Friday, July 22, 2005
Under the beating rays of the afternoon sun, Ken Sederstrom and his 18-year-old son Thomas sifted through 60 years' worth of trinkets and trash in the South St. Paul back yard of a stubborn old man who never threw anything away.
"That's a lot of good luck," Ken Sederstrom said, pointing to a box full of rusty horseshoes.
Old car parts. Boxes of decades-old empty beer bottles. Random planks of wood.
It all has to go before 88-year-old Robert George Schulze can come home from Dakota County jail, where he has been held since Tuesday. His back yard was just too messy.
The city of South St. Paul had received complaints from neighbors since before 1992 about the junky yard. Letters from the city turned into notices, then to visits from city inspectors, then to fines and finally to court action.
"Each time he'd appear, he'd pay the fines and not comply the next month," said Assistant City Attorney Kori Land.
Dakota County District Judge Leslie Metzen gave Schulze 30 days to clean up, threatening him with jail time if that didn't happen.
It didn't happen.
...and Schultze is still in jail. Read the rest of the story in the Minneapolis Star-Tribune.
Ed.: I find it distressing that a judge would imprison an elderly person due to his accumulation of excess junk. Dealing with someone who lives in a so-called "garbage house" calls for compassion and the careful involvement of social welfare, medical, and legal professionals--not the iron hand of the law. What is Judge Metzen thinking???
The United States faces a medical emergency. Costs of the nation's healthcare system are growing so fast they are out of control. Many employers are dumping escalating healthcare expenses for both employees and their retired workers as fast as they can manage, fearing a loss of competitiveness.
So far, the White House and other would-be physicians have decided that the answer is more of the same - the magic of consumer choice in a free market. But some are skeptical that this will provide a real cure.
"The whole idea is unsound," says Arnold Relman, a Harvard Medical School expert. Yet influential people in Washington have persuaded themselves that a more competitive healthcare system will slash costs enough to keep it workable.
The numbers seem to back up Dr. Relman's conclusion.
Currently, the average American consumes $6,420 worth of healthcare services a year. That's more than $12,200 a year for the average family. It's the most inefficient medical system among industrial nations.
Facing growing criticism of its advertising, the drug industry Thursday announced a preliminary set of voluntary guidelines that its trade group says would lead to better consumer information. Two leading consumer advocates immediately assailed the proposal for not going far enough.
The Pharmaceutical Research and Manufacturers of America (PhRMA) recommended that drugmakers:
• Discuss new drugs with doctors before launching consumer ad campaigns. The guidelines do not specify how long to withhold advertising.
• Target ads to age-appropriate audiences.
• Include information about risks and benefits.
• Not make false or misleading claims and make claims only when there is substantial evidence to back them up.
"By approving these principles, the industry is demonstrating its commitment to direct-to-consumer advertising as a way to encourage doctor-patient discussions and provide patients and consumers with accurate, accessible and timely health information," said Billy Tauzin, CEO of PhRMA, in a written statement.
6 MARQUETTE ELDER'S ADVISOR,
NO. 2, SPRING, 2005.
Ershow-Levenberg, Linda S. Court approval of Medicaid spend-down
planning by guardians. 6 Marq. Edler's Advisor 197-215 (2005).
Wessels, Carol J. Treated with respect: enforcing patient autonomy by
defending advance directives. 6 Marq. Elder's Advisor 217-242 (2005).
Bush, Thomas E. Disabled adult children. 6 Marq. Elder's Advisor
Stein, Judith. Introduction to Medicare for people with multiple
sclerosis. 6 Marq. Elder's Advisor 265-281 (2005).
Neiburger, Ben A. Employment tax issues in home health care contracts.
6 Marq. Elder's Advisor 283-300 (2005).
Jedrzejewski, Jennifer. Student article. The Economic Growth and Tax
Relief Reconciliation Act of 2001 and its effect on estate planning. 6
Marq. Elder's Advisor 301-324 (2005).
