Elder Law Prof Blog

Taking Care:Ethical Caregiving in an Aging Society

The President's Council on Bioethics has just released "Taking Care:  Ethical Caregiving in our Aging Society." Here's an excerpt:

Taking Care addresses the ethical challenges of caregiving in our rapidly aging society, with special attention to the care of people with dementia. Our purpose is to provide a humanly rich account of the caregiving dilemmas—social, familial, and personal—and to offer some important ethical guidelines for the care of persons who can no longer care for themselves.

There is no question that we are on the threshold of a “mass geriatric society,” a society of more long-lived individuals than ever before in human history. For this great gift of longer and healthier life for ourselves and our loved ones we are, and should be, enormously grateful. No sensible person would wish to return us to a time—not that long ago—in which the diagnosis of uncontrolled diabetes meant certain death within a month or two, in which women commonly died giving birth, children often died of smallpox and polio, and nothing could be done for tuberculosis, syphilis, and other deadly infectious diseases. Old age today is—for the most part and for most people—much better than it used to be: millions of Americans are staying healthy and active well into their seventies and eighties, and some deep into their nineties. By historical standards, it is a wonderful time to be old.

At the same time, however, there are good reasons to be concerned about the human and moral shape that a mass geriatric society will take, especially if the “price” many people pay for the gift of added years of healthier life is a period of protracted debility, dementia, and dependence stacked up at the end before they eventually die. Such a reshaping of the lifecycle will create enormous challenges for nearly every family and for the entire society. The economic challenges facing Social Security, Medicare, and Medicaid are more or less well known. A looming crisis of long-term care for the incapacitated has received less attention, partly because we prefer to avert our gaze, largely because we lack an adequate human and ethical understanding of this issue.

Socially, we have preferred to place our hopes in programs that promote healthy aging and in scientific research seeking remedies for incapacitating diseases like Alzheimer’s. Insofar as we do approach the topic of long-term care, we worry mainly about numbers and logistics: How many will need it? Who will provide it? How will we pay for it? The ethical questions of what the young owe the old, what the old owe the young, and what we all owe each other do not get mentioned. Neither do the questions of social support for the caregivers or a good end of life for us all.

In the meantime, millions of American families, more each decade, already face the difficult task of caring for frail and incapacitated elders, often entirely on their own with very little social support. And millions more, “the worried well,” live anxiously, dreading the prospect that the curse of untreatable dementia and disability will descend on them before a cure arrives, to ruin their final years, deplete their savings, and burden their loved ones with the obligation to care for them. Their generalized anxiety often focuses on end-of-life decision-making, commonly expressed in a fear that others will impose life-sustaining treatments on them when they are too demented to choose for themselves or too diminished to benefit from the intervention.

Largely in response to these anxieties of the worried well, our society has embraced the idea of advance directives, especially living wills, in which individuals try to determine in advance how they wish to be treated should they become incapacitated. This approach to the dilemmas of caregiving gives major ethical weight to personal autonomy and choice and personal pride in self-sufficiency. But in so doing, it deliberately ignores the truth of human interdependence and of our unavoidable need for human presence and care, especially when we can no longer take care of ourselves. The moral emphasis on choosing in advance needs to be replaced with a moral emphasis on caring in the present. The moral emphasis on independence needs to be supplemented with a moral commitment to serve the lives of those we love, regardless of their disabilities. A culture of caregiving requires moral support from an ethics of care.

And here's an op-ed piece by Leon Kass relating to the report, from the Washington Post.

                                                                    

Senator Plans To Push Elderly Home Monitor System

I don't know if this is a good thing, or just really Big Brother-creepy...truly.

From The Iowa Channel on-line:

DES MOINES, Iowa -- An Iowa senator is planning to push for a new program to save the state in Medicaid costs.Marguerite Avant, 81, lives alone in big house, and is surrounded by pictures of her family.Now, her family can keep tabs her with a new monitoring system called QuietCare, which is made by a division of the ADT security company.

There are motion detectors in the refrigerator, near Avant's medications, and in her bedroom that report her activities to a Web site."You can see by the activity index she woke up on Monday at 4 a.m.," said Tom Vasquez, of ADT. Caregivers can then watch her activities online.

