same as the population at large. Grandparents are also spending a considerable amount on gifts — many likely tech-focused — for their grandkids." Perhaps, unsurprisingly, is the interest in technology's impact on cars and driving with almost 25% keen on "advanced driver assistance technology." As well, about 25% of those surveyed were atrracted to online learning.
One important note from the survey: lack of confidence in security. and privacy online. "Privacy and security issues remain a concern for many in the older age bracket, with Americans over 50 not placing much trust in institutions to keep their personal data safe. AARP finds fewer than 1 in 4 trust online retailers, the federal government, and telecom service providers, among others. A related finding, meanwhile, highlights an opportunity to provide more education to older adults specifically on safe tech practices: Nearly 1 in 5 indicates they have low confidence in their safety online."
Monday, February 4, 2019
Kaiser Health News published a story, Frail Seniors Find Ways To Live Independently. The focus of the story is on "a program for frail low-income seniors: Community Aging in Place — Advancing Better Living for Elders (CAPABLE). Over the course of several months last year, an occupational therapist visited Jeffery and discussed issues she wanted to address. A handyman installed a new carpet. A visiting nurse gave her the feeling of being looked after."
A study of the project, recently published in the Journal of the American Medical Society (JAMA) Internal Medicine shows promising results. "New research shows that CAPABLE provides considerable help to vulnerable seniors who have trouble with “activities of daily living” — taking a shower or a bath, getting dressed, transferring in and out of bed, using the toilet or moving around easily at home. Over the course of five months, participants in the program experienced 30 percent fewer difficulties with such activities, according to a randomized clinical trial...."
The article also explores the costs of the program-and it saves money! There are efforts to expand this program's reach, including approaching "Medicare Advantage plans, which cover about 19 million Medicare recipients and can now offer an array of nonmedical benefits to members, to adopt CAPABLE. Also, Johns Hopkins and Stanford Medicine have submitted a proposal to have traditional Medicare offer the program as a bundled package of services. Accountable care organizations, groups of hospitals and physicians that assume financial risk for the health of their patients, are also interested, given the potential benefits and cost savings."
Sunday, February 3, 2019
The BBC ran a story recently about elders in Japan committing crimes, to spend time in jail. The elders may be lonely, or may have outlived their savings and can't afford to live independently anymore. Why some Japanese pensioners want to go to jail
[One individual noted in the story] represents a striking trend in Japanese crime. In a remarkably law-abiding society, a rapidly growing proportion of crimes is carried about by over-65s. In 1997 this age group accounted for about one in 20 convictions but 20 years later the figure had grown to more than one in five - a rate that far outstrips the growth of the over-65s as a proportion of the population (though they now make up more than a quarter of the total).
Further, recidivism is an issue with this age group: "2,500 over-65s convicted in 2016, more than a third had more than five previous convictions." The article notes that shoplifting is the most common crime. One researcher "[i]n a paper published in 2016 he calculates that the costs of rent, food and healthcare alone will leave recipients in debt if they have no other income - and that's before they've paid for heating or clothes. In the past it was traditional for children to look after their parents, but in the provinces a lack of economic opportunities has led many younger people to move away, leaving their parents to fend for themselves." The article explains low pensions are part of the issue as well as increasing isolation and loneliness.
Thanks to two of our alums for alerting me to this article.
Monday, January 28, 2019
Elder drivers is a topic I cover in my class every spring, and it's one guaranteed to generate a robust discussion. So a recent story about Prince Phillip allows me to bring in current events to this topic. The Washington Post ran this article, Britain’s Prince Philip, 97, crashed his car. Rescuers say it’s ‘amazing people weren’t seriously injured.’.
Of course, age alone is not an indicator of good or bad driving, but stories like this one allow the students to think about the various issues and how we may as a society address them. Geographic location and financial stability also play into the options available for those who shouldn't (or can't) drive. In our area, public transportation isn't as plentiful as other urban areas. The students, of course, would open up a ride-sharing app on their smart phones and order a car. Elders may not be able to afford to do so, or even know it exists. There are a number of issues that can then arise for those who lose the ability to get places. And of course, we all have an interest in getting unsafe drivers off the road.
I am guessing that Prince Phillip likely has many more transportation options that an average 97 year old in the U.S. Families frequently need to have "the chat" with their elder relative about stopping driving. The Washington Post article addressed that. "So, who might ask Philip to hand over his car keys? 'It will be the Queen, she’ll be the only one who can really tell him...'”
Sunday, January 27, 2019
CNN ran a story last week about a blood test that detects Alzheimer's. Blood test could detect Alzheimer's up to 16 years before symptoms begin, study says starts with an explanation of the "technical" aspects where the test would "measur[e] changes in the levels of a protein in the blood, called neurofilament light chain (NfL) [which] researchers believe [with] any rise in levels of the protein could be an early sign of the disease..." The study is in the most recent issue of Nature Medicine.
