Tuesday, October 5, 2021
The Adult Protective Services Technical Assistance Resource Center (APS-TARC) released a new brief, COVID-19 Fraud and Scams: What APS Needs to Know. Noting the pandemic causes greater use of technology, increased isolation and changes to personal circumstances, the Brief discusses several COVID-related scams. These include healthcare scams, government impersonator scams, money transfer scams, charity scams, mortgage relief scams, helper scams, and scams around vaccinations, treatments for COVID, and tech. The Brief offers suggestions for prevention, agencies to contact for help, and dealing with misinformation.
Monday, October 4, 2021
My dear friend and colleague, Professor Feeley, sent me a link to this recent article, Likely cause of Alzheimer’s identified in new study.
Here's a brief bit of info about the study
[S]cientists in Australia have recently discovered an additional factor that may be responsible for the development of this neurodegenerative condition.
Lead study author Dr. John Mamo, Ph.D. — distinguished professor and director of the Curtin Health Innovation Research Institute at Curtin University in Perth, Australia — explained to Medical News Today the conclusion from the new research...
“This study,” he added, “shows that exaggerated abundance in blood of potentially toxic fat-protein complexes can damage microscopic brain blood vessels called capillaries and, thereafter, leak into the brain, causing inflammation and brain cell death.”
Several lines of study suggest that peripheral metabolism of amyloid beta (Aß) is associated with risk for Alzheimer disease (AD). In blood, greater than 90% of Aß is complexed as an apolipoprotein, raising the possibility of a lipoprotein-mediated axis for AD risk. In this study, we report that genetic modification of C57BL/6J mice engineered to synthesise human Aß only in liver (hepatocyte-specific human amyloid (HSHA) strain) has marked neurodegeneration concomitant with capillary dysfunction, parenchymal extravasation of lipoprotein-Aß, and neurovascular inflammation. Moreover, the HSHA mice showed impaired performance in the passive avoidance test, suggesting impairment in hippocampal-dependent learning. Transmission electron microscopy shows marked neurovascular disruption in HSHA mice. This study provides causal evidence of a lipoprotein-Aß /capillary axis for onset and progression of a neurodegenerative process.
Friday, October 1, 2021
A couple of weeks ago, the Commonwealth Fund released a report, The Impact of COVID-19 on Older Adults: Findings from the 2021 International Health Policy Survey of Older Adults. Here are the survey highlights:
Compared to their counterparts in the other survey countries, older adults in the U.S. have suffered the most economically from the COVID-19 pandemic, with more losing a job or using up all or most of their savings.
Latino/Hispanic and Black older adults in the U.S. have been far more likely than white older adults to experience significant negative economic consequences.
COVID vaccination rates for older adults were highest in countries where vaccines were most widely available when the survey was fielded. In the United Kingdom, nearly all older adults (97%) had already been vaccinated. The U.S. had the largest percentage of older adults who were not planning to get vaccinated.
The conclusion includes several steps for going forward "to reduce this burden on older Americans and to ensure that their health care needs are met":
Reducing care barriers... affordable access to care is increasingly a priority for policymakers and care delivery systems. Timely access to primary care is particularly important for older adults with multiple chronic conditions, because effective treatment requires coordination and follow-up plans....
Role of telemedicine... countries clearly have an opportunity to improve care delivery to older adults through the expansion of virtual care services for those unable or resistant to receiving care in a clinician’s office....
Expanding vaccination ... "[f]or older adults who said they were not planning to get vaccinated, limited trust in government to ensure vaccine safety and concerns with side effects were the most cited reasons. To increase uptake in this population, messaging campaigns should address their apprehension by engaging a wide range of voices, from clinicians and scientists to community members and local, state, and federal government agencies, to get the word out....
Thursday, September 30, 2021
Jane Brody wrote an article a few weeks ago for the New York Times, How to Age Gracefully. The catalyst for the article is a new book, “Stupid Things I Won’t Do When I Get Old, the title of which really appealed to me! The book inspired her to take an "inventory of my life and started at the top, with my hair. I’d been coloring it for decades, lighter and lighter as I got older. But I noticed that during the pandemic, many people (men as well as women of all ages) had stopped covering their gray. And they looked just fine, sometimes better than they did with hair dyed dark above a wrinkled facade. Today, I too am gray and loving it, although I can no longer blame my dog for the white hairs on the couch!" She also changed her attitude about her clothing and use of makeup. She also discusses things she won't stop doing just because of her age, some of which observers might consider risky behavior. As she observes, "[s]ooner or later, we all must recognize what is no longer possible and find alternatives... [and has] vowed to stop talking to whoever will listen about my aches, pains and ailments, what [the book's author] called the “organ recital.” It doesn’t provide relief — in fact, it might even make the pain worse. Rather than instill empathy, the “organ recital” likely turns most people off, especially young ones." She discusses two more major hurdles she will tackle, clutter and driving. She offers this quite lovely advice for us "Live each day as if it’s your last, with an eye on the future in case it’s not...."