Babe, Katie. Student article. Property tax relief for the elderly: a
survey of the nation. 6 Marq. Elder's Advisor 325-359 (2005).
Wong, Olivia M. Book note. (Reviewing Howard Eglit, Age and Ageism in
the American Legal System.) 6 Marq. Elder's Advisor 361-380 (2005).
Thursday, July 21, 2005
"OASDI Monthly Statistics, June 2005," (Social Security Administration, Office of Policy, July 2005, .pdf and HTML format).
"OASDI Beneficiaries by State and County, 2004," (Social Security Administration, Office of Policy, July 2005, .pdf, Excel, and HTML format, 191p.).
"SSI Monthly Statistics, June 2005," (Social Security Administration, Office of Policy, July 2005, .pdf and HTML format).
DHHS OIG REPORT: "Multistate Review of Medicaid Drug Rebate Programs," (US
Department of Health and Human Service, Office of the Inspector General,
A-06-03-00048, July 2005, .pdf format, 22p.).
CENTERS FOR MEDICARE AND MEDICAID SERVICES ANNOUNCEMENT: "CY 2006 Hospital Outpatient Prospective Payment System," (CMS-1501-P, July 18, 2005, .pdf format, 803p.).
AARP GLOBAL AGING PROGRAM REPORT: "International Retirement Security Survey," (July 2005, .pdf format, 116p.).
KAISER FAMILY FOUNDATION CHARTBOOK: "Medicare Chart Book 2005," (July 2005, .pdf format, 77p.).
URBAN INSTITUTE REPORT: "Estate Tax Reform - A Third Option," by C. Eugene Steuerle (Tax Analysts, July 2005, .pdf format, 2p.).
AUSTRALIAN INSTITUTE OF HEALTH AND WELFARE REPORT:
A. "Residential Aged Care in Australia 2003-04: A Statistical Overview," (Aged Care Statistics Series No. 20, July 2005, .pdf format, 97p.).
PARIS-JOURDAN SCIENCES ECONOMIQUES: "Demographic transition, intergenerational transfers and the increase in public and national debts," by Jean-Pierre Laffargue (Working Paper 2005-25, June 2005, .pdf format, 30p.).
INSTITUTE FOR FISCAL STUDIES [UK]: "Preparing for retirement: the pension arrangements and retirement expectations of those approaching state pension age in England," by James Banks, Carl Emmerson and Zoë Oldfield (IFS Working Papers, W05/13, July 2005, .pdf format, 37p.).
Thanks, as always, to Charlie Fiss at CAAR for finding all this cool stuff.
Prof. Shari Motro (Richmond) has asked me to post the following request for information:
Subject: Looking for elderly cohabiters who pool resources
I am a University of Richmond law professor writing about marital status
and tax policy. I am looking for examples of elderly pairs who live
together and pool resources but are not engaged in an intimate
relationship. Ideally I'd like to find people who share income and have
contractual commitments to each other (e.g., power of attorney), but
these are not necessary. Thank you in advance.
Contact Prof. Motro directly at email@example.com.
From the AP:
Families have a lot of misconceptions about estate planning. Some think it's something only old people need to do. Others think it's all about avoiding taxes, or that it's only about money. But proper estate planning -- while it can involve all those things -- is much more. It's about who gets your possessions when you die. It's about who raises your children if they're still minors. It's about who makes critical medical decisions if you're incapacitated.
"Estate planning is important to anybody who cares about what happens after they die, irrespective of wealth or age," said David Ness, president of the Raymond James Trust Co., which is headquartered in St. Petersburg, Fla.
But many Americans apparently can't get over the emotions associated with death, and that stops them from putting their estates in order.
A recent Gallup Poll found that half of American adults do not have a will, the legal document in which you name the people who are to receive your property after you die. And nearly 60 percent of Americans haven't prepared a living will, which spells out the medical care you do or don't want to receive if you become incapacitated by an accident or terminal illness.
