Elder Law Prof Blog

Representatives introduce Medicare Transitional Care Act

Representatives Earl Blumenauer (OR-03) and Tom Petri (WI-06) ihave recently ntroduced the bipartisan Medicare Transitional Care Act, which will support and coordinate care for Medicare beneficiaries as they move from the hospital setting to their homes or other care setting, and ensure that appropriate follow-up care is provided during this vulnerable period.  The benefit is flexible, supporting a number of much-needed care models including improved assessment, planning, medications management, movement between care levels, and coordination of support services such as meals and medical equipment.

 

“Transitions from hospital to home can be complicated and risky, especially for individuals with multiple chronic illnesses,” said Blumenauer. “There’s a lot of confusion and uncertainty over instructions, medications, and prognosis. Our bill will support people coming out of the hospital so they don’t just wind up right back in, which is expensive and dangerous.”

 

“It doesn’t make sense to have a program that only provides part of the care Medicare patients need just to have them become sick again as soon as they leave the hospital,” said Petri.  “Providing greater support for Medicare patients as they transition from the hospital back home would improve their health and quality of life while saving taxpayers’ money.”

 

“As providers seek to improve patient outcomes through more coordinated care, Congress must continue to look for effective policies that address gaps in care for our most vulnerable patients, and improving transitions between care settings is critical to that effort,” said National Transitions of Care Coalition Executive Director, Cheri Lattimer. “The Medicare Transitional Care Act puts in place necessary infrastructure and incentives to foster care transition interventions, with collaborative team approaches that have proven successful, which will lead to better health outcomes for beneficiaries and offer real cost savings for patients, the health care system and taxpayers.”

 

Researchers with the Robert Wood Johnson Foundation have estimated that inadequate care coordination, including inadequate management of care transitions, was responsible for $25 to $45 billion in wasteful spending in 2011 through avoidable complications and unnecessary hospital readmissions.

 

The Medicare Transitional Care Act is supported by organizations including The National Transitions of Care Coalition, American Society of Aging, Caregiver Action Network, Case Management Society of America, Society for Post-Acute and Long-Term Care Medicine, Hudson Health Plan, Rush University Medical Center, and Sanofi.

 

It couldn't be more timely: ACL funding opportunity for supported decision-making

A huge theme at the 3rd World Congress on Guardianship was supported decision-making.  I was pleased and suprised to find this in my mailbox this morning:

ACL Funding Opportunity: Supported Decision Making

The purpose of this project is to create a training and technical assistance/resource center on supported decision making. The Center will collect and disseminate materials on supported decision-making, including the experiences of people with intellectual and developmental disabilities (I/DD) in making informed decisions with the use of supports. The project will also include a proposal to develop measures to compare outcomes for people with I/DD and older Americans who use supported decision-making methods and practices to exert control and choice in their own lives compared with outcomes for individuals under substituted decision-making arrangements.

Deadline:  Electronically submitted applications must be submitted no later than July 2, 2014 at 11:59 p.m.

Click here to download additional information including the application package.

ACL issues guidance memo implementing Windsor

In May 2014, the Administration for Community Living (ACL), an agency within the Department of Health and Human Services,  issued guidance applicable to all ACL grantees concerning the federal government's policy on same-sex marriages following the Supreme Court Decision in  United States v. Windsor, 133 S. Ct. 2675 (2013).  The Court in Windsor found that Section 3 of the Defense of Marriage Act (DOMA) impermissibly discriminates against same-sex couples who have been lawfully married in accordance with the laws of a given state.

According to its guidance, the policy of the ACL is to treat same-sex marriages the same as opposite sex marriages to the "extent reasonably possible."  In this regard ACL sets out the following:

• ACL programs should recognize as family members individuals of the same sex who are lawfully married under the law of a state, territory, or foreign jurisdiction. This policy applies based on the jurisdiction in which the marriage was celebrated.
• ACL will recognize the marriage, regardless of whether the individuals are domiciled or reside in a state or territory that does not recognize the marriage.
• When the ACL guidance discusses individuals of the same sex who are "legally married," the intention is to include all legal marriages, regardless of the individuals' current domicile or residence.

Programs affected by the ACL policy include (a) The Administration on Intellectual and Developmental Disabilities; (b) State Protection and Advocacy Systems under the Developmental Disabilities Act ("DD Act"), including their governing boards and advisory councils; (c) the National Network of University Centers for Excellence in Developmental Disabilities; (d) Projects of National Significance, including projects made through grants, contracts, or cooperative agreements; (e)  Help America Vote Act Protection and Advocacy Systems; (f) Home Delivered Nutrition Services; and (g)  the National Family Caregiver Support Program,

To the extent necessary, ACL states that it will revise its grant terms and conditions to incorporate its guidance.  The ACL's full Windsor-related guidance is available at: http://www.acl.gov/Funding_Opportunities/Grantee_Info/docs/
Community_Living_Guidance.pdf.

Source:  Center for Medicare Advocay

The Economics of Intergenerational Care: Friday at Law & Society

On the second of four days at Law and Society in Minneapolis, the Critical Research Network for Aging, Law and Society hosts a session on "The Economics of Intergenerational Care," chaired by Hendrik Hartog of Princeton University.  Scheduled topics and speakers include:

• Money and Stuff: Gen X Caregivers and Financial Decision-Making for Their Baby Boomer Parents, by Amy Ziettlow, Institute of American Values;
• Compensating Family Members to Care for Eldery Relatives, by Peggie Smith, Washington University at St. Louis;
• Intergenerational Economies, by Alicia Kelly, Widener University School of Law; and
• Valuing Care, by Nina Kohn, Syracuse University

The first day of presentations was intense, enjoyable, and at times, tragic (including the presentations on the historical tragedies of growing old as a slave, by Alix Lerner, and the modern day tragedy of Detroit's bankruptcy for retirees, by Susan Cancelosi).  For those interested in helping to plan future CRN programming at Law & Society, make sure you touch base with Nina Kohn or Nancy Knauer.   Next year's Law & Society program is in Seattle.

Law & Society-A Sunday Session

Following up on co-blogger Katherine Pearson's post about elder law sessions at the Law & Society conference,  I just wanted to add one more to the agenda:  the roundtable session on Sunday, June 1, 2014 from 10:15-Noon at St. Thomas U., Room MSL 235.  The topic is Comparative Perspectives on Guardianship Law. This roundtable is based somewhat on the book, Comparative Perspectives on Adult Guardianship, edited by our own blog-founder, Kim Dayton.  Panelists include Kim (author & editor), Dr. Issi Doron (Israel; author), me (author), Professor Nancy Knauer (Temple Law) and Professor Jason Palmer (Stetson Law).  Here is a description of the roundtable:

The Roundtable discussion will address adult guardianship laws and procedures from a comparative perspective. With leading scholars in the field, the Roundtable will explore a variety of guardianship regimes, as well as trends in guardianship reform. Particular issues will also include how to address LGBT issues within guardianship reform, ethical considerations in adult guardianship, and multi-jurisdictional issues. Participants will also address the UN Convention on the Rights of Persons with Disabilities.

Speaking of the book, Professor Dayton and I are currently attending the Third World Congress on Guardianship, where we participated in the opening plenary panel Comparative Perspectives on Adult Guardianship, with several of the chapter authors on the panel including me (moderating), Kim, Senior Judge Denzil Lush (England/Wales), Dr. Makoto Arai (Japan), and Professor Cheol Ung Je (Korea).

Elder Law is rocking in the U.S. today!!

Related articles

Out Of State Guardianship Act Awaits Governor's Signature

National Guardianship Association offers public benefits webinar aimed at guardians

Greenlee kicks off 3d World Congress on Adult Guardianship

Asst. Sec. on Aging Kathy Greenlee helped to kick off the 3d World Congress on Adult Guardianship with truly one of the most powerful speeches on valuing our seniors that I have ever heard.  Greenlee spoke of the danger of trivializing the lives of the elderly, especially those with advanced dementia, reminding us that the loss of memory does not equal the loss of self.  I wish I had recorded her speech, but thankfully, it will be published later this year in Stetson's  Journal of International Law & Aging Policy.  Stay tuned for more reports on the Congress from your intrepid reporters, Kim Dayton and Becky Morgan!

 

Law & Society Annual Meeting on "Rethinking Elder Law's Rules & Norms" and More

Law & Society Association's Annual Meeting is always a feast -- with hundreds of presentations and papers, often with cross-discipline themes and presenters.  This year's four day program starts today in Minneapolis.  On tap are three elder law-themed sessions hosted by Aging, Law & Society. The session on "Rethinking Elder Law's Rules & Norms" will  be chaired by Nina Kohn, Syracuse University.

Scheduled paper presentations include:

• Adult Protective Services and Therapeutic Jurisprudence, by Michael Schindler, Bar-Ilan University;
• Age, Gender and Lifetime Discrmination against Working Women, by Susan Bisom-Rapp, Thomas Jefferson School of Law and Malcolm Sargeant, Middlesex University Business School;
• Effective Affective Forecasting in Older Adult Caregiving, by Eve Brank and Lindsey Wylie, University of Nebraska-Lincoln;
• Sexuality & Incapacity, by Alexander Boni-Saenz, Chicago-Kent College of Law;
• Beyond the Law: Legal Consciousness in Older Age Care Contexts, by Sue Westwood, Keele University

Nancy Knauer of Temple Law School is chairing the session on "Accessing and Experiencing Jusice in Older Age."  Presentations include:

• From Vienna to Madrid and Beyond, by Israel Doron, University of Haifa;
• Lessons from Detroit: Retiree Benefits in the Real World, by Susan Cancelosi, Wayne State University Law School;
• Older Persons Use of the European Court of Human Rights, by Benny Spanier, Haifa University;
• Crossing Borders and Barriers: Assessing Older Adults' Access to Legal Advice in the Search for Effective Justice, by Katherine Pearson, Penn State University Dickinson School of Law, Joseph Duffy, Queens University Belfast, and Subhajit Basu, University of Leeds

A workshop on "Ethics of Care and Support in Law and Aging," to be chared by Sue Westwood, Keele University, includes:

• Aging with a Plan: What You Should Consider in Middle Age to Plan for Caregiving and Your Own Old Age, by  Sharona Hoffman, Case Western Reserve University;
• An Ethic of Care Critique of the UK Care Bill/Act, by Sarah Webber, University of Bristol;
• Both Property and Pauper: Slaver, Old Age, and the Inverted Logic of Capitalist Exchange, by Alix Lerner, Princeton University;
• Responding to Financial Vulnerability: Advances in Gerotchnology as an Alternative to the Substitute Decision Making Model, by Margaret Hall, Thompson Rivers University and Margaret Easton, Simon Fraser University

An international cast of characters, yes?  More soon, with details from the front.

Dual-Eligibles Face Longer Stays & Higher Patient-to-Staff Ratios for Nursing Home Care

Led by Momotazur Rahman, Department of Health Services Policy and Practice at Brown University, researchers at Brown and Harvard have analyzed placements in nursing homes for Medicare-only and "dual-eligible" Medicare/Medicaid individuals. In their May 2014 study published (and linked here) in Medical Research and Review, they conclude that the low-income patients are more likely to be sent to lower quality (as measured by staffing radios) nursing homes.  Their abstract outlines their call for reform for referral processes:

"Medicare and Medicaid dual-eligible beneficiaries use more medical care and experience worse health outcomes than Medicare-only beneficiaries. This article points to a possible inefficiency in the skilled nursing facility (SNF) admission process, specifically that patients and SNFs are partially matched based on dual-eligibility status, and investigates its influence on patients’ SNF length of stay. Using a set of fee-for-service beneficiaries newly admitted for Medicare-paid SNF care, we document two findings: (1) compared with Medicare-only patients, dual-eligibