Friday, April 19, 2019

New Article on Compassionate Release

Professor Jalila Jeffferson-Bullock has published a new article, Quelling the Silver Tsunami: Compassionate Release of Elderly Offenders. The article appears in 79 Ohio State Law Journal 937-990 (2018)  and is available on SSRN here.

The abstract to the article tells us

Sentencing reform appears resurrected. Following a brief hiatus and an expectedly unwelcoming recent federal response, sentencing reform is again reemerging as a major initiative. Congress and the several states are poised to immediately accomplish major reform of the United States criminal sentencing structure. Proposals that would, among other initiatives, drastically reduce criminal sentences, restore rehabilitative programs to inmates, generate sentencing parity, normalize probation for low-level offenses, and shrink the overall prison footprint are ambling through various legislative processes throughout the country. Though groundbreaking and certainly welcome, these reforms largely ignore the special needs of the imprisoned elderly. One of the most foreseeable, yet ironically ignored, consequences of 1980's and 1990's harsh sentencing laws, is the dramatic upsurge in prison population through the predictable process of human aging. Coined the prison “silver tsunami” phenomenon, surging numbers of elderly inmates raises significant moral, health, and fiscal implications deserving keen scrutiny. It is imperative, then, that any overhaul of criminal sentencing focuses on how to meaningfully address the graying of America's prisons.

I usually stop the blog post with the abstract, but I want you to read the opening of the article, too.

I am 70 years old, and I have eight more years to spend in this prison--if I make it. None of my other siblings lived to see their 71st birthday. Lots of the young guys in here still feel like they have something to prove. They pick fights with each other, talk stuff to the guards, smuggle drug, phones, movies, and liquor in. Me, I'm over that. I read the Bible, exercise,and try to be a good example to the other guys. That's how I spend my days. I guess that's all I would do if I were out too. Except, I wouldn't have to do it alone. I think a lot about my wife, been married forty years. My kids are grown and moved all over the country. And my grandbabies, I never can see them. Not being with them, knowing that I may die in here, all alone--that's punishment on top of punishment. (citations omitted)

Read this article-a timely and important topic!

April 19, 2019 in Consumer Information, Crimes, Current Affairs | Permalink | Comments (0)

Monday, April 8, 2019

Data on Non-Fatal Cases of Violence vs. Older Adults

A few days ago the CDC issued a new report, Nonfatal Assaults and Homicides Among Adults Aged ≥60 Years — United States, 2002–2016.

Perhaps unsurprisingly, the CDC notes that the violence vs. older adults hasn't gotten the same attention and research as other cohorts. So, "[u]sing data ... [the] CDC analyzed rates of nonfatal assaults and homicides against older adults during 2002–2016. Across the 15-year period, the nonfatal assault rate increased 75.4% (from 77.7 to 136.3 per 100,000) among men, and from 2007 to 2016, increased 35.4% (from 43.8 to 59.3) among women. From 2010 to 2016, the homicide rate increased among men by 7.1%, and a 19.3% increase was observed from 2013 to 2016 among men aged 60–69 years." (citations omitted)

Look at that data again.  "Nonfatal assaults [against older men] increased 75.4% (from 77.7 to 136.3 per 100,000) " with a 35.4% increase among women. "Growth in both the older adult population and the rates of violence against this group, especially among men, suggests an important need for violence prevention strategies " In my opinion, that is an understatement regarding the need for more research and prevention strategies.

The CDC discusses the limitations of their research and also offer that "[c]ollectively, these findings highlight the need to strengthen violence prevention among older adults. Unfortunately, few strategies have been rigorously evaluated." (citations omitted)  In particular one idea caught my eye:  "[i]ncorporating geriatric specialists in EDs might help link clinical care to service referrals."

This report is an important step, but we need more. The CDC report concludes "[v]iolence against older adults is an emerging and underreported public health problem. EDs might be promising settings to identify older adults at risk for violence and treat and support those already affected." (citations omitted).

 

April 8, 2019 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care, Statistics | Permalink | Comments (0)

VA Nursing Homes-Call For Action

Last week The Hill ran an opinion piece, Patients in VA nursing homes are suffering — Wilkie needs to take responsibility. Responding to stories about poor care, the Secretary of the VA "responded that VA’s nursing homes 'care[ ] for sicker and more complex patients in its nursing homes than do private facilities.'" Although that may be true, the article notes, that is not a justification for poor care and the reported issues "are easily preventable and are not complex problems."  This follows the VA release of "a series of inspection reports detailing deficiencies in 52 out of 99 nursing home care facilities that caused “actual harm” to veterans."  Those numbers should give everyone pause.  The author calls for more "accountability [from the VA] by accepting responsibility for the problems outlined in them rather than making excuses and deflecting." Distinguishing between accepting responsibility and blame, the author offers that "[a] culture of responsibility is a greater asset to an organization like VA than the things we most often hear about, such as an increased budgets or legislative changes."