Wednesday, September 29, 2021
I don't know if it will be "record-breaking", but the buzz is that it's going to be larger than that of recent history. CNBC reported Social Security cost-of-living adjustment could be at least 6% in 2022, the higher amount being due to inflation, but the increase in purchasing power will be tempered by the Medicare Part B premiums and income taxes. The Senior Citizens League (the source of the estimate) explains its process "Our forecast is based on CPI data through August, and there is still one more month of consumer price data to come in before we get the official announcement in October ... [and] [t]his year is particularly difficult to forecast with certainty... [due to] inflation patterns, caused in large part due to the COVID-19 pandemic, [which] were unprecedented...."
It won't be long before we get the official news from SSA. Stay tuned....
Tuesday, September 28, 2021
We all know the importance of caregiving and some of the issues facing the U.S. vis a vis caregivers. First, an article a few days ago published in the Huffington Post, Why A Transformation Of Caregiving Could Be Biden’s B.F.D. Here's one excerpt from the article
It’s got three main components. One is an initiative to provide up to three months of paid leave to take care of family members, including newborns. Another is a proposal to make child care and prekindergarten available to any family that wants it, and to improve the quality of that care for everyone. The third piece is a proposal to fund what are known as “home- and community-based services,” a clunky piece of policy-speak that refers to programs that allow disabled and elderly Americans to live on their own rather than in nursing homes and other institutions.
After discussing the politics of the plan, the article provides a history of caregiving. "Responsibility for caregiving has historically fallen disproportionately on women ― who, in turn, were expected to provide it for little or no pay. That was possible, in part, because until relatively recently in history most women didn’t have alternatives in the paid workforce. That was especially true for women of color, who were subject to discrimination (and, at one time, enslavement)." Discussing the pay scale for caregivers, and the approach in other countries, the article discusses the "policy opportunity" at hand in Congress.
Then consider this recent article from the New York Times, Long Hours, Low Pay, Loneliness and a Booming Industry, about the home health industry.
The industry is in the midst of enormous growth. By 2030, 21 percent of the American population will be at the retirement age, up from 15 percent in 2014, and older adults have long been moving away from institutionalized care. In a 2018 AARP survey, 76 percent of those ages 50 and older said they preferred to remain in their current residence as they age. In 2019, national spending on home health care reached a high of $113.5 billion, a 40 percent increase from 2013, according to the most recent data from the Centers for Medicare and Medicaid Services.
The ranks of home care aides are expected to grow by more than those of any other job in the next decade, according to the Bureau of Labor Statistics. It’s also among the lowest paying occupations on the list.
The article examines the wages of aides and the activities they perform. The article also covers the impact of the pandemic on them, including those who died of COVID. The article looks at the regulations of home health agencies in NY. This particular part of the article gave me pause. "Working overnight makes an already isolating and demanding job even more so. Aides assigned to “live-in shifts” spend 24 hours a day at a patient’s home, sometimes for several days in a row. The aides are paid for only 13 hours of that time because they are expected to get eight hours of sleep and three hours of meal breaks, according to New York State guidelines and federal regulations." And it is only recently that aide have been protected by the Fair Labor Standards Act "Home health aides are classified as “domestic service” workers, many of whom were exempt from a set of labor protections known as the Fair Labor Standards Act until 2015, when the Department of Labor expanded its regulations."
Monday, September 27, 2021
Recently a friend noted with concern that she'd been advised that an elderly relative would be receiving "antibodies" in her assisted living community. The confusion was "if she has been fully vaccinated, and hasn't tested positive herself, why would she need "antibodies?" Turns out there were new incidences of COVID-19 in her wing of older adults, many of them with multiple risks factors, and the staff was being proactive. More than likely, what she was receiving was "monoclonal antibodies." The question arose before the question of authorization of "booster" shots had been addressed by the FDA.