This is not a cure, but there are advantages to knowing this far in advance that the person has Alzheimer's. For starters, as the story notes, it would help with testing of treatments. From a legal point of view, it may encourage more clients to plan.
Monday, January 21, 2019
Hate housework? Well here's a new reason to look forward to it. According to a story on NPR, Daily Movement--Even Household Chores--May Boost Brain Health in Elderly a recent "study finds even simple housework like cooking or cleaning may make a difference in brain health in our 70s and 80s."
The study looked at 454 older adults who were 70 or older when the research began. Of those adults, 191 had behavioral signs of dementia and 263 did not. All were given thinking and memory tests every year for 20 years.
In the last years of research before death, each participant wore an activity monitor called an accelerometer, similar to a Fitbit, which measured physical activity around the clock — everything from small movements such as walking around the house to more vigorous movements like exercise routines. Researchers collected and evaluated 10 days of movement data for each participant and calculated an average daily activity score.
The findings show that higher levels of daily movement were linked to better thinking and memory skills, as measured by the yearly cognitive tests.
The article discusses limitations on the study and the need for more research. In the interim, get out a dust cloth and the broom and start cleaning!
Friday, January 18, 2019
Mark your calendars for this upcoming webinar on student loan debts and elders, scheduled for January 29 at 2 est. Here's a description of this free webinar:
A growing number of older adults are carrying more student loan debt than ever before. Many took loans for their own studies while some also borrowed or cosigned loans for a child or another person. Student loan repayment—or debt collection consequences following non-payment—can impede saving for retirement or making ends meet on a fixed income. Unfortunately, even Social Security benefits can be taken to repay defaulted student loans.
This webcast will present the basics of student loan law and a framework for issue-spotting and solving common student loan problems. Topics covered during the webcast will include: identifying a loan type/status, making loan payments affordable, evaluating loan cancellation options, stopping involuntary debt collection activity, and curing default.
To register, click here
Thursday, January 17, 2019
My dear friend and executive director of the ABA Commission on Law and Aging sent me a notice about a part-time employment opportunity for two students. The Coalition to Transform Advanced Care (C-TAC) ("an alliance of 140 organizations whose sole purpose is to ensure that all Americans with advanced illness, especially the sickest and most vulnerable, receive comprehensive, high-quality, person- and family-centered care that is consistent with their goals and values and honors their dignity") has announced two student fellowship opportunities for a project, "two part-time, temporary positions as C-TAC Changemaker Fellows. Fellows will primarily undertake research for programs that align with their interests (policy, family caregiving, health disparities, data/metrics) and will be assigned a C-TAC mentor. Supporting program staff will also be an important opportunity for the Fellows to learn and support projects." Students need to be at least seeking a bachelor's or master's degree and have relevant interests in advocacy, public policy and the political realm. More information-contact Allan Malievsky (AMalievsky@thectac.org) with “C-TAC Changemaker” in the subject line.
Wednesday, January 16, 2019
Regardless of whether you are one of the lucky ones who have not been a victim of ID theft, or are part of the unlucky group who have been victims of ID theft, you will want to attend this webinar. The Center for Victim Research is offering a webinar on January 17, 2019 at 2 p.m. on Identity Theft and Fraud: What Do We Know from Research and Practice? The webinar will cover
the current evidence on the challenges faced by victims of identity theft and fraud.
The experiences of victims of identity theft and fraud are under-researched, while the responses to their needs remain underdeveloped and have typically not yet been evaluated. CVR researchers Dr. Yasemin Irvin-Erickson and Ms. Alexandra Ricks will present key findings from the first comprehensive review of national research and practice evidence on this topic.
Topics covered will include:
- The prevalence of identity theft and fraud
- Harms and consequences experienced by victims
- Services available and where the field needs to grow
To register for the webinar, click here.
Tuesday, January 15, 2019
Health & Human Services has posted information on their blog about how they are implementing the new hiring process for ALJs. Establishing a New Merit-Based Process for Appointing Administrative Law Judges at HHS explains the new process, the reasons for it, and when it became effective.
HHS is announcing how the department will implement a new ALJ selection and appointment process. The department’s ALJs work for the Office of Medicare Hearings and Appeals (101) and the Departmental Appeals Board (13). The DAB also has seven administrative appeals judges and five Departmental Appeals Board members, and the new ALJ selection and appointment process will apply to these “comparable officials” as well.
The new HHS ALJ selection and appointment process - PDF is effective immediately and is described on the websites of the OMHA and the DAB.
This process is described in the post as merit-based and does not require consultation with anyone outside of the process. The process is described in detail in a 4 page document from November, 2018, available here.
To understand the significance of this change, read my blog post from October 26, 2018 here.