"I'm excited about it, until I do something wrong," Avant said. The computer keeps track of how often she reaches for her pills, how many times she opens the refrigerator and learns how active she is on a daily basis. If something changes, the system alerts the family with a phone call.

A sensor is set up inside and outside the bathroom to monitor how long the person is in there, since bathroom falls are common.  State Sen. Matt McCoy said the system can give peace of mind to children and save the state money.

"The average cost of a nursing home is $2,500," McCoy said. He said taxpayers would say $30,000 per year if an elderly person were prevented from entering a nursing home for a year.

Avant said the $90 monthly fee for the service is worth it. "It makes me feel not so alone," she said.
Avant wants to stay in her home and welcomes in modern technology like an old friend.  "It will stop my family from worrying about me so much," she said.

...next thing you know, she'll have a chip in her head....

Judge: Companies can offer two-tier retiree health packages

USA Today reported yesterday:

Reversing her earlier decision, a federal judge ruled that companies may offer younger retirees better health care benefits than they give older retirees who qualify for Medicare.

The AARP sued over the rule change proposed by the Equal Employment Opportunity Commission on grounds that unequal health packages amount to age discrimination.

U.S. District Judge Anita B. Brody initially agreed, granting an injunction in March that barred the federal agency from adopting the rule. However, a recent U.S. Supreme Court ruling in an unrelated case compelled her to change course, she said in a ruling Tuesday.

Brody prohibited the agency from acting, though, until the AARP has a chance to appeal.

A lawyer for the AARP, which sued on behalf of several members who saw their health benefits decline when they turned 65, said an appeal is likely.

Get the full opinion here.

Female and Elder Consumers and Payers Sue Pfizer Over Deceptive Marketing of Lipitor(R)

    Consumers today filed the first-of-its- kind nationwide class-action lawsuit against Pfizer (NYSE: PFE), claiming the world's largest drug company misled consumers into using its anti-cholesterol drug Lipitor despite the absence of evidence from clinical trials that these drugs are of any benefit to large segments of the population.    According to Steve Berman, the lead attorney for the proposed class, Pfizer promoted Lipitor by claiming it prevents heart disease in women and the elderly, where no clinical test has established such a benefit. In fact, according to the complaint, women without heart disease taking Lipitor actually developed 10 percent more heart attacks than women treated with a placebo.
    The lawsuit alleges that Pfizer engaged in a massive campaign to convince both doctors and patients that Lipitor is a beneficial treatment for nearly everyone with elevated cholesterol, even though no studies have shown it to be effective for women and those over 65 years of age who do not already have heart disease or diabetes.

Get the rest of the story from PRNewswire.

Irish Health Minister Promises: Elderly to benefit from improved home care

Dependent elderly citizens are to benefit from a stronger support network this winter to help them remain in their homes, the Tánaiste revealed today. Health Minister Mary Harney pledged to substantially increase home care packages, rather than placing people in residential care, as part of a new policy towards elderly people. “It is time for new thinking, new policies and new practices on services for our senior citizens,” Ms Harney said. “A key priority is supporting people to stay in their own homes and communities and moving away from the practise of placing people in residential care as a first option.”

At the National Economic and Social Forum plenary session on long term care at Dublin’s Royal Kilmainham Hospital, Ms Harney said around 28% of residents or about 5,000 people in long-stay beds were in low to medium dependency categories.  She said many of these people could be cared for in their homes with the appropriate level of supports.

“Currently, we do not offer enough support to high dependency patients who want to remain at home. I am determined to change this and I expect we shall see a major increase in Home Care Packages this winer as a cornerstone of new thinking and new policies on long term care,” Ms Harney said.

Read the rest of this story at Ireland On-Line.

McGuinty Government to make important health care announcement

NEWMARKET, ON, Sept. 28 /CNW/ - Ontario Health and Long-Term Care
Minister George Smitherman will make an important announcement concerning the
future of Southlake Regional Health Centre.

    DATE:        Thursday, September 29, 2005

    TIME:        10:00 a.m.

    LOCATION:    Southlake Regional Health Centre
                 East Lobby, 596 Davis Drive
                 Newmarket ON
                 Main Entrance off Roxborough Road.

