Elder Law Prof Blog

Elder Law Prof Profile: Kenney Hegland (Arizona)

Professor Kenney F. Hegland is the James E. Rogers Professor of Law at the University of Arizona, where he teaches a variety of courses including Elder Law.  His academic and work bio:  Harvard Law School, LL.M. (1974); University of California, Berkeley, LL.B. (1966) Law Review and Coif; Stanford, A.B. (1963).  Professor of Law, University of Arizona College of Law, 1971 - present; Visiting Professor, USD London Program, 1999; Acting Dean, 1988 - 1989, University of Arizona College of Law; Associate Dean, University of Arizona College of Law, , 1986 - 1988; Visiting Professor, Harvard, 1980; Visiting Professor, UCLA, 1976 - 1977.  Full details are available at the Arizona Law website.

About his elder law course, Hegland says, "The best part of my class occurs outside the classroom. Each student must have a field project and most likely it has little to do with elder law. Perhaps it will be delivering meals on wheels, teaching computers at a Senior's Center, or hanging out with a member of their church, recording their life history.  Students find this most rewarding -- I love reading of their endeavnors."

In addition to authoring an extraordinary list of publications that includes books, Nutshells, and a host of traditional law review articles, Professor Hegland wrote the book "Fifty and Beyond, The Law You and Your Parents Need to Know (Carolina Academic Press 1999)", co-authored with elder law guru Allan Boguzt. "It was wonderful learning this area and trying to make it understandable to lay folks."  Another recent publication is his an essay on living wills, "Suggestions, Not Demands," which he says "takes a different, and I believe more humane, approach."  This article appeared in the October 2004 issue of the Arizona Bar Journal (October 2004) and is available on SSRN.

When he's not being a law professor, Prof. Hegland plays tennis, reads novels, and hangs out with his family. 

Book Review: Elders on Trial: Age and Ageism in the American Legal System

Susan Haire, Department of Political Science, University of Georgia, reviews

ELDERS ON TRIAL:  AGE AND AGEISM IN THE AMERICAN LEGAL SYSTEM, by Howard Eglit.  Gainesville, FL: University Press of Florida, 2004.  336pp.  Cloth. $49.95.  ISBN: 0-8130-2765-9:

In 1900, approximately four percent of the U.S. population was over 65.   By 2030, it is expected that 21 percent of the population will fall into this age group. In ELDERS ON TRIAL:  AGE AND AGEISM IN THE AMERICAN LEGAL SYSTEM, Howard Eglit explores the effects of this dramatic demographic shift on the legal system.  This account draws on existing empirical studies, rather than presenting original research, to explore the sources of ageism among judges, jurors, and litigants, and to evaluate how (or whether) the age of a legal actor affects performance. 

 

In the initial chapters, Eglit describes the nature of ageism in American society.  As he notes, Americans are ambivalent about aging, holding images of the older population that vary from selfless, wise statesman to the physically and mentally “slow.”  Eglit concludes that it would be more appropriate to label ageism as a bias (rather than a prejudice) and therefore defines it as a “skewing of attitudes and actions that typically (but not always) either works to the detriment of the subjects of those attitudes and actions or makes problematic ‘accurate’ treatment of oldsters, that is treatment that accords with objective, as opposed to subjective reality” (p.24).

 

Although age may be a legitimate criterion for dispensing certain privileges and identifying responsibilities, age bias arises when inaccurate stereotypes concerning the older population guide decisions.  Seeking to understand the sources of bias, Eglit outlines varying approaches and findings from multiple disciplines.  Tracing changes in attitudes toward the elderly over time, Eglit uses historical studies to note distinct trends that coincide with other political and social events in the 18th and 19th centuries.  He also discusses a rationale advanced by scholars drawing on the belief that productivity declines with age. These negative (and generally inaccurate) stereotypes contribute to age-based employment discrimination.  Although the Age Discrimination in Employment Act (ADEA) provides an avenue for pursuing a remedy to unlawful age discrimination, as Eglit notes, its use has been limited and perceptions of age-related declines in job performance linger in the workplace.  Moreover, older workers are often resented by their co-workers for benefits associated with seniority.

Read the rest of this review.

Howard Eglit is Professor of Law at Illinois Institute of Technology, Chicago-Kent College of Law.

KFF Poll: Public Cites Health Care As Second Most Important Problem for Government To Address

Americans rank health care (22%) behind only war and foreign policy issues (28%)
and just ahead of the economy (20%) as the most important problem for the
government to address according to the July/August Kaiser Health Poll Report
tracking survey. Fewer people name terrorism (9%), tax and budget issues (6%),
education (5%), and crime (3%) as the most important problem.