Monday, January 14, 2019
Last week, I wrote about the possible use of medical marijuana for treatment of anxiety in patients with dementia, pointing to the importance of peer-reviewed studies. This week, I learned of a new study on the use of medical marijuana at a nursing home, and when I read the study I was not surprised to learn the study had occurred at Hebrew Home at Riverdale in New York, a location I have come to associate with both research and thoughtful innovation. Studies of medical marijuana are complicated by the disjunction in federal and state laws governing purchase and use.
In “Medical Cannabis in the Skilled Nursing Facility: A Novel Approach to Improving Symptom Management and Quality of Life,” the authors described a medical policy and procedure (P&P) they implemented at their New York-based SNF for the safe use and administration of cannabis for residents with a qualifying diagnosis. To be compliant with state and federal statutes, policy requires that residents must purchase their own cannabis product directly from a state-certified dispensary.
After the program started in 2016, the facility provided educational sessions for residents and distributed a medical cannabis fact sheet that was also made available to family members. To date, 10 residents have participated in the program and seven have been receiving medical cannabis for over a year. Participants range in age from 62 to 100. Of the 10 participants, six qualified for the program due to a chronic pain diagnosis, two due to Parkinson’s disease, and one due to both diagnoses. One resident is participating in the program for a seizure disorder.
Most residents who use cannabis for pain management said that it has lessened the severity of their chronic pain. This, in turn, has resulted in opioid dosage reductions and an improved sense of well-being. Those individuals receiving cannabis for Parkinson’s reported mild improvement with rigidity complaints. The patient with seizure disorder has experienced a marked reduction in seizure activity with the cannabis therapy.
This study did not address cannabis as a treatment for symptoms of dementia-related anxiety. For more, see Medical Cannabis in the Skilled Nursing Facility: A Novel Approach to Improving Symptom Management and Quality of Life, published January 2019. Interestingly, the authors are a medical doctor, Zachary J. Palace, and Daniel Reingold, who lists both a Masters of Social Work and a J.D. for his background.
January 14, 2019 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, State Statutes/Regulations, Statistics | Permalink | Comments (0)
Sunday, January 13, 2019
Know anyone who has hearing loss? Maybe you yourself suffer from hearing loss-and if not now, you may in the future. Hearing loss has ramifications beyond the loss of hearing. As the article in the New York Times explains in Hearing Loss Threatens Mind, Life and Limb "[n]ot only is poor hearing annoying and inconvenient for millions of people, especially the elderly. It is also an unmistakable health hazard, threatening mind, life and limb, that could cost Medicare much more than it would to provide hearing aids and services for every older American with hearing loss." Oh and the news doesn't get any better: "[t]wo huge new studies have demonstrated a clear association between untreated hearing loss and an increased risk of dementia, depression, falls and even cardiovascular diseases. In a significant number of people, the studies indicate, uncorrected hearing loss itself appears to be the cause of the associated health problem."
Those with age-related hearing loss can tell you it doesn't happen overnight. In fact, because it "comes on really slowly, [it makes] it harder for people to know when to take it seriously...." The article explains the correlation between hearing loss and the impact on the brain (fascinating yet scary). And in case you didn't know "hearing aids and accompanying services are typically not covered by medical insurance, Medicare included. Such coverage was specifically excluded when the Medicare law was passed in 1965, a time when hearing loss was not generally recognized as a medical issue and hearing aids were not very effective...."
So, do a few things now: 1. write your Congressperson about Medicare's coverage of hearing aids, 2. schedule an appointment to have your hearing testing and 3. turn down the volume on your devices.
Thursday, January 10, 2019
This is the time of year when students stop by to chat. Perhaps they are first year students who want to talk about exame, or grades or class rank. But more often for me, it is students who want to talk about how to get into elder law.
Along that line, a short article written by experienced attorney Monica Franklin, a CELA in eastern Tennessee, is helpful. She begins with some values questions -- such as "do you have a social worker's soul and a nurse's curiosity?" She points to the different subject matters that can be addressed under the heading of "elder law," from what she calls the meat and potatoes of estate planning, probate and conservatorship, to th more complex areas of "public benefits, health care advocacy, and special needs trust" planning.
She recommends resources, including accreditation courses offered by the National Elder Law Foundation, cautioning that she personally found the certification exam to be "more difficult than the bar exam." But she makes it clear she also found certification worthwhile, both as a goal to increase her own knowledge base, and because the recognition that attends status as a Certified Elder Law Attorney helps her practice base.
In her own state of Tennessee, she recommends becoming familiar with the Tennessee Justice Center, a "nonprofit law firm that has served vulnerable families since 1995." Is there a similar specialized practice in your own region?
Ms. Franklin concludes that her own state "needs more qualified elder law attorneys. It is a field where governmental actors often misinterpret the law to the detriment of our most vulnerable citizens: older adults and individuals with disabilities."