As explained in this WebMD Health News article, titled Monoclonal Antibodies vs. Vaccines vs. COVID-19, from August 2021, families with loved ones in communal settings may want to discuss monoclonal antibodies with the health care team:
Can I help relatives in assisted living get it?
If you believe that a relative in a residential facility -- like a nursing home, assisted living facility, long-term care home, or prison -- has COVID-19 or has been exposed, the first thing you should do is have a conversation with the medical leadership at the facility.
[Michigan Department of Health and Human Services Division of EMS and Trauma Director, Dr. William Fales] has partnered Michigan-based paramedics with several nursing homes in the state to have monoclonal antibodies delivered to these facilities when there’s an outbreak. It’s also possible for long-term care pharmacies to get monoclonal antibodies to administer in-house. If the medical leadership doesn’t appear to be aware of the treatment, you can use the same websites to find the nearest infusion center and begin coordinating treatment with it.
It's a good idea, Fales says, to find out where monoclonal antibodies are offered in your area, and perhaps talk with your doctor or a high-risk loved one’s doctor about how to get them, to be prepared. The faster you can get the treatment, the more likely it will help.
I was interested in this recent opinion from the Penn. Supreme Court. Not elder law specific, but interesting info none the less. In Penn. v. Purnell, the court was reviewing
the appropriate test to apply to a trial court’s determination concerning whether a witness in a criminal case may utilize a “comfort dog” for support during his or her trial testimony. We hold that a trial court should balance the degree to which the accommodation will assist the witness in testifying in a truthful manner against any possible prejudice to the defendant’s right to a fair trial. Here, the trial court allowed a witness to testify with the assistance of a comfort dog, and the Superior Court concluded that the trial court did not abuse its discretion in this regard. For the reasons stated below, we agree with the Superior Court and, therefore, affirm that court’s judgment."
The issue arose when one witness to a killing was concerned about her own safety, so the State sought
a “comfort dog” be present during [the witness'] testimony. ... The motion explained that a sheriff’s deputy would transport the comfort dog, Melody, to the court and that the dog would enter the courtroom before the jury’s entrance. According to the motion, the comfort dog would be placed in the witness stand outside the presence of the jury and would exit the courtroom after the jury left the room. (citations omitted).
After reviewing arguments and rulings from other states, the court determined "that trial courts have the discretion to permit a witness to testify with the assistance of a comfort dog. In exercising that discretion, courts should balance the degree to which the accommodation will assist the witness in
testifying in a truthful manner against any possible prejudice to the defendant’s right to a fair
trial and employ means to mitigate any such prejudice."
The full opinion is available here.
Friday, September 24, 2021
In any given week, I often have someone reach out to me, a mere lawyer, asking me for suggestions about how to access assistance for a family member, a friend, or a colleague who is experiencing "mild to moderate dementia." Of course, part of those requests arise because of my identity as an elder law attorney. But, still, I think that such requests are a sign of the public's difficulty in identifying trustworthy alternatives. This week, for example, a call came from a commercial attorney who was startled to realize he might be the closest to a family friend who is struggling with her doctor's strongly-worded recommendation that she should no longer live alone, because of serious difficulties with her memory and balance. The family was unable or unwilling to help her. Thus, the commercial attorney was learning about how/whether he could become her surrogate, if needed, for accessing better care and more suitable living arrangements. Without such a friend, the decision-maker would likely end up being a complete stranger.
Also this week, however, I was researching a question that led me to put "dementia" into a search box on the Westlaw search engine for recent court decisions. I expected to see guardianship and conservatorship cases, as that is probably the most obvious reason why lawyers and courts would be involved with dementia.
Instead, 3 of the first 5 case decisions (reported during September 15-September 24) reported on Westlaw involved requests by convicted criminal defendants for relief or modification of sentences due to consequences of dementia. This means judges are being asked to evaluate the severity of progressive conditions and the impact of the diagnosis on the likelihood the defendant will reoffend if released. See e.g., Sentencing Guidelines Manual's application notes listing "advanced dementia" as a possible factor in considering whether there are "extraordinary and compelling reasons" for a reduced or modified sentence.