                            www.health.gov.on.ca

Sen. Wyden Says He Has Enough Votes for Measure That Would Permit Federal Government To Negotiate Medicare Medication Prices Directly

From the Las Vegas Sun:

WASHINGTON (AP) - An Oregon senator says he has enough votes in the Senate to pass an amendment allowing the government to negotiate Medicare drug prices directly with pharmaceutical companies, a change opposed by President Bush and other Republicans as well as the drug industry.

"We're looking for the right vehicle to get this important provision into law and get some cost containment into the Medicare benefit," Sen. Ron Wyden [D-Ore.] said at a news conference.

Wyden's comment came as a new study showed that people who get their drug benefits through the Veterans Affairs Department paid about $220 less for a yearlong prescription than those who used the government's Medicare drug card.

The study by Families USA, an advocacy group, said older people using the discount cards paid more than they would have paid through the VA for 49 of the 50 drugs most frequently used by senior citizens.

Wyden, a Democrat who voted for the 2003 bill, has come under intense criticism from senior advocates and others who opposed the bill as far short of the reform needed to make Medicare effective and affordable. He has vowed to change the law, starting with the plan to grant bargaining power for drug prices.

Wyden has worked with Sen. Olympia Snowe, R-Maine, to push for government bargaining power for prescription drugs. An amendment they co-sponsored failed by two votes during Senate budget deliberations in March.

Wyden declined to identify the two senators who have changed their minds, but he repeated several times that he and Snowe had the votes needed to approve the amendment.

The 2003 law specifically bars Medicare administrators from interfering in any way with negotiations between Medicare recipients and hospitals, drug manufacturers, wholesalers or suppliers.

Even if the measure passes the Senate, it is unlikely to become law. President Bush and Republican leaders in the House and Senate oppose the provision, saying it could result in massive cost shifts to privately insured patients. The pharmaceutical industry also opposes the plan.

Ken Johnson, a senior vice president with the Pharmaceutical Research and Manufacturers of America, said there is no reason to believe that granting the government bargaining power under the Medicare law would lower drug costs.

"The system was set up so that robust competition among private insurance companies would drive prices down," Johnson said. "More competition equals lower prices. It is simple economics."

Ed: As noted previously in this blog, the MMA was drafted in part by the pharmaceutical industry, which did not want to allow CMS the authority to negotiate directly for lower prices.

Warning: Not Elder Law: Facial bone loss contributes to looking older

You can blame the bones in the face, not just gravity, for those wrinkles, jowls, and the general drooping appearance that comes with age. A new study shows that the shrinking of facial bones plays a surprisingly important role in the aging of the face. Dr. David Kahn, a Palo Alto, California-based plastic surgeon and author of the study told Reuters Health: "What I think happens is that the bones in the face lose volume and recede a little bit as we age." He presented the results of the study Sunday at the annual meeting of the American Society of Plastic Surgeons in Chicago. "When we think of aging of the face," Kahn continued, "we typically just think that the soft tissue -- the skin and the fat -- deteriorates and becomes looser or bigger and we typically just lift everything back up and take out some skin to tighten it back up."

Get the rest of the sad, sad truth at Reuters Health.

The Other MMA Drug Benefit: Changes to Reimbursement for Medicare Part B Drugs

The American Health Lawyers Association is hosting a teleconference entitled

The Other MMA Drug Benefit: Changes to Reimbursement for Medicare Part B Drugs
Thursday, September 29, 2005
1:00-2:30 pm Eastern; 12:00-1:30 pm Central; 11:00 am–12:30 pm Mountain; 10:00-11:30 am Pacific

Register online or call the Member Service Center at (202) 833-0766. Registrations must be received by 5:00 on September 28.

Although the new Medicare Part D drug benefit has received much attention as of late, recent changes to reimbursement for drugs reimbursed under Medicare Part B have a far larger impact on hospitals, physicians, and other healthcare providers and suppliers. After much scrutiny by Congress, OIG, and others for over a decade, Congress effected major changes to Part B drug reimbursement in the Medicare Modernization Act of 2003. In large part, these changes reduce payments to entities and individuals that submit claims for Part B drugs, but there may be some opportunities for some. While affected parties struggle to protect their bottom lines in light of these changes, they must also consider the additional compliance risks that are an integral part of the complete overhaul of the prior system.

This teleconference discusses how the changes brought about by the MMA, as implemented by CMS, affect various healthcare entities and individuals.