For more, see So, You Want to Be an Elder Law Attorney (available on Westlaw and behind a registration firewall), published in the Tennessee Bar Journal, February 2018.
This article is a couple of months old, but I don't think the subject is at all dated. Stat ran an opinion piece, U.S. hospitals ignore improving elder care. That’s a mistake explaining that hospitals aren't designed to be elder-friendly
In the 21st century, health care is to elderhood as education is to childhood. But we don’t see bond measures for the “construction, expansion, renovation, and equipping” of hospitals to optimize care of old people, an investment that would surely benefit Americans of all ages.
People age 65 and older make up just 16 percent of the U.S. population but nearly 40 percent of hospitalized adults. In 2014, Americans over age 74 had the highest rate of hospital stays, followed by those in their late 60s and early 70s.
Remarkably, hospitals aren’t designed with elders in mind. Walk through one and you’ll almost invariably find cheerful decor for children, services and facilities aimed at adults, and a gauntlet of obstacles and insults to elders.
Thinking about the design of the hospitals, consider these notes from the article' "[o]ld people end up in old buildings. That usually means long walks down halls without railings or chairs with arms for rest stops. It means signs that are hard to read until you are right under them. It means a one-size-fits-all approach to both facilities and care that doesn’t acknowledge that the needs, preferences, and realities of a 75- or 95-year-old with a medical condition might differ from those of a 35- or 55-year-old with the same thing."
Noticing the volume of business from this demographic, the article highlights some efforts
A collaboration of industry leaders, including the American Hospital Association, the John A. Hartford Foundation, and the Institute for Healthcare Improvement, has launched an age-friendly health system initiative. While its purview is limited to a few geriatric conditions, it’s a step in the right direction. (And the field of geriatrics is finally beginning to model itself after pediatrics, taking a more whole health, life stage approach to elderhood.)
Some of the best ideas for hospital design come from outside health care. Innovations developed for aging-in-place homes or continuing care communities offer prototypes of “silver architecture.” Businesses like Microsoft are investing in structural and people-flow design that meets needs across the lifespan. They are adopting the position that if you design for the mythical “average human” you create barriers, whereas if you design for those with disabilities you create systems that benefit everyone.
Wednesday, January 9, 2019
There's no cure for Alzheimer's but according to a recent article in the New York Times, Dementia May Never Improve, but Many Patients Still Can Learn individuals with dementia can be taught certain forgotten skills. Known as "cognitive rehabilitation", "[t]he practice brings occupational and other therapists into the homes of dementia patients to learn which everyday activities they’re struggling with and which abilities they want to preserve or improve upon." It's important to realize that this training won't reverse the decline from the disease, but instead "the therapists devise individual strategies that can help, at least in the early and moderate stages of the disease. The therapists show patients how to compensate for memory problems and to practice new techniques." But, and this is important, the therapy can make a huge difference for folks with dementia---the "researchers have demonstrated that people with dementia can significantly improve their ability to do the tasks they’ve opted to tackle, their chosen priorities. Those improvements persist over months, perhaps up to a year, even as participants’ cognition declines in other ways."
Another approach being used in the U.S., the "T.A.P. program includes more patients with serious cognitive loss than cognitive rehab does. And it takes a somewhat different tack: T.A.P. aims to reduce the troubling behaviors that can accompany dementia: repeated questions, wandering, rejecting assistance, verbal or physical aggression" with the study showing "the frequency of such behaviors decreased compared to a control group, allowing family members to spend fewer daily hours caring for patients."
This is important research-read this article!
Tuesday, January 8, 2019
Here is the abstract of his article
Discrimination scholars have traditionally justified antidiscrimination laws by appealing to the value of equality. Egalitarian theories locate the moral wrong of discrimination in the unfavorable treatment one individual receives as compared to another. However, discrimination theory has neglected to engage seriously with the socio-legal category of age, which poses a challenge to this egalitarian consensus due to its unique temporal character. Unlike other identity categories, an individual’s age inevitably changes over time. Consequently, any age-based legal rule will ultimately yield equal treatment over the lifecourse. This explains the weak constitutional protection for age and the fact that age-based legal rules are commonplace, determining everything from access to health care to criminal sentences to voting rights. The central claim of this Article is that equality can neither adequately describe the moral wrong of age discrimination nor justify the current landscape of statutory age discrimination law. The wrong of age discrimination lies not in a comparison, but instead in the deprivation of some intrinsic interest that extends throughout the lifecourse. Thus, we must turn to non-comparative values, such as liberty or dignity, to flesh out the theoretical foundation of age discrimination law. Exploring this alternative normative foundation generates valuable insights for current debates in discrimination theory and the legal regulation of age.
The article will be published in vol 53 of the Ga. Law Review.