Click here to read the USA Today story about the deficiencies found in the VA nursing homes.

 

April 8, 2019 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Veterans | Permalink | Comments (0)

Friday, April 5, 2019

Winter Snowstorms & Impact on Elders

This isn't so much a news item for you as it is me thinking out loud about how the weather can impact the lives of elders. Living in Florida (and far enough South in Florida that frost is something we read about happening to others), absent a big weather event (think hurricane or tornado) we don't have to deal with the aftermath of significant winter weather events. 

What got me thinking about this was the bomb cyclone from a few weeks ago. I was out in Colorado when it was moving through and although on the fringes of the storm, it was enough.  The weathercasters were urging people to stay indoors and some folks lost power for a while.  After the storm passed, the state and local DOT did amazing jobs clearing the roads, and businesses cleared their drives and sidewalks. But not every property owner seemed to be as diligent about doing this. And there is was the melt and freeze cycles of the day, slush and puddles as the temperatures rose, turning to sheets of ice at nights and in the mornings.   This situation is possible in any location that gets snow or even rain. 

It made me think about navigating the aftermath of weather events, especially if we are looking toward making communities more livable and more walkable.  What help is available for older persons who can get out and about, but shouldn't be out and about walking on icy sidewalks  (really I guess, who should?). How do municipalities get businesses and property owners to clear sidewalks and driveways? What help is available to survive the cold during a power outage?

Ready.gov has helpful info about dealing with snowstorms (as well as other types of disasters). Google elderly and snowstorm and you will find lots of wonderful stories about neighbors helping elders .  Area Agencies on Aging are always a good start for info as well as Senior Centers.

Once the storm went through and we went outside, let me tell you the landscape was breathtakingly beautiful! The folks in Colorado are masterful at handling these snow events and I have no doubt that those who live there  know how to navigate Mother Nature's events (just like we in Florida know how to deal with the humidity!) The mother of one of my dearest friends lives there and just shrugs it off when I ask her about navigating snow. Or maybe it is simply me, a Floridian, unable to process the concept of living in and navigating weather other than the kind we experience on a daily basis.  Remember-planning ahead is critical. Just like we in Florida have our hurricane kits ready starting June 1, get a "blizzard box" or snowstorm survival kit together!

 

 

April 5, 2019 | Permalink | Comments (0)

Thursday, April 4, 2019

Phased Retirement In Other Countries

The GAO published a new report examining the experiences of other countries with phased retirement of workers. Older Workers: Other Countries' Experiences with Phased Retirement reports on "17 countries with aging populations and national pension systems similar to the Social Security program in the United States. These countries also have arrangements that allow workers to reduce their working hours as they transition into retirement, referred to as 'phased retirement.'"

The report is available here as a pdf.  Some of the highlights from the report:

GAO's four case study countries—Canada, Germany, Sweden, and the United Kingdom (UK)—were described as employing various strategies at the national level to encourage phased retirement, and specific programs differed with respect to design specifics and sources of supplemental income for participants. Canada and the U.K. were described as having national policies that make it easier for workers to reduce their hours and receive a portion of their pension benefits from employer-sponsored pension plans while continuing to accrue pension benefits in the same plan. Experts described two national programs available to employers and workers in Germany, with one program using tax preferences. Experts also said Sweden implemented a policy in 2010 that allows partial retirement and access to partial pension benefits to encourage workers to stay in the labor force longer.

Even with unique considerations in the United States, other countries' experiences with phased retirement could inform U.S. efforts. Some employer-specific conditions, such as employers offering employee-directed retirement plans and not being covered by collective bargaining are more common in the United States, but the case study countries included examples of designs for phased retirement programs in such settings. Certain programs allow access to employer-sponsored or national pension benefits while working part-time. For example, experts said the U.K. allows workers to draw a portion of their account based pension tax-free, and one U.K. employer GAO spoke to also allows concurrent contributions to those plans. In addition, experts said that certain program design elements help determine the success of some programs. Such elements could inform the United States experience. For instance, U.S. employers told us that while offering phased retirement to specific groups of workers may be challenging because of employment discrimination laws, a union representative in Germany noted that they reached an agreement where employers may set restrictions or caps on participation, such as 3 percent of the workforce, to manage the number of workers in the program. Employers in the U.S. could explore whether using a similar approach, taking into consideration any legal concerns or other practical challenges, could help them to control the number of workers participating in phased retirement programs.

 

April 4, 2019 in Consumer Information, Current Affairs, International, Other, Retirement | Permalink

Tuesday, April 2, 2019

Nursing Home Oversight-Two Updates

Following up on Katherine's important post, I was noticing a couple of news items regarding nursing home regulation I wanted to share.  A couple of weeks ago Bloomberg Law ran this article, Nursing Homes Want Care Disputes Kept Out of Court to Curb Costs. The article focuses on the use of pre-dispute arbitration clauses in nursing home admission contracts. You may recall that CMS was going to ban their use but the current administration changed directions. "The White House Office of Management and Budget is reviewing a Health and Human Services regulation that would allow nursing homes that receive Medicaid and Medicare funding—which is nearly all of them—to enforce those “pre-dispute” arbitration clauses. The Trump administration proposed the change in June 2017."