A Valley Springs (CA) couple accused of neglecting the husband's 91-year-old mother to the point she was lying in her own body fluids, has been denied a reduction in their bail.
Alan Deyarmon, 54, and Rosie Deyarmon, 51, are being held in the Calaveras County Jail in lieu of $130,000 bail each.
They each face charges of elder abuse, stealing or embezzling from an elderly patient, and two counts of child endangerment involving two boys.
The rest of this story is available in the Calaveras Enterprise. Warning: the facts of this case are pretty grim--not for the weak-of-stomach.
Wednesday, July 20, 2005
The United States Senate Special Committee on Aging heard today from Vincent Russo, past president of the National Academy of Elder Law Attorneys (NAELA). Russo has served thousands of individuals facing the current long-term care crisis. Russo addressed "two ill advised proposals that will harm tens of thousands of older Americans who have worked all of their lives, paid taxes and have never been on public assistance." One proposal to make penalties harsher calls for changing the start of the penalty period from the date of transfers to the date one applies for Medicaid. The other proposal would increase the lookback period to five years. Russo asserts that these proposals will create unacceptable new obstacles for vulnerable, frail elderly individuals and persons with disabilities to get care, partly because the proposals will require recordkeeping and documentation that is far beyond the normal practices of the elderly, especially poor and chronically ill. "Making asset transfer penalties more punitive will mainly hurt seniors who are faced with horrific health and income security choices and who are acting in good faith," said Russo.
Abstract: Patients and their families struggle with myriad choices concerning medical treatments that frequently precede death. Advance directives have been proposed as a tool to facilitate end-of-life decision making, yet frequently fail to achieve this goal. In the context of the case of a man with metastatic cancer for whom an advance directive was unable to prevent a traumatic death, I review the challenges in creating and implementing advance directives, discuss factors that can affect clear decision making; including trust, uncertainty, emotion, hope, and the presence of multiple medical providers; and offer practical suggestions for physicians. Advance care planning remains a useful tool for approaching conversations with patients about the end of life. However, such planning should occur within a framework that emphasizes responding to patient and family emotions and focuses more on goals for care and less on specific treatments.
Ohio's largest organization representing long-term care providers today filed a class action lawsuit against the Ohio Department of Job and Family Services (ODJFS) and the Ohio Department of Health. The lawsuit by the Ohio Health Care Association (OHCA) and several association members asserts that provisions of the recently passed biennial budget bill violate federal and state law.
"We must stand up for our members and protest some of the things that the budget bill does," said Peter Van Runkle, OHCA's President and Chief Executive Officer. "There are provisions in the bill that inappropriately penalize people who are trying to provide quality care to Ohio's seniors," he added.
The suit (Ohio Health Care Association, et al. v. Barbara Riley, Director, et al), which was filed in the Franklin County Court of Common Pleas, takes aim at a new formula for Medicaid payments to nursing homes being implemented by ODJFS. "The new price-based system does not take adequate account of capital expenditures that providers need to make so residents can have safe, pleasant living environments and to comply with ever-increasing building regulations," said Mr. Van Runkle. OHCA's lawsuit points out that the state did not follow the requirements of federal law when it adopted the new pricing system.
Tuesday, July 19, 2005
One of the best resources on the web for elder law policymakers and advocates is the KFF's Statehealthfacts.org website. Almost any critical piece of health-related info you might need--percentage of uninsured, cost of health insurance, women and minority health statistics--for all fifty states and the nation as a whole--is available in an easy to navigate format. Topics covered for each state include:
Demographics and the Economy
Health Coverage & Uninsured
Medicaid & SCHIP
Health Costs & Budgets
Managed Care & Health Insurance
Providers & Service Use
Each of these broad topic areas contains many subcategories. For example "Demographics and the Economy" covers
Distribution by Age
Distribution by Citizenship Status
Distribution by Family Structure
Distribution by Gender
Distribution by Race/Ethnicity
People in Poverty
Distribution by FPL
Poverty Rate by Age
Poverty Rate by Family Structure
Adult Poverty Rate by Gender
Poverty Rate by Metropolitan Status
Poverty Rate by Race/Ethnicity
Median Household Income
Total Yearly Income
Distribution by Status
Alternative Work Arrangements
Gross State Product
Total Gross State Product
State Collections per Capita
Total State Spending
Per Capita State Spending
Distribution of General Fund Spending
Wow! What more can you need when you're getting ready to write a letter to the editor or your next law review article!