Dems Introduce Legislation That Would Allow Medicare Beneficiaries Additional Six Months To Enroll in Drug Benefit Without Penalty

Via KFF and the Congressional Quarterly:

Reps. Pete Stark (D-Calif.) and Jan Schakowsky (D-Ill.) have introduced a bill (HR 3861) that would extend from May 15, 2006, until Dec. 31, 2006, the deadline for beneficiaries to enroll in the Medicare prescription drug benefit without financial penalties, CQ HealthBeat reports. In addition, the bill would allow beneficiaries to make a one-time change in their enrollment plan during 2006 and would prohibit beneficiaries' former employers from dropping retiree health benefits during the first year of the drug benefit. In a news release, Stark and Schakowsky said beneficiaries need more time to consider their options under the drug benefit. Stark said the bill would "provide beneficiaries extra protections during the first year of this complex new program so that they won't feel pressured into making a bad choice." Schakowsky said, "Senior citizens and people with disabilities will soon be inundated by marketers and have to sort through 40 to 50 plans without the support of independent counselors. That's why we need this bill"

Here's the bill.

VA Drug Program Said Cheaper Than Medicare

It appears that the Medicare discount card program was no benefit to veterans:

WASHINGTON -- People who get their drug benefits through the Veterans Affairs Department paid about $220 less for a yearlong prescription than those who used the government's Medicare drug card, said a study released Tuesday.

Families USA, an advocacy group, said older people using the discount cards paid more than they would have paid through the VA for 49 of the 50 most frequently used drugs for senior citizens.

The discount cards have been in effect for less than 18 months. They will be replaced Jan. 1 by a comprehensive benefit that beneficiaries can obtain by enrolling with a private plan.

A spokesman for the Centers for Medicare and Medicaid Services, or CMS, said the discount cards did exactly as advertised -- providing a savings of 10 to 25 percent for those who otherwise did not have drug coverage. It's not fair to compare them to the more comprehensive benefit to come, he said.

"This is old news," said the spokesman, Gary Karr.

He also said there will be a greater choice of drugs under the coming benefit than there is under the VA program.

Families USA opposed legislation in 2003 that brought created the coming benefit under Medicare. Ron Pollack, the organization's executive director, said he believes the comparison between plans shows what can occur when the federal government negotiates on behalf of consumers.

Read more in Newsday/AP.

CMS Posts Medicare Part D info for providers.

Get it here.  http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/SE0520.pdf

Health Casts from KFF

his Week on HealthCast            

* Caring for the Elderly: Is There Any Answer to Rising Health Costs? - Alliance for Health Reform, Health Affairs and RAND - 9/26/2005

* Implementing The Medicare Drug Benefit: The Stories Ahead - Alliance for Health Reform - 9/27/2005

* In Need of Correction: The Prison Cycle of Health Care - American Public Health Association and Community Voices Initiative - 9/28/2005

Think about this....

Chinese seniors over 60 reach 130 million

(Xinhua)

The number of senior citizens above the age of 60 has reached 130 million in China, or more than one tenth of the country's total population.

And China's gray-haired population has kept an annual growth rate of three percent, according to information from a recent forum on the country's old-age care trends and countermeasures held in Kunming, capital of southwest China's Yunnan Province.

The birth rate has kept falling, while the average life span has continued to rise in China, thanks to social, economic and scientific progress and improvement in medical and health conditions.

It is estimated that by the year of 2015, the population of senior citizens above the age of 60 will exceed 200 million yuan in the country and the figure will rise to 280 million by 2025.

 

We're extending our lives, but at what price?

How much is an extra year of your life worth?

That blunt inquiry is at the heart of a Rand Corp. study to be published today, and the answers are sobering.

The well-known think tank found that costly future treatments such as improved defibrillators or drugs for Alzheimer's disease pose great financial risk to the Medicare program.

For instance, the study found that new pacemakers could cost Medicare and other insurers $1.4 million for every extra year of life they add. In comparison, healthcare economists often use $100,000 per added year of life as the maximum of benefit worth paying by the government insurer. In another example, the study predicted the use of tumor-strangling drugs would mean $498,809 per additional life-year.