It's no surprise when I tell you that there are those supporting the use of pre-dispute arbitration clauses and those that oppose them.  AARP's legislative policy arm has opposed the current administration's position on their use, arguing "that the provisions of [Trump’s] proposed rule would very likely have dangerous and harmful impacts on nursing home residents, as well as their families.” 

As the use of mandatory pre-dispute arbitration clauses in contracts grows, there is some push back. "Arbitration clauses are commonplace in contracts for cellphones, credit cards, gym memberships, and other services, but there’s a growing movement to limit their use. Last month, House Democrats introduced the Forced Arbitration Injustice Reversal Act, which would ban mandatory arbitration clauses in consumer, employment, and other contracts." 

Congress, at least in 2017, and the current administration seem to be in favor of the use of the clauses, since in 2017 the Republican members of Congress "voted to repeal a Consumer Financial Protection Bureau rule banning mandatory arbitration clauses in financial contracts" which the President signed into law.

Admittedly, there are advantages to arbitration for certain kinds of cases.  Whether they are appropriate for resolution of cases involving nursing home residents is one of those "agree to disagree" issues for many.

Then last week, the Washington Post published an opinion, The hidden victims of Trump’s deregulatory agenda: Nursing home residents looks at the impact of the changes from the administration, specifically "[t]he number of per-day fines plummeted. The ban on mandatory arbitration was blocked. [The President] even delayed the enforcement of new health and safety requirements by 18 months, much to the delight of the nursing home industry."

Regarding the drop in fines, so what does this mean? The author says this means "less accountability for nursing homes that treat their residents poorly. The Kaiser Family Foundation recently published an analysis that found that under the Trump administration, the average fine levied against nursing homes that have endangered or injured residents dropped from a high of $41,260 in 2016 to $28,405 in the first quarter of 2018. That may not look like an enormous dip, but that average likely reflects a shift back toward levying one-off fines for violations."

CMS disagrees. Although the amount of penalties may have decreased, they point out that the number of fines being issued has gone up.  The author takes a contrary view, " the Kaiser analysis found that the administration has issued fewer penalties in cases in which nursing homes put residents in immediate jeopardy of harm. And the fines CMS did issue averaged 18 percent less than the ones levied at the end of the Obama administration."

For those Special Focus Facilities, one expert offers that "the Trump administration has largely pulled back its enforcement of them, issuing increasingly small fines even though the government continued to cite them for serious violations, according to [the expert's] most recent analysis of CMS data in January."

This is an important issue and one that is far from being resolved. So, stay tuned.

April 2, 2019 in Consumer Information, Current Affairs, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care | Permalink | Comments (0)

Monday, April 1, 2019

New Article on Planning for Beneficiaries with Special Needs

Kristen Lewis has published a really great article in the March 2019 issue of Estate Planning Magazine.  Planning Challenges for Beneficiaries With Special Needs. To accommodate adequately the particular circumstances of beneficiaries with special needs, multiple trusts may be required provides a comprehensive discussion of 10 challenges faced by estate planners when a beneficiary has special needs.

Consider the opening of this article

Disabilities do not discriminate based on a family’s socio-economic status. Families of great wealth have children or other beneficiaries with disabilities at the same rate as families of modest means. Estate planning attorneys, and the other allied professionals who serve these families, are no longer able to take the position that “We don’t do special needs planning,” or worse yet, recommend that the child or other beneficiary with a disability simply be disinherited (which is likely grounds for malpractice). A recent study by the Centers for Disease Control and Prevention concluded that the prevalence of Autism Spectrum Disorder (ASD) has risen to one in every 68 births in the U.S. A more recent study concluded that the estimated prevalence of children in the U.S. with a “parent-reported” diagnosis of ASD is now one in 40. The 2010 U.S. Census reported that almost 20% of the U.S. civilian non-institutionalized population claimed to have a disability.  With statistics like these, estate planners and allied professionals must become, and remain, educated about the tools and techniques available to help clients secure the future of beneficiaries with disabilities within the broader context of estate planning. A critical first step is recognizing, and knowing how to overcome, the most common challenges to effective special needs planning. (citations omitted)

Read this article, then save it to your library as a resource.  You will be glad you did!

PS-shameless plug: Mark your calendars for Stetson Law's 2019 Special Needs Planning Institute for October 16-18, 2019. Registration opens July 1. #StetsonSNT2019

 

April 1, 2019 in Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Estates and Trusts, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Sunday, March 31, 2019

Bye Bye Donut Hole

The Medicare Part D donut hole closed this year (yay) and although it may be gone, it's not forgotten.

Due to federal legislation, the donut hole is closed for brand-name drugs in 2019. This closure means that [that a beneficiary] will be responsible for 25% of the cost of ... brand-name drugs in this coverage period. Although the donut hole for brand-name drugs has closed, [the beneficiary] may still see a difference in cost between the initial coverage period and the donut hole. For example, if a drug’s total cost is $100 and [the beneficiary] pay[s] [the] plan’s $20 copay during the initial coverage period, [the beneficiary] will be responsible for paying $25 (25% of $100) during the coverage gap. The donut hole will close for generic drugs in 2020, at which point [a beneficiary] will be responsible for 25% of the cost of ...  generic drugs.

Kaiser Health News last week ran a story about the demise of the donut hole and the out of pocket costs beneficiaries still face. Doughnut Hole Is Gone, But Medicare’s Uncapped Drug Costs Still Bite Into Budgets  focuses on the need for an annual cap on out of pocket drug spending by telling the stories of some of those who have significant out of pocket costs even with the elimination of the donut hole. "Legislative changes have gradually closed the doughnut hole so that, this year, beneficiaries no longer face a coverage gap. In a standard Medicare drug plan, beneficiaries pay 25 percent of the price of their brand-name drugs until they reach $5,100 in out-of-pocket costs. Once patients reach that threshold, the catastrophic portion of their coverage kicks in and their obligation drops to 5 percent. But it never disappears."

Although none of the Medicare programs have caps on spending, the article illustrates that those enrolled in original Medicare can purchase Medigap policies, which do not extend to Part D  prescription drug plans.  There's a great chart in the article that compares the existing Part D program with proposed legislation which illustrates the effect of the recent proposal to cap the annual amount. 

Stay tuned and stay healthy.

March 31, 2019 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Broken System(s) and Good People Who Still Care

For those who read this Blog regularly, thank you.  Especially as I have been leaving the bulk of recent postings to my wonderful  blogging colleague and all-round elder law guru, Rebecca Morgan.  Thank you most of all, Becky! 

It is early morning on a Sunday as I type this.  The Arizona sun is not quite above the eastern horizon.  A calm morning after several days ...  okay, I confess, weeks ... of small troubles.  I had time to read The New York Times, and there it is once again, an article with a title and content that seem right on point for what I am pondering:

Patients ‘Hit the Call Bell and Nobody Comes.’ Hospital Nurses Demand ‘Safe Staffing’ Levels.

For the last several weeks, my sister and I have been struggling to understand how best to help our mother in the latest part of her journey with dementia.  Recently she fell twice in single week, when rising before dawn and struggling to get dressed by herself.  She did not need to be up so early, but in a lifetime of early rising, it is hard to change. Learning new routines, such as calling for help, is never easy, but especially so when memory and awareness are impaired by dementia.  Her second fall resulted in what Mom had long feared most, a fear that will resonate for many people.  She fractured her hip, as well as a few annoying ribs.  

This put the three of us, my sister, my mother and me, squarely in the middle of doctor consultations, hospitals, rehabilitation centers, home care agencies and a search for alternatives for care.  Do you have a mental image of Queen Elizabeth in London?  Perhaps you have seen photos or news footage of her in recent weeks, walking with determination and carrying her purse, as she attends to her royal duties?  Well, Queen Elizabeth and our mother are the same age and seem to have very similar abilities to persevere.  We think of our mother as a slightly smaller version of the Queen, perhaps walking a bit slower although with equal commitment to the task, complete with her own favorite handbag.  Or she was until the recent set of events.

At age 93, Mom sailed through surgery to stabilize her fractured hip, and even did pretty well during the first phase of recovery in the hospital.  One small blessing for Mom is that she has no memory of the falls, no recollection of the surgery, and no memory of pain. Thus she's surprised when it "hurts" to try to stand, much less walk.  Of course, both pain and understanding of what pain signifies, are important reminders of the need to take things slow.  

We've done the hospital surgery stay "thing" before with Mom, and we've learned to treat such events as a marathon, rather than a sprint.  We've learned, for example, that our mother's agitation after surgery makes IVs difficult and that any form of narcotic pain medication is likely to trigger days of vivid and disturbing hallucinations. For pain, fortunately tylenol is enough with Mom.  We work hard to come up with a way for someone (usually my sister, until I can fly in) to be there each night, when we know hospital staffing levels can be low and call buttons may not be answered quickly. We know that without being there, when Mom does sometimes complain of pain, we will to need to remind the staff that tylenol is usually sufficient.

We try to rotate nights.  My sister is a pro, and after weeks of my somewhat frantic naps on airplanes, I've become pretty good at falling into a wakeful sleep mode in an upright position.  Staying overnight in a hospital is disorienting for the healthiest person and much more so for someone like my mother who cannot understand why this "hotel" has staff members that keep waking her up at night to take her temperature and hand her medication to swallow.  I will be forever grateful to the nurse who, after my mother spit a full mouthful of water and the medicine back in her face, nonetheless returned promptly to help throughout the third shift, still offering smiles and kind words.  The nurses who advocate for change in The New York Times article have it right -- "safe staffing levels" are one key to sound hospital care; only with adequate staffing can nurses be expected to keep working in such taxing circumstances.