Two cases decided by federal courts on the same day stood out:
In U.S. v. Shabazz (USDC for District of Columbia, 9/22/21), compassionate release was denied for a 55 year old man, who had served 46 of his 67 month sentence for heroin and cocaine sales. The defendant was seeking early release to help provide live-in care for his 80 year old mother who was suffering from worsening dementia, requiring constant care. The court observed:
The Court finds that Mr. Shabazz does not meet this high bar [of proof to support compassionate release]. To be clear, the Court fully credits the assertions of Mr. Shabazz, his sister, and [his mother's] doctor with regard to [his mother's] condition. But Mr. Shabazz has not shown that he is the “only available caregiver” for his mother, nor is his situation so rare as to qualify as “extraordinary.” While the Court is deeply sympathetic with the plight of Mr. Shabazz, his mother, and his sister, this case simply does not present the kind of “extraordinary and compelling” circumstances required to reduce a defendant's sentence under [18 U.S.C. ] § 3582(c).
In U.S. v. Wiman (USDC Indiana, 9/22/21), granted release for a man who had served more than 6 years of a 110 month sentence for armed bank robbery, based on evidence of the defendant's diagnosis of Parkinson's related dementia. The court observed:
Mr. Wiman is 73 years old. He has been diagnosed with Parkinson's disease and Parkinson's dementia. Those conditions are progressing, and he has recently been transferred to a federal medical center so that he can reside in a memory disorder unit. Over the past several months, his medical records show that he has ongoing gait problems and has fallen multiple times despite using a walker. BOP medical staff also report that Mr. Wiman requires assistance with activities of daily living. Finally, BOP medical staff report that Mr. Wiman is occasionally confused.
Importantly, Parkinson's disease is a progressive disorder that cannot be cured [citing Mayo Clinic website]. While medications can improve symptoms, those symptoms worsen as the condition progresses over time. That is, there is no reason to believe that Mr. Wiman's condition will improve. To the contrary, it will likely continue to deteriorate. . . .
DOJ's Elder Justice Initiative has announced its fall webinar series.
Thursday September 30, 2021 2-3 p.m., INNOVATIONS IN GUARDIANSHIP: MAXIMIZING AUTONOMY AND ENSURING ACCOUNTABILITY.
Guardianship is one approach to providing support and assistance to adults who need help with decision-making about finances and personal issues. However, as recent high-profile and less visible cases illustrate, guardianship can also infringe on personal rights and can lead to mistreatment of older adults and adults with disabilities.
Join us for a webinar to discuss current trends and challenges in state guardianship systems, policies and practice. Using real-life guardianship scenarios, the webinar will explore ways to maximize autonomy and ensure accountability throughout the guardianship process. Presenters will discuss less restrictive alternatives to guardianship as well as ways to improve adjudication and post-appointment oversight of guardians.
To register, click here
Thursday October 21, 2021 2-3 p.m., IMPLEMENTING ELDER ABUSE RESTRAINING ORDERS
With the growing criminalization of elder abuse, greater attention has focused on elder abuse restraining orders, which are commonly used in the domestic violence context. Approximately sixteen states have an elder abuse restraining order statute, including California, with an additional three states having a financial exploitation only restraining order statute. Learn how one county-level adult protective services program in California implemented their restraining order statute. Overcoming some initial challenges, the presenters will share their lessons learned.
To register, click here.
Thursday November 18, 2-3 p.m., IDENTIFYING AND PROSECUTING POWER OF ATTORNEY ABUSE
Financial powers of attorney are legal tools commonly used to plan for the possibility that an adult may need help with financial decision-making in the future, but they can be used to steal money and property. Presenters will discuss common scenarios and recent prosecutions.
To register, click here.
September 24, 2021 in Consumer Information, Crimes, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Programs/CLEs, State Statutes/Regulations | Permalink | Comments (0)
Thursday, September 23, 2021
The Senate's Select Committee on Aging is holding a hearing today at 9:30 a.m. on "Frauds, Scams and COVID-19: How Con Artists Have Targeted Older Americans During the Pandemic". The witnesses include three experts and one consumer. The hearing will be available through a live feed. Click here to watch the hearing.
Wednesday, September 22, 2021
Professor Richard Kaplan recently published a new article comparing Medicare for All to current Medicare. Just a note-I make a point of reading anything Professor Kaplan publishes (just look at his download stats on SSRN, and you will see that many others share my opinion). He's a true elder law scholar and ROCK STAR. Here is the abstract for Medicare for All vs. Medicare As Is: Eight Key Differences.