When asked about seven specific health care problems
<http://www.kff.org/healthpollreport/aug_2005/care/hcp_aug05_4.cfm>, people age
65 and older (23%) are more likely than young adults (14% of ages 18-29, 13% of
ages 30-49, and 14% of ages 50-64) to say lowering the cost of prescription
drugs is the most important issue for the President and Congress to address.
Younger Americans are more likely to pick lowering the cost of health insurance
as the most important health issue (26% of ages 18-29, 30% of ages 30-49, and
27% of ages 50-64); while just over one in ten (12%) seniors say it should be
the top health priority.

The Kaiser Health Poll Report provides ongoing tracking of public opinion in
three key areas: health care worries, health care priorities and attention to
health news. The report is based on data from a bimonthly national random sample
survey designed and analyzed by researchers at the Kaiser Family Foundation.

Findings for the current survey are based on a national random sample of 1,205
adults conducted August 4-8, 2005. The margin of sampling error is ± 3%. The
complete Kaiser Health Poll Report is available online
<http://www.kff.org/healthpollreport/CurrentEdition/index.cfm>.

Joint Conference: National Council on the Aging and American Society on Aging

The 2006 NCOA-ASA Joint Conference takes place Thursday-Sunday, March 16-19, 2006, at the Hilton and Marriott hotels in Anaheim, California, USA. Additionally, a host of preconference events will take place on Wednesday. See the conference schedule for details as they become available. The preliminary conference announcement will be available in late October. If you would like to receive one or multiple copies to distribute to colleagues, click here.

Call for Papers: Due Sept. 1, 2005

The International Conference on Aging, Disability, and Independence will be held in St. Petersburg, FL on Feb.  1-5, 2006.  Call for papers closes on Sept. 1, 2005.  Get more info on the conference and submission requirements here.

Chinese elderly offered adult day care option

China has the world's largest elderly population--currently some 98 million persons aged 65 and older.  Here's how one province is helping its aged citizens:

SHENYANG: Zhang Hongwen, 75, wolfed down his breakfast because he was in a hurry to meet worthy chess adversaries somewhere in Tiexi District of Shenyang.

"I just can't help coming here, It's much more interesting than staying at home alone and watching TV," said Zhang, sitting in a newly established day centre for the elderly.

The centre was set up by the local government to take care of senior citizens left alone at home while their children go out to work.

The local government invested almost 500,000 yuan (US$61,650) in establishing the 120 square-metre centre, which includes a gymnasium, an entertainment room and a dining hall.

Senior citizens can enjoy the facilities and services for just 1 yuan (US 12 cent) per day, whilst those from poorer families can be exempted from the fee.

Read more in The China Daily.

KFF Updates State Medicaid Benefits Database

A newly enhanced interactive database based on 50-state survey data provides 
easy access to information on health services provided by each state's Medicaid 
program. You can search the database by state or Medicaid benefit and compare 
benefit packages from 2003 and 2004.

Access the database at KFF's Medicaid Benefits page.

AARP Publishes Boomer Retirement Info

Retirement Plan Coverage of Baby Boomers: Analysis of 1998 SIPP Data
Research Report

Satyendra Verma, AARP Public Policy Institute

August 2005

Abstract:  Baby Boomers form the largest group of U.S. workers. In 1998, the reference period for this comprehensive study of the retirement coverage of all U.S. workers, boomers (then aged 33 to 52) represented 51% of the workforce. This AARP Public Policy Institute chartbook by Satyendra K. Verma analyzes the retirement coverage for boomers as well as younger workers (age 16-32), older workers (age 53-64), and retired workers (age 65 and older). Coverage is defined in three broad measures: at current job, during entire career, and any (and all) coverage--which includes pensions, IRA and Keogh accounts.

Clearly displayed in many charts and tables (with brief explanations or thematic highlights) is retirement plan coverage by many factors, including age, gender, income, education, marital status, and race. Other categories include class of employment (private or public), size of firm, length of time on primary job, and full or part-time employment. Besides retirement coverage, the book also details types of plans (defined-benefit and defined-contribution plans), rollovers, and lump-sum distributions--including the ways in which these distributions were spent or channeled.

Get it from AARP.

SSA Releases "Life Tables for the US Social Security Area 1900-2100"

Actuarial Study No. 120 displays life tables based on historical and projected mortality in the area
covered by the United States Social Security program. This projected mortality was used in estimating the future costs for the Old-Age, Survivors, and Disability Insurance (OASDI) program included in the 2005 Report of the OASDI Board of Trustees to Congress. A web address for this and other Actuarial Studies is www.socialsecurity.gov/OACT/NOTES/actstud.html.