The next decision was about where to go after the hospital. One option presented by the discharge planner was to go to a skilled nursing facility, a/k/a nursing home.  We had previewed a wide range of places and we already had a list of possibilities. But we were pretty confident Mom could tolerate physical therapy, and therefore, after consultation, we opted for a facility that specialized in rehabilitation.  

One complication:  The rehab facility's admissions director said that they were not willing to take someone with dementia unless the family made sure there was 24/7 assistance during periods of confusion and, they emphasized, to keep her from wandering.  With gratitude, we accepted a brochure offered by the admissions director for a local home care agency that they had worked with before.  My sister, a true angel, and I, very much a mortal, knew we couldn't do this alone.

And thus began a strange variation on the "Bell Rings; Nobody Comes" theme of The New York Times article about hospital care.

The first yellow flag was when one of the line staff, a certified nursing assistant (CNA) at the rehab facility, who heard we were hiring companions from an agency, commented, "Well, okay, if you want to do that, but just so you know, these people don't do a darn thing.  They won't lift a finger to help."  I didn't know what to say; I think I said something like, "Well, let us know if there is a problem."

The "problem" emerged quickly.  Companions from the home care agency said the rehab staff were not responding to call buttons when help was needed for our mother.  The rehab staff were complaining that the companions didn't provide any help.   I talked to an administrator at the rehab center.  He assured me that their policy was for staff  to respond promptly to call buttons and that he would remind the staff that a family member or hired companion was doing "the right thing" by using the call buttons to seek help.  

But the reports continued, even as Mom began to recover more function, and thus actually needed more help in key tasks because she was more mobile.  Different companions and even friends reported that the CNAs at the rehab center would, for example, help our mother to the bathroom toilet, but then would refuse to stay until she finished.  Some reported the CNA turning to the agency's companion and saying with disdain, "You should handle it from here."  

I tried talking again with Rehab's administrators, this time the director of nursing.  She was also quick to reassure me that we were not wrong to ask the rehab staff to assist our mother in the bathroom and to remain with her till she finished, as our mother was still unable to rise on her own and also could not or would not use the pull cord.  She thought the most recent report was about one new rehab employee, who may not yet understand his or her role.

But the reports continued.  One report came from a friend visiting Mom.  She noticed buzzers ringing endlessly on Mom's floor, even when available staff were chatting nearby.  I tried talking with the management staff again.  At one point, the home care agency actually swooped in and removed a companion we hired to help our mother, after the rehab center complained to them that the companion was complaining "too loudly" about the rehab staffing and lack of coordination with staff.  In response to the turmoil my sister ended up taking another night shift in rehab (after a long-day as an administrator for a charter school).  I started planning another flight to Arizona.

I slowly began to realize that this was not a problem that could be "fixed" with polite requests or even more directly-worded complaints about staffing roles.   I learned:

  • The direct care workers at the rehab center felt seriously over-worked and under-appreciated;
  • The rehab center was often short-staffed, especially when employees called off on short notice; 
  • The direct care workers resented the agency's companions "doing nothing" when an extra pair of hands, any hands, would have made their work easier;
  • There was tension between the direct care workers, most of them CNAs, and the cehab Center's other "higher" staff, including nurses and shift supervisors;
  • Family members of other patients were also concerned and confused about what to do about unevenness of care.  They weren't required to have a companion as their loved one did not have the dreaded "dementia." But their need for prompt assistance for loved ones recovering from car accidents, strokes, or major surgery was just as great.

A family member of another patient in rehab commented to me, "This is a broken system."  At first I thought she meant the Rehab Center.  But she clarified.  "This is just one part of a broken care system."  She meant that all of care is a broken system.

Continue reading

March 31, 2019 in Cognitive Impairment, Consumer Information, Current Affairs, Ethical Issues, Federal Statutes/Regulations, Games, Health Care/Long Term Care, Medicare, State Statutes/Regulations | Permalink | Comments (1)

Friday, March 29, 2019

Will There Ever Be A Cure for Alzheimer's?