This article examines eight principal differences between the Medicare-for-All proposal championed by Senator Sanders, inter alia, and the Medicare program as it actually exists. In doing so, the article shows how the current program bears little resemblance to what the Medicare-for-All proponents are trying to enact. Those key differences include: (1) Medicare is a real program, (2) Medicare is only health care financing, (3) Medicare is an earned entitlement, (4) Medicare is not a simple program, (5)Medicare has a significant co-insurance component, (6) Medicare’s financing relies on non-Medicare enrollees, (7) Medicare’s coverage of long-term care is minimal, and (8) Medicare can accommodate expansion without major disruption. The article concludes that the differences between Medicare as it is and Medicare-for-All are too significant to elide and may make the effort to enact Medicare-for All less likely to succeed.
Professor Kaplan, thanks for publishing in Stetson Law's Journal of Aging, Law, & Policy.
Tuesday, September 21, 2021
A recent opinion piece in USA Today was comparing the provisions of the New Mexico Aid-in-Dying law to those in other states, Terminal patients deserve death with dignity. New Mexico aid-in-dying law sets standard.
According to the author, there are 3 sections of the statute that are improvements over statutes in other states:
- Offsetting the growing physician shortage statewide. The law mirrors the practice of medicine found in other fields and allows advanced practice registered nurses and physician assistants to use their training to serve as either the prescribing or consulting clinician.
- Requiring only one written request and one 48-hour waiting period between receiving and filling the prescription for aid-in-dying medication. The prescribing provider has the ability to waive the 48-hour waiting period if the terminally ill person is likely to die during that waiting period.
Clarifying that if a health care provider objects to participating in medical aid in dying, they must inform the terminally ill person and refer them to either a willing provider or a party who can help the terminally ill patient find assistance.
Furthermore, providers that oppose medical aid in dying must accurately and clearly disclose that on websites and in any appropriate materials given to patients.
The law also takes a different approach to the waiting period used in other states, and according to the author, Oregon shortened its waiting period a couple of years ago "to allow doctors to waive the 15-day waiting period" and recently, "California passed legislation to improve access ... by reducing the mandatory 15-day waiting period between the two requests for aid-in-dying medication to 48 hours."
Monday, September 20, 2021
Mark your calendars now for a free webinar, Pandemic-Related Disaster Assistance for SSI Recipients, hosted by the National Center on Law & Elder Rights. Scheduled for September 21, 2021 at 2 eastern, the webinar description explains:
The Social Security Administration (SSA) recently changed their rules about how pandemic-related financial assistance can affect an individual’s eligibility for Supplemental Security Income (SSI) or monthly SSI benefit amount. Previously, SSA had been counting many types of assistance as income and resources for SSI purposes, resulting in individuals having their SSI benefits reduced or suspended, or having their applications for SSI benefits denied. However, due to the severity of the ongoing COVID-19 pandemic, SSA has decided they will not count most types of pandemic-related financial assistance against SSI eligibility or benefit amount.
This training will review the guidance issued by SSA on what types of financial assistance they now consider pandemic-related disaster assistance, what steps they will be taking to restore individuals’ SSI benefits, and what advocates can do to assist clients with contacting SSA to access or restore SSI benefits.
To register, click here.
Friday, September 17, 2021
Morris Klein, elder law attorney, friend and frequent contributor to this blog sent me links to two articles. Washington's first-in-the-nation long-term care program starts in January, with opt-out deadline soon and Payroll Tax Will Fund New Washington Long-Term Care Program.
The WA Cares fund was created by [their] Legislature in 2019 as a safety net for the seven in 10 people who will ultimately need professional or personal care at some point in their lives.
The only opportunity to opt out of the program is fast approaching, raising questions for workers who may be deciding whether getting a private policy is better or worse. Here, we lay out answers to some of the common questions.
. . .
Part of the motivation for creating the worker-funded program is the fact that private long-term care insurance policies can be too expensive for retirees to keep paying premiums on until they need to use them.
"Beginning in 2025, the plan will pay benefits to enrollees who need help with non-hospital-based health care expenses." "As more families applied for Medicaid, [Washington's legislators] saw a greater share of the state’s future budgets going to health care expenses. So, in 2019, the legislature ... opted to put the state in the long-term care business."
The articles are worth reading to learn more about how the program will work. Considerations for employees in deciding whether to stay in or opt out can be found here.
Thursday, September 16, 2021
The U.S. Food and Drug Administration hearing on Friday, September 17, 2021 to address the question of approval for "booster" doses of Covid-19 vaccines is scheduled to be "open" to the public through online portals. The hearing begins at 8:30 a.m. Eastern time.