The Center for Budget and Policy Priorities has issued WHAT DOES THE SAFETY NET ACCOMPLISH? Series of Reports Examine Research Findings.
Public benefit programs cut the number of poor Americans nearly in half (from 58 million to 31 million) and dramatically reduce the severity of poverty for those who remain poor, while providing health coverage to tens of millions of people who otherwise would be uninsured, according to a new report from the Center on Budget and Policy Priorities.
The report is one of a series the Center is issuing that reviews recent research on the effects of public benefit programs, primarily “safety-net” programs aimed at low-income families and individuals. The reports, based on a broad range of government and non-government studies, are particularly relevant today as policymakers begin to consider possible budget reductions in some of these programs in September, when Congress is charged with producing “budget reconciliation” legislation.
The first set of reports, issued today, cover Medicaid and the State Children’s Health Insurance Program (SCHIP), food and nutrition programs, the Supplemental Security Income Program for the elderly and disabled poor, and the Earned Income Tax Credit. Each report includes state-by-state data on the number of people assisted by that program. A separate Center report issued today examines the combined impact of the nation’s system of public benefit programs. Forthcoming reports will cover areas such as housing, child care, and child support enforcement.
Monday, July 18, 2005
Here's a way of expressing the costs of long term care in the average middle American can really understand:
The mounting cost of long term care has become a "monster" that is devouring acre after acre of the nation's prime cropland, pasture, and woodlands. . . It's a problem that affects agricultural families in every state, not just the farm belt.
"We've translated health-care dollars into acres, [and] the land rural families have spent a lifetime acquiring and cultivating." It turns out that the current cost for one month of nursing-home care roughly equals the selling price of an acre of rural land.
The average rate for a private room in a nursing home is now $70,080 a year, according to the latest MetLife Market Survey of Nursing Home and Home Care Costs, released in September, 2004. That's about $5,840 a month, a typical conservative selling price for many fertile acres in agricultural areas. The ratio varies from state to state and farm to farm, of course. Here are three examples:* 441-acre farm, Clay County, Illinois: $1,411,200 ($3,200 per acre)
1.83 -- Acres consumed by one month of long term care
* 165-acre farm, Covington County, Alabama: $1,200,000 ($7,273 per acre)
0.80 -- Acres consumed by one month of long term care
* 135-acre farm, Steuben County, NY: $375,000 ($2,778 per acre)
2.10 -- Acres consumed by one month of long term care
Long term care expenses consume even more acres in some areas, especially when the farm or ranch is small. For example, a 97-acre farm in Crawford County, Kansas -- up for sale at $145,500 -- would be "eaten up" at the rate of 3.89 acres per month! "If you're not protected by insurance, you've got to figure that for every month you're laid up, there goes another acre ... or more," says Truesdell.
A POTENTIAL crisis in long-term care is looming. Advances in medical science have seen life expectancy soar - and with it the incidence of prolonged health problems and the need for care in old age.
Although the Community Care & Health (Scotland) Act 2002 was billed as providing "free care for all", it only introduced free personal care at home - and even then, this is subject to availability.
"There's a perception that care is paid for," said Jason Hemmings, an associate director of Albannach Financial Management, which staged three Edinburgh seminars on the subject last month.
"The government contributed to that, claiming recent legislation introduced 'free care in Scotland', but it's quite easy to see that care isn't free."