Two recent stories from the Wall Street Journal on a recent failure of an Alzheimer's drug in testing made me pause. Latest Experimental Alzheimer’s Drug Fails Testing. Drugmakers Biogen and Eisai ended studies of treatment, deeming it unlikely to benefit patients in latest research setback  ("[t]he search for new Alzheimer’s disease treatments hit another big setback on Thursday when drugmakers Biogen Inc. and Eisai Co. said they would terminate two late-stage studies of an experimental drug after determining it would likely fail to help patients") and Where Alzheimer’s Research Is Pushing Ahead. Disappointing results for drugs targeting Beta amyloid buildup in the brain has renewed focus on drugs that act in other ways ("[t]he failure last week of Biogen Inc. and Eisai Co.’s once-promising Alzheimer’s disease drug was the latest in a spate of disappointments for medicines designed to target Beta amyloid, a sticky substance long known to accumulate in the brains of people with the disease...The repeated failure of such drugs are giving greater currency to efforts by academics and smaller biotech companies to better understand the biology of Alzheimer's ....) (subscription required to read both articles) certainly wasn't the headlines we hope for.  Then this article in Time Magazine caught my eye. What the End of a Promising Alzheimer’s Drug Trial Means for One Patient in the Study describes this "failure is the latest in a string of let-downs involving drugs that target amyloid, leading experts to question whether future treatment strategies should focus so heavily on amyloid plaques. Therapies that target some of the other proteins involved in the disease are ongoing, but until recently, the predominance of amyloid in the brains of people affected by Alzheimer’s has led drugmakers to focus on that protein in particular."  The article also summaries different tactics that researchers are considering next, so at least there's still hope. Stay tuned.

March 29, 2019 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Other, Statistics | Permalink | Comments (0)

Thursday, March 28, 2019

New GAO Report on Retirement Security

The GAO has issued a new report, Retirement Security:  Most Households Approaching Retirement Have Low Savings, an Update. The report, an update from the 2015 report, is 4 pages long and available here as a pdf. The update incorporates "estimates on the percentage of households aged 55 and over with selected financial resources."  Here are the fast facts from this update

The 2015 report on retirement security included estimates on the percentage of households aged 55 and over without retirement savings or a defined benefit plan (traditional employment-based pension plans that offer benefits based on factors like salary and years of service)... We updated these estimates using data from the most recent Survey of Consumer Finances, which was released in September 2017... We found that the percent of households headed by someone aged 55 and over that had no retirement savings decreased from about 52 percent in 2013 to about 48 percent in 2016.

 

March 28, 2019 in Consumer Information, Current Affairs, Other, Retirement, Social Security | Permalink | Comments (0)

Wednesday, March 27, 2019

NJ Bill on Medical Aid in Dying

The NJ legislature has passed a medical aid in dying bill which the Governor of NJ has indicated he will sign. New Jersey approves bill allowing terminally ill patients the right to die reports that the votes were somewhat close, with the NJ House voting 41-33 and the NJ Senate, 21-16.  Safeguards similar to the laws in other states for medical aid in dying are included in the NJ legislation. "Two physicians would be required to attest that the person had less than six months to live. The patient would have to ask for the medication three times — twice orally and once in writing — before receiving it. The written request would have to be witnessed by two people, including one who is not a family member, a beneficiary of the patient's will or the attending physician... The patient would then be required to self-administer the medicine, if he or she decides to take it at all." The legislation is available here.

 

 

March 27, 2019 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (0)

Wednesday, March 20, 2019

CDC Says Dementia Deaths Up

The Atlanta Journal Constitution reported last week that the Rate of dementia deaths in US has more than doubled, CDC says from the new report for the National Center for Health Statistics.

Here is the abstract from the 29 page report from the National Center for Health Statistics:

Objectives—This report presents data on mortality attributable to dementia. Data for dementia as an underlying cause of death from 2000 through 2017 are shown by selected characteristics such as age, sex, race and Hispanic origin, and state of residence. Trends in dementia deaths overall and by specific cause are presented. The reporting of dementia as a contributing cause of death is also described.

Methods—Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia. Using multiple cause-of-death data files, dementia is considered to include deaths attributed to unspecified dementia; Alzheimer disease; vascular dementia; and other degenerative diseases of nervous system, not elsewhere classified.

Results—In 2017, a total of 261,914 deaths attributable to dementia as an underlying cause of death were reported in the United States. Forty-six percent of these deaths were due to Alzheimer disease. In 2017, the age-adjusted death rate for dementia as an underlying cause of death was 66.7 deaths per 100,000 U.S. standard population. Age-adjusted death rates were higher for females (72.7) than for males (56.4). Death rates increased with age from 56.9 deaths per 100,000 among people aged 65–74 to 2,707.3 deaths per 100,000 among people aged 85 and over. Age-adjusted death rates were higher among the non-Hispanic white population (70.8) compared with the non-Hispanic black population (65.0) and the Hispanic population (46.0). Age-adjusted death rates for dementia varied by state and urbanization category. Overall, age-adjusted death rates for dementia increased from 2000 to 2017. Rates were steady from 2013 through 2016, and increased from 2016 to 2017. Patterns of reporting the individual dementia causes varied across states and across time.

Conclusions—Death rates due to dementia varied by age, sex, race and Hispanic origin, and state. In 2017, Alzheimer disease accounted for almost one-half of all dementia deaths. The proportion of dementia deaths attributed to Alzheimer disease varies across states.