The FDA's website helpfully links to the submissions from the drug companies and other interested parties as well to the hearing portal. In contrast to The Lancet article published earlier this week which takes the position that a booster vaccine dose is not "currently" indicated for most members of the public, Pfizer and Moderna each submitted materials to the FDA this week in support of administering third shots beginning six months after an individual's second shot. Pfizer is recommending a full-strength dose for its booster shot, while Moderna is recommending a dose that is 1/3 the level of its original doses. It appears both companies are citing observational studies, clinical trials, and antibody tests in support of their recommendations, including studies in the U.S., Israel, and South Africa, and discuss histories of reactogenicity, adverse events, and risk/benefit assessments.
Here's the useful FDA vaccine hearing webpage and links: https://www.fda.gov/advisory-committees/advisory-committee-calendar/vaccines-and-related-biological-products-advisory-committee-september-17-2021-meeting-announcement#event-materials
AARP Research has a new report, Working Caregivers' Worries Over Workplace Return. With some employers bringing employees back to the physical office, will the flexibility provided by working from home completely disappear?
AARP surveyed Americans who provide unpaid care to a family member or friend and work part- or full-time to learn about their concerns coming out of the pandemic. Of the national sample of adults polled by phone, 56% say their employer offered new benefits as a result of the pandemic, such as flexible schedules and the ability to work remotely.
As of July, about half of caregivers (52%) were continuing to work from home at least some of the time and 89% would like that option going forward. Most said it's been easier to juggle the demands of work and caregiving while not having to commute (49% to a great degree and 40% to some degree), according to the AARP survey.
The full report is available here. I have pasted the key findings here for your convenience:
- Working caregivers have felt the strain as the COVID-19 pandemic has ensued. With nearly eight in ten saying the pandemic increased their level of stress. Two in three caregivers (66%) express concern that they will have difficulty juggling responsibilities in the next 12 months.
- More than half of working caregivers say their employer instituted new benefits as a result of the pandemic. The most common benefits instituted were flexible schedules and the ability to work remotely.
- Flexibility is important for working caregivers to successfully balance caregiving with work. In fact, it is so highly valued that more than four in ten caregivers say they would consider looking for a new job if their employer rolled back any of the benefits they instituted during the pandemic.
- A slight majority of working caregivers currently have the ability to work at home at least some of the time and most want to continue with this arrangement.
- Nearly half say working at home has helped them manage their dual roles a great deal.
In addition to balancing responsibilities, working caregivers are most concerned about exposing the person they care for to the coronavirus or leaving them home unattended while they go to work.
Wednesday, September 15, 2021
I'm finding myself spending a lot of time reading and thinking about the Food and Drug Administration (FDA) and Federal Trade Commission (FTC). Of course, public concerns about the efficacy of Covid-10 vaccines dominate the attention of many of us working on health-related legal concerns that affect older adults. For example, I've been researching questions about the potential for FDA approved antibody tests for Covid-19 vaccines.
But also intriguing is a report that a slow-moving FTC suit against developers and marketers of the dietary supplement known as Prevagen may be getting closer to a possible trial date in the Southern District of New York. A dismissal of the 2017 law suit filed jointly by the FTC and the New York Attorney General was overturned in 2019 by the Second Circuit in a summary order, concluding that the "FTC and New York have made plausible allegations that Defendants] marketing campaign for Prevagen contained deceptive representations." For more on this and other Prevagen-related suits, see the Washington Post's recent article Does the Supplement Prevagen Improve Memory? A Court Case is Asking that Question.
Plus, there are significant questions arising in the wake of the FDA's June 7, 2021 announcement of its "accelerated" approval of aducanumab for treatment of Alzheimer's Disease. See e.g., Recently Approved Alzheimer Drug Raises Questions that May Never Be Answered (JAMA Network, July 21, 2021).
As noted in Dr. Jason Karlawish's important new book, The Problem of Alzheimer's: How Science, Culture, and Politics Turned a Rare Disease into a Crisis and What We Can Do About It, the number of Alzheimer's patients in the U.S. will rise to an estimated 13.8 million by 2025. The caregiver market alone is searching desperately for answers, and it can be very hard to make individual decisions about risks and benefits without trustworthy information. This is a tough time for what we might call a pandemic crisis about "trust."