Dana Goldman, the study's lead author and Rand's director of health economics, says the conclusions cut across the conventional wisdom that the biggest risk to Medicare is the aging of the US population.

Goldman said his study shows that the unforeseen costs of new technologies might be an even more difficult problem because they are less predictable.

Read more in the Boston Globe. 

Check out this great series on retirement savings and the boomers...we're in trouble.

Today' Minneapolis Star Tribune has a great series of articles on the boomers' retirement planning strategies--or lack thereof.  They include:

Amid woeful tales, a story of retirement-plan success

In the glass-half-full spirit, the news is not all bad on retirement these days.… H.J. Cummins

Cash-balance plans change rules of game

Call them "pensions lite."One of the biggest jolts in all the pension turbulence has been cash-balance plans, the latest big iteration of retirement benefits for working Americans.… H.J. Cummins

Broad legal definition enables professionals to boost pensions

Even as pensions fade away for most workers, some of the country's highest-paid professionals have found a way to significantly boost the money they put into their pensions, some socking away as much as $100,000 a year.… H.J. Cummins

On 401(k)s, many dropping the ball

Sonja Gauthier had hoped to save about a half-million dollars in her 401(k) account before she retired. After 10 years and plenty of good intentions, she has only $32,000 tucked away.… H.J. Cummins

3 generations of retirement plans

One American family traces the course of retirement income from big, safe-bet pensions to a 401(k), to a third generation that expects nothing from anyone. They are the Williams family -- grandpa Bruce, son Brian and grandson Erik.… H.J. Cummins

Know your pension definitions

Traditional…

How poorly Americans save for retirement

Six in 10 U.S. workers say they are saving in some way for retirement. But half say their family assets, not counting their homes, add up to less than $25,000.…

Investing calendar

Pensions are in crisis

Retired mechanic Randy Daly had two thoughts when Northwest Airlines declared bankruptcy: "I'm going to lose medical benefits for me and my wife," he said. And, "If my pension gets turned over to the government, I'm going to lose some more money."Both are strong possibilities for the Apple Valley resident, who's 61, and together they would cost him about $1,300 of the $2,860 monthly benefit he just started collecting in April.… H.J. Cummins

Mafia retirement benefits often include funeral, little else

Via the Associated Press/Minneapolis Star Tribune:

No pension, no medical benefits, no prescription plan. When you're a mob boss, retirement is more bronze casket than golden parachute.

Since the 1930s ascension of the Mafia, its leaders have departed "The Life'' almost exclusively through their deaths. Albert Anastasia, Carmine Galante and "Big Paul'' Castellano were brutally (and memorably) assassinated; Vito Genovese, John Gotti and "Fat Tony'' Salerno died in prison.

A third, more palatable option emerged in recent years: The Witness Protection Program, for those who found relocation to Arizona preferable to interment in Queens.

Ed:  there's more to this story, but I couldn't resist the headline....

CMS Announces Approved Part D Plans

CMS has announced the drug plans that will be available to Part D enrollees beginning in January 2006.  To find your state's approved plans, visit the CMS Medicare Drug Plan Approvals site.

KFF posts latest reports on health care costs, counting the unisured, and prescription drug info.

  KaierEDU has several new resources available, including: a new tutorial on Counting the Uninsured, which illustrates the various data sources used to estimate the number of uninsured, comparing the U.S. Census Bureau's current Population Survey to other major national surveys; a new issue module on Health Care Costs provides access to a large body of research and information on the impact and sources of rising health care costs; and an issue module on Prescription Drug Costs focuses on the growth in prescription drug costs, particularly compared to other sectors of the health care system. New health policy syllabi from faculty are also available. KaiserEDU.org is an online resource for faculty and students from the Kaiser Family Foundation.

Get it all here.

24 Elderly Evacuees Die When Bus Catches Fire

The evacuation of the U.S. Gulf Coast turned deadly on Friday when a bus carrying elderly evacuees fleeing Hurricane Rita along a major escape route burst into flames and killed an estimated 24 people on board, officials said.

    The accident turned a historic evacuation already delayed by endless traffic jams into a nightmare, as the Category 4 hurricane barreled toward the heart of the U.S. oil industry with winds near 135 mph (217 kph) and Texas officials predicted catastrophic destruction.

Read the rest of this story in Reuters Business.