 

March 20, 2019 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Other, Science, Statistics | Permalink | Comments (0)

Tuesday, March 19, 2019

Combating Loneliness in Older Adults

Kaiser Health News ran a story last week on how to push back vs. loneliness in older adults. Understanding Loneliness In Older Adults — And Tailoring A Solution doesn't mean telling folks to get a hobby. Instead, the idea of fighting loneliness is making connections with others, living a purpose-filled life, and having important social roles.  Loneliness among elders has been found to be connected to many issues. "Four surveys (by Cigna, AARP, the Kaiser Family Foundation and the University of Michigan) have examined the extent of loneliness and social isolation in older adults in the past year. And health insurers, health care systems, senior housing operators and social service agencies are launching or expanding initiatives."  Not everyone will respond well to one solution, so it's important that programs offer alternatives.

Interestingly, the story describes two categories of loneliness, what might be called short-term and long-term loneliness. "The headlines are alarming: Between 33 and 43 percent of older Americans are lonely, they proclaim. But those figures combine two groups: people who are sometimes lonely and those who are always lonely... The distinction matters because people who are sometimes lonely don’t necessarily stay that way; they can move in and out of this state. And the potential health impact of loneliness — a higher risk of heart disease, dementia, immune dysfunction, functional impairment and early death — depends on its severity."

The article not only explores the length of loneliness but the depth and types of it as well. "According to a well-established framework, “emotional loneliness” occurs when someone feels the lack of intimate relationships. “Social loneliness” is the lack of satisfying contact with family members, friends, neighbors or other community members. “Collective loneliness” is the feeling of not being valued by the broader community. .. Some experts add another category: “existential loneliness,” or the sense that life lacks meaning or purpose."

A program that might effectively combat loneliness has to look at the causes of it. Those include the sense that people don't care about you, disappointing relationships, for example. Some types of loneliness might have an easier fix. The article offers the example of "[s]omeone who’s lost a sense of being meaningfully connected to other people because of hearing loss — the most common type of disability among older adults — can be encouraged to use a hearing aid. Someone who can’t drive anymore and has stopped getting out of the house can get assistance with transportation. Or someone who’s lost a sibling or a spouse can be directed to a bereavement program."

The article is very interesting and brings depth to a very important topic.

March 19, 2019 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other, Statistics | Permalink | Comments (0)

Monday, March 18, 2019

Florida AG Creates Senior Protection Team

Florida Attorney General Ashley Moody announced last week the creation of the Senior Protection Team "an intra-agency group of experts working together to fight fraud and abuse. The team is comprised of leading members from the Attorney General’s Office of Statewide Prosecution, Consumer Protection Division and Medicaid Fraud Control Unit. Seniors v. Crime and the Florida Department of Law Enforcement will also actively assist the team with investigations and outreach efforts." The team is being led by Statewide Prosecutor, Nick Cox, a long-time advocate for the protection of elders from scams and frauds.

Kudos to General Moody!

March 18, 2019 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Florida AG Creates Senior Protection Team

Florida Attorney General Ashley Moody announced last week the creation of the Senior Protection Team "an intra-agency group of experts working together to fight fraud and abuse. The team is comprised of leading members from the Attorney General’s Office of Statewide Prosecution, Consumer Protection Division and Medicaid Fraud Control Unit. Seniors v. Crime and the Florida Department of Law Enforcement will also actively assist the team with investigations and outreach efforts." The team is being led by Statewide Prosecutor, Nick Cox, a long-time advocate for the protection of elders from scams and frauds.

Kudos to General Moody!

March 18, 2019 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Friday, March 15, 2019

College Students Living In Elder Living Communities

AARP's Livable Communities newsletter had 2 articles of interest regarding housing and elders.  The first, Rethinking Student Housing focuses on several projects  along the lines of an artist-in-residence program, where music students get free housing in an elder housing community in return for performances as well as "helping with errands and socializing with ...  neighbors."  The second article, Rethinking What Makes a Great Roommate, focuses on a project that melds two issues: lack of affordable housing and elders who want to stay in their homes but need income. This project,  "Nesterly, a website that connects older people who have rooms to spare with young and lower income people seeking medium-term affordable housing. "Homeshare with another generation: The easy, safe way to rent a room," states the site's homepage. "  There is a small fee to use the service, which checks out the potential renters.  The two parties come to agreement on the terms and price.

Two very creative ideas!

March 15, 2019 in Consumer Information, Current Affairs, Housing, Music, Other | Permalink | Comments (0)

Thursday, March 14, 2019

Check out the Updated Law Enforcement Guide EAGLE 2.0

EAGLE, the Elder Abuse Guide for Law Enforcement, has been updated and the newest version is now available.  The email announcing the updates explains

EAGLE 2.0 has incorporated roll call videos developed by the International Association of Chiefs of Police (IACP), Department of Justice updates and archived webinars.   EAGLE is both a systematic and streamlined tool for law enforcement to assess elder abuse, as defined by the statutes of each state.  Although EAGLE was designed for law enforcement and by law enforcement, EAGLE is for anyone who would like to learn more about the types of elder abuse and what can be done to build strong community supports to prevent future occurrences. 

The roll call videos are in six parts and based on real cases, "highlight[ing] the actions of responding officer that led to a resolution of the case."

This guide is an incredibly valuable resource. Be sure to check out the webpage!

 

March 14, 2019 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, State Statutes/Regulations | Permalink | Comments (0)

Wednesday, March 13, 2019

New Report from Consumer Financial Protection Bureau

The Consumer Financial Protection Bureau (CFPB) released a new report at the end of February, Suspicious Activity Reports on Elder Financial Exploitation: Issues and Trends.

Here is a summary of the report

Since 2013, financial institutions have reported to the federal government over 180,000 suspicious activities targeting older adults, involving a total of more than $6 billion. The reports provide unique data on these suspicious activities, which can enhance ongoing efforts to prevent elder financial exploitation and to punish wrongdoers.

This report presents the findings of a study of elder financial exploitation Suspicious Activity Reports (EFE SARs) filed with the federal government by financial institutions such as banks and money services businesses between 2013 and 2017. This is the first public analysis of EFE SAR filings since the Financial Crimes Enforcement Network (FinCEN), which receives and maintains the database of SARs, introduced electronic SAR filing with a designated category for “elder financial exploitation” in 2013. The findings provide an opportunity to better understand the complex problem of elder financial exploitation and to identify ways to improve prevention and response.

The full report is available here.

The key findings of the report provide some sobering data:

SAR filings on elder financial exploitation quadrupled from 2013 to 2017. In 2017, elder financial exploitation (EFE) SARs totaled 63,500. Based on recent prevalence studies, these 2017 SARs likely represent a tiny fraction of actual incidents of elder financial exploitation.

Money services businesses have filed an increasing share of EFE SARs.In 2016, money services business (MSB) filings surpassed depository institution (DI) filings. In 2017, MSB SARs comprised 58 percent of EFE SARs, compared to 15 percent in 2013.

Financial institutions reported a total of $1.7 billion in suspicious activities in 2017, including actual losses and attempts to steal the older adults’ funds

Nearly 80 percent of EFE SARs involved a monetary loss to older adults and/or filers (i.e. financial institutions).

In EFE SARs involving a loss to an older adult, the average amount lost was $34,200. In 7 percent of these EFE SARs, the loss exceeded $100,000.

When a filer lost money, the average loss per filer was $16,700.

One third of the individuals who lost money were ages 80 and older.

Adults ages 70 to 79 had the highest average monetary loss ($45,300).

Losses were greater when the older adult knew the suspect. The average loss per person was about $50,000 when the older adult knew the suspect and $17,000 when the suspect was a stranger.

Types of suspicious activity varied significantly by filer.When the filer was an MSB, 69 percent of EFE SARs described scams by strangers. DI filings, in contrast, involved an array of financial crimes, with 27 percent involving stranger scams.

More than half of EFE SARs involved a money transfer. The second-most common financial product used to move funds was a checking or savings account (44 percent).

Checking or savings accounts had the highest monetary losses. The average monetary loss to the older adult was $48,300 for EFE SARs involving a checking or savings account while the average loss was $32,800 for EFE SARs involving a money transfer.

The suspicious activity reported in an EFE SAR took place, on average, over a four-month period.

Fewer than one-third of EFE SARs indicated that the filer reported the suspicious activity to a local, state, or federal authority. Only one percent of MSB SARs stated that the MSB reported the suspicious activity in the SAR to a government entity such as adult protective services or law enforcement.

Read the entire report. The information is important.

Thanks to Julie Childs from the DOJ Elder Justice Initiative for alerting me to this new report.

March 13, 2019 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Federal Cases, Federal Statutes/Regulations, Other, Statistics | Permalink | Comments (0)

Tuesday, March 12, 2019

When Do Lawyers Have to Report Suspected Elder Abuse-A Webinar

Mark your calendars for this important webinar.  The National Center for Law and Elder Rights is offering this webinar, Elder Abuse: Mandatory and Permissive Reporting For Lawyers, on April 3, 2019 from 2-3 edt.

Here is the info about the webinar

When working with older adults, lawyers may be faced with legal and ethical decisions about when and how to report suspected elder abuse. In making these decisions, lawyers must balance the ethical need to honor their client’s autonomy, with potential legal requirements to intervene. An understanding of mandatory and permissive reporting laws is essential for lawyers working in this field.

This webcast will introduce lawyers to the concept of mandatory and permissive reporting, and provide an overview of the analysis a lawyer should take when determining how to proceed in circumstances of suspected abuse. Participants will learn how to:

• Analyze reporting obligations

• Determine who is a mandatory reporter in their state

• Inform clients about mandatory reporting requirements

• Weigh the benefits and burdens of reporting

The webcast will build on previous NCLER trainings, including Legal Basics: Elder Abuse and Legal Basics: Signs of Elder Abuse, Neglect, and Exploitation.

 

To register, click here.

March 12, 2019 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Legal Practice/Practice Management, Webinars | Permalink | Comments (0)