Warning:  this study is not for the math-impaired.  Here's a sample of the text:

    The life table functions lx, dx, Lx, Tx, and were calculated
as follows:

l0 = 100,000
dx = lx • 1qx x = 1, 2, 3, …
lx = lx-1 • (1 - 1qx-1) x = 1, 2, 3, …
L0 = l0 - 1f0 • d0
Lx = lx - .5 • dx x = 1, 2, 3, …
Tx = Lx + Lx+1 + Lx+2 + … + L148 x = 0, 1, 2, 3, …
= Tx / lx x = 0, 1, 2, 3, …

***

One method that has been used to calculate probabilities of
death for a life table that are consistent with the underlying
pattern of mortality experienced in the population is to
require that the life table central death rates for quinquennial
age groups, 5mx, equal the population central death rates,
5Mx. That is 5mx = 5Mx for x = 5, 10, 15, …, 90
Unfortunately, making these central death rates equal may
introduce error when they should differ because the age distribution
within the quinquennial age groups in the stationary
population implied by the life table differs from that in the
actual population under study. The degree of consistency can
be improved using the relationship,

5mx =
dx + dx+1 + dx+2 + dx+3 + dx+4
Lx + Lx+1 + Lx+2 + Lx+3 + Lx+4
=
dx •Lx+
dx+1 •Lx+1+
dx+2 •Lx+2+
dx+3 •Lx+3+
dx+4 •Lx+4 Lx Lx+1 Lx+2 Lx+3 Lx+4
Lx + Lx+1 + Lx+2 + Lx+3 + Lx+4
=
mx•Lx + mx+1•Lx+1 + mx+2•Lx+2 + mx+3•Lx+3 + mx+4•Lx+4
Lx + Lx+1 + Lx+2 + Lx+3 + Lx+4

If you understand that, then this publication is for you!

New, Improved Version of HRS Data Released

From the University of Michigan's Health and Retirement Study page: 

A new version of the RAND HRS Data File has been released, replacing all prior versions.

The RAND HRS Data file is a cleaned and easy-to-use version of the Health and Retirement     Study (HRS) with derived variables covering a broad range of measures and named     consistently across waves. The file was developed by the RAND Center for the Study of Aging     with funding from the National Institute on Aging (NIA) and Social Security     Administration (SSA).

As of 2005, eight HRS waves are available for study. The RAND HRS Data file (Version E) is based on 1992, 1993, 1994, 1995, 1996, 1998, 2000 and the 2002 final releases of HRS data. The complete HRS includes four entry cohorts, as does the RAND file. The file incorporates only the core interviews. It does not include exit interview or any restricted data.

Besides incorporating the 2002 final releases, this version corrects known problems and adds     some new variables for insurance, pensions, retirement, poverty and nursing home utilization.

Please see the     rnd_Edd.pdf file for a brief data description. The data are described in     detail in the RAND HRS Data Documentation, which is included in this     distribution. It contains complete descriptions of the derived variables,     including descriptions of how they are constructed, notes on cross-wave differences,     and all raw HRS variables used.

The Office of Research, Evaluation, and Statistics at SSA provided important research direction in the design of this data file.

See the RAND Contributions page for further information.

CMS Proposes Vaccination Rule for LTC facilities

In an effort to boost immunization rates at long-term care (LTC) facilities participating in Medicare or Medicaid, CMS has proposed to require the facilities to provide immunizations against influenza and pneumococcal disease to residents as a new condition of participation (COP). Under the proposed rule, LTC facilities would be required to offer the influenza vaccine annually, between October 1 and March 31. An offer of pneumococcal vaccine usually will be required only once during a beneficiary's lifetime.

According to input from the Centers for Disease Control, most individuals will require the pneumococcal vaccine only once. A second dose is recommended for individuals over age 65 whose first dose was administered more than five years ago, before they reached age 65.

Each facility must offer residents or, if applicable, their personal representatives, the opportunity to accept or refuse the service unless the immunization is medically contraindicated or the resident has already been immunized. If the resident or personal representative refuses, the facility must document the refusal.

See the Proposed Rule.

Administrative Office, US Courts Warns of Jury Service ID Theft Scam

The Administrative Office of the United States Courts is warning that "some citizens have received phone calls for allegedly failing to comply with jury service in federal or state courts. These calls could lead to identity theft and fraud. " Get details.