So far, the government has shown little inclination to give everyone entitlement to whatever long-term care they require - including domestic and nursing care - free of charge.
Lesley Collins, the managing director of the independent financial adviser Independent Women, said: "We're facing a potential future crisis in long-term care. But, for the time being, the onus is on us as individuals to provide for ourselves."
And it is far from cheap. In Scotland, everyone is entitled to a flat rate of £145 per week, once they become resident in a care home. An extra £65 is payable for those who require nursing care in that home.
But, the cost of care in your own home amounts to a typical £350 per week - £18,200 per year, according to Laing & Buisson. The Scottish average for care in a nursing home comes in at £406 per week - some £21,100 per annum - which leaves a significant short-fall.
From the Fort Wayne (IN) Journal Gazette:
In an act of defiance, West Virginia sued the federal government over a 1993 law requiring states to recover Medicaid expenses by harvesting the estates of recipients who die.
The state lost.
Begrudgingly, West Virginia has started seeking repayments since that 2002 ruling. Michigan still has no recovery program, however, and Georgia and Texas are beginning programs, a testament to the emotions and politics that surround the issue.
Although the majority of states, including Indiana, have stepped up efforts to recoup expenses since the feds made it a requirement 12 years ago, a new survey has found the states have recovered only a fraction of the vast amounts the governments spend on long-term Medicaid care, and they differ significantly in what assets they pursue.
The survey was conducted last year and released last month by the American Bar Association and AARP, an organization representing seniors.
From the New York Times:
Four months before enrollment begins, the Bush administration has started a cross-country campaign to sell its most significant domestic policy initiative, the new Medicare drug benefit. But it is encountering skepticism from some consumers, whose participation is critical to the program's success.
In a stop here, four top Bush administration officials, including the surgeon general of the United States, said the drug benefit would be a boon to retirees, worth $1,300 a year to a typical recipient and much more to those with low incomes.
But the officials offered none of the details that would have allowed beneficiaries to judge for themselves. Crucial information, like the monthly premiums and the names of covered drugs, will not be available until mid-September.
After hearing federal officials praise the program for about 45 minutes, Joan M. Jenness, 72, of Bridgton, Me., said: "I heard nothing I had not heard before. I still have lots of questions."
Everyone enrolled in Medicare is eligible for prescription drug coverage. But public opinion polls suggest that many people have not heard about the new benefit or do not understand it, and many have not decided whether to sign up for it.
The Mayo Clinic has just posted a layperson-oriented overview of advance medical directives. It's generic--no state-specific information--but useful nonetheless.
For links for individual state laws on advance directives, the National Elder Law Network.
Ruth Ratzlaff has pointed out to me hat the APA missed the mark somewhat on its premature anticipation of the scope of Part D coverage for various mental health-related medications. The article I mentioned went to press before actual regs were issued. For details of Part D's mental health medication coverage and other issues, see CMA's paper, Will My Prescription Drugs by Covered?
Ed.: CMS seems more concerned these days with how to characterize various aspects of the Part D benefit (which I learned on Friday is not to be called "the Part D benefit") than educating seniors about the true consequences of the 2003 legislation...for example, the 1%.month penalty applied to those who don't enroll in the program when first eligible is not a penalty, it's "an increased cost." My prediction: the doublespeak won't stem the tide of outrage when the nation's 35 million seniors figure out on Jan. 2 just what their drug benefit really costs them--and that they can't insure themselves against the $3000 donut hole of out of pocket costs that they'll have to pay when the initial benefit runs out at $2250 of drug costs....see the KFF website's prescription drug calculator for more info.
Friday, July 15, 2005
APA is "cautiously optimistic" that patients with mental
illness covered under the new Medicare Part D prescription drug benefit will
have broad access to most psychotropic medications. However, there are some
Read the rest of the story.
As noted here last month, Medicare Part D won't cover many common anxiety drugs presently in wide use by the elderly.