We know they come out every year. This year is no exception. They are out! What do we learn from them? I'll give you the highlights here (those of you who have looked at the reports before know they are long and detailed....)
The Medicare Trustees' Report, released August 31, 2021, is available here. The introduction explains the impact of COVID, and COVID vaccines, on Medicare, but not "Aduhelm, the Alzheimer’s disease drug that has been recently approved." The introduction also references potential future scientific advances and how that would be factored into projections. The one thing everyone wants to know from the Trustees Annual Report is what is the fiscal health of Medicare? "The estimated depletion date for the HI trust fund is 2026, the same as in last year’s report. As in past years, the Trustees have determined that the fund is not adequately financed over the next 10 years. HI income is projected to be lower than last year’s estimates due to lower payroll taxes." If you don't have time to peruse the entire report, read the introduction. It's very interesting!
Here's an excerpt from the conclusion:
The Trustees project that HI tax income and other dedicated revenues will fall short of HI expenditures in all future years. The HI trust fund does not meet either the Trustees’ test of short-range financial adequacy or their test of long-range close actuarial balance.
The Part B and Part D accounts in the SMI trust fund are expected to be adequately financed because income from premiums and general revenue are reset each year to cover expected costs. Such financing, however, would have to increase faster than the economy to cover expected expenditure growth.
The financial projections in this report indicate a need for substantial changes to address Medicare’s financial challenges. The sooner solutions are enacted, the more flexible and gradual they can be. The early introduction of reforms increases the time available for affected individuals and organizations—including health care providers, beneficiaries, and taxpayers—to adjust their expectations and behavior. The Trustees recommend that Congress and the executive branch work closely together with a sense of urgency to address these challenges.
The 2021 Social Security Trustees' Report is available through this page.
According to a summary provided by the SSA & Medicare Trustees, "Based on our best estimates, the 2021 reports show:"
• The Old-Age and Survivors Insurance (OASI) Trust Fund, which pays retirement and survivors benefits, will be able to pay scheduled benefits on a timely basis until 2033, one year earlier than reported last year. At that time, the fund's reserves will become depleted and continuing tax income will be sufficient to pay 76 percent of scheduled benefits.
• The Disability Insurance (DI) Trust Fund, which pays disability benefits, will be able to pay scheduled benefits until 2057, 8 years earlier than in last year's report. At that time, the fund's reserves will become depleted and continuing tax income will be sufficient to pay 91 percent of scheduled benefits.
Tuesday, September 14, 2021
- A perfect kickoff with opening remarks on the theme of the conference from Syracuse Law Professor Nina Kohn, who outlined the civil rights of older persons, reminding us of existing laws and the potential for legal reforms;
- A unique "property law" perspective on the importance of careful planning about ownership or rights of use, in order to maximize the safety and goals of the older person, provided by Professor Lior Strahilevitz from University of Chicago Law School;
- Several sessions formed the heart of the conference by taking on enormously difficult topics arising in the context of Covid-19 about access to health care, including what I found to be a fascinating perspective from Professor Barbara Pfeffer Billauer from her recent work in Israel. She started with an interesting introduction of three specific pandemic responses she's identified in her research. She then focused on how "Policy Pariah-itizing" has had a negative effect on health care for older adults, with examples from Israel, Italy, and China. I was also deeply impressed by the candid presentations of several direct care providers, including nursing care professionals Esperanza Sanchez and Nelda Godfrey, about the ethical issues and practical pressures they are experiencing;
- Illinois Law Professor Dick Kaplan offered timely perspectives on incorporating cultural sensitivity in Elder Law Courses. His slides had great context, drawing in part from an article he published about ten years ago at 40 Stetson Law Review 15;
- Real world examples about tough end-of-life decisions involving family members and/or formally appointed surrogates, with Deirdre Lock and Tristan Sullivan-Wilson from the Weinberg Center for Elder Justice leading breakout groups for discussions.
I know I'm failing to mention other great sessions (there were simultaneous tracks and I was playing a bit of leap-frog). But the good news is we can keep our eyes out for the Touro Law Review compilation of the articles from this conference, scheduled for Spring 2022 publication. I know it was a big lift to pull off the conference in the middle of the fall semester. Thank you!
September 14, 2021 in Advance Directives/End-of-Life, Books, Cognitive Impairment, Consumer Information, Crimes, Current Affairs, Dementia/Alzheimer’s, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Housing, International, Property Management, Science | Permalink