Editor's note:  The elderly are particularly susceptible to telephone scams such as this one, so get the word out!

Elder Law Prof Profile: Marshall Kapp (Southern Illinois)

                          Marshall B. Kapp was educated at Johns Hopkins University (B.A.), George Washington University Law School (J.D. with Honors), and Harvard University School of Public Health (M.P.H.)  He is the Garwin Distinguished Professor of Law & Medicine at Southern Illinois University School of Law and School of Medicine.  He is Professor Emeritus from the School of Medicine at Wright State University, where, from 1980 through 2003, he was a faculty member in the Departments of Community Health and Psychiatry and taught courses on the legal and ethical aspects of health care.  He also was Director of WSU's Office of Geriatric Medicine and Gerontology and held an adjunct faculty appointment at the University of Dayton School of Law.  From 1998-2001, he was designated Wright State University’s Frederick A. White Distinguished Professor of Service. He is the author or co-author of a substantial number of published articles, book chapters, and reviews.  Mr. Kapp was the founding editor (2000-2005) of the ETHICS, LAW, AND AGING REVIEW (formerly the Journal of Ethics, Law, and Aging, 1994-1999) formerly published by Springer Publishing Company and founding editor (1994-2005) of Springer's Book Series on Ethics, Law and Aging.  Additionally, he is the present Editor of the Journal of Legal Medicine, the official scholarly publication of the American College of Legal Medicine.  He is a Fellow of the Gerontological Society of America and of the American College of Legal Medicine and currently serves as Secretary of the American Society on Aging.  He spent the 1987-88 academic year on Professional Development Leave as a Robert Wood Johnson Foundation Faculty Fellow in Health Care Finance.  In 1997, he received the Journal of Healthcare Risk Management Award for Writing Excellence as Author of the Year from the American Society for Healthcare Risk Management.  In 1998, he was named Ohio Researcher of the Year by the Ohio Research Council in Aging.  In 2003, he received the Donald Kent Award of the Gerontological Society of America for exemplifying “the highest standards for professional leadership in gerontology through teaching, service, and interpretation of gerontology to the larger society.” 

Professor Kapp teaches a Law and Aging seminar at SIU.  Get more information on him at the SIU Law Website.

Elder Law Profs on Parade

Starting today and continuing for the next two or three weeks. I'll be featuring elder law profs from around the country--get to know your fellow teachers of the fastest growing practice specialty in the country (according to the latest BLS reports).  If you know of a law prof or adjunct faculty member who should be featured here, send me a short bio and link to further info for inclusion on the site.

Michigan may slash funding for home health care for seniors

From The Detroit News Online:

Hundreds of frail seniors and adults with disabilities are on a waiting list to join a popular social services program called MI Choice. Designed to help people who need assistance to stay in their homes rather than go to nursing homes, the program provides help with everything from meals to cleaning to transportation.

State lawmakers are contemplating a $7.5 million to $9.7 million cut to MI Choice because of the state's budget troubles and what some say are high administrative costs. Social service officials say the cuts would effectively close the program to new enrollment, waiting lists will swell, and client care could suffer. More than 1,000 people in Metro Detroit already are on waiting lists.

Advocates of the cuts, however, say they are providing more money for client care by streamlining administrative costs. Mary Ablan, executive director of the Area Agencies on Aging Association of Michigan, said if lawmakers' proposed cuts begin Oct. 1, there will be fewer social workers and nurses, which could affect care for clients.

Read more.

Prices of Drugs for Elderly Said to Far Outrun Inflation

    For the third consecutive year, the average prices of dozens of brand-name prescription drugs widely used by elderly Americans have risen more than twice as fast as general inflation, according to a survey to be released today by the advocacy group AARP.

    The 12-month average increase for 195 drugs was 6.6 percent, or more than double the 3.1 percent rise in the Consumer Price Index that tracks general inflation.

    Also in line with the trend in recent years, there was little inflation - less than 1 percent - in the average price of generic drugs, AARP said.

    Consumer groups, including AARP, which represents older Americans, have been trying to persuade Congress and the Bush administration to use Medicare's vast purchasing power to bargain directly with drug makers on prices. Under the 2003 law that set up the new drug benefit, Medicare is currently barred from such negotiating, but must accept prices negotiated by insurers, drugstore chains and pharmacy benefit managers - which individually lack Medicare's clout.

For the complete article go to http://www.truthout.org/issues_05/081605HB.shtml.

Snapshot:  California’s Fragile Nursing Home Industry

This snapshot report examines nursing home care in California and uncovers problems with staffing, quality of care, regulatory compliance, and financial stability.

The report notes serious problems in California’s nursing homes:

• Only a small percentage of the state’s freestanding nursing homes meet the standards recommended for staffing levels to provide good nursing care.

• Continuing high staff turnover threatens quality of care. More than two-thirds of the nursing staff in California’s nursing homes left their jobs in 2003.

• Many residents show clinical signs of poor care as a result of being left in bed all or most of the time, or being placed in physical restraints.

• Most nursing homes do not meet government compliance standards for care and safety. Fifteen percent of homes were cited for very serious quality of care problems or substandard care, which causes harm or jeopardy to the health of residents. Some 77 percent had serious noncompliance with federal care and safety regulations during their most recent mandatory inspection.

• Half of the state’s nursing homes reported negative or zero profit margins.

The snapshot illustrates the current state of California’s long-term care facilities as they face growing demands and diminishing resources. The number of Californians age 65 and older is projected to nearly double by 2025—a larger growth rate than any other state.

For the complete article go to http://www.chcf.org/topics/view.cfm?itemid=113183.

Health Mystery in New York:  Heart Disease

Death rates from heart disease in New York City and its suburbs are among the highest recorded in the country, and no one quite knows why.

The pattern has raised questions about whether people in the New York area live with an excess of heart disease risks - stress, bad diets, too little exercise. But it has also prompted speculation that doctors in the area may lump deaths with more subtle causes into the heart disease category, making that toll look worse than it actually is.

Now, there are efforts under way to sort out the mystery: The New York City health department and the National Institutes of Health are conducting extensive studies to better assess poorly measured factors like stress, blood pressure and cholesterol in people in the New York area.

But the phenomenon is only now drawing attention, as epidemiologists become more interested in geographic variation in disease.

The clearest predictors of heart disease are certain risky behaviors, like smoking and eating a high-fat diet. But according to the Centers for Disease Control's Behavioral Risk Factor Surveillance System, an annual national survey, people in the New York area, whether the city or suburbs, smoke less than average and are less likely to be obese than those in the rest of the country. They may not get as much exercise, however, and they may also have higher cholesterol levels.

The discordant rates for stroke and heart disease in the New York area also lead some authorities to suggest that doctors and hospitals lump deaths from other causes into heart disease categories.

For complete article go to http://www.nytimes.com/2005/08/18/nyregion/18heart.html?th&emc=th.

Has Time Run Out?  The Coming Avian Flu Pandemic 

  Deadly avian flu is on the wing.

    The first bar-headed geese have already arrived at their wintering grounds near the Cauvery River in the southern Indian state of Karnataka. Over the next ten weeks, 100,000 more geese, gulls, and cormorants will leave their summer home at Lake Qinghai in western China, headed for India, Bangladesh, Myanmar, and, eventually, Australia.

    In anticipation of this next, and perhaps inevitable, stage in the world journey of avian flu, poultry populations are being tracked in Moscow; Alaskan scientists are studying birds migrating across the Bering Straits, and even the Swiss are looking over their shoulders at the tufted ducks and pochards arriving from Eurasia.

    At the least, gearing up for larger-scale production will take many months and production itself is limited by the antiquated technology of vaccine manufacture which depends upon a vulnerable and limited supply of fertile chicken eggs. It would also likely mean the curtailment of the production of the annual winter flu vaccine that is so often a lifesaver for many senior citizens.

    Moreover, the majority of the world, including all the poor countries of South Asia and Africa where, history tells us, pandemics are likely to hit especially hard, will have no access to expensive anti-virals or scarce vaccines. It is even doubtful whether the WHO will have the minimal pharmaceuticals to respond to an initial outbreak.

      As for a universally available "world vaccine," it remains a pipe-dream without new, billion-dollar commitments from the rich countries, above all the United States, and even then, we are probably too late.

For the complete article go to http://www.truthout.org/docs_2005/081705C.shtml.

The Role of Public Health in Healthy Aging

Individuals in the United States paradoxically long for and dread old age. The alternative to growing old is an outcome few of us would prefer. But aging seems inevitably associated with decline. Independent choices, a hallmark of adulthood, can be lost between one day and the next with a heart attack, a stroke, or a fractured hip. This issue of the U. S. Centers for Disease Control and Prevention's journal, "Preventing Chronic Disease," explores the role of public health in healthy aging.

Source: Preventing Chronic Disease (Jul 2005)

Full story: http://www.cdc.gov/pcd/issues/2005/jul/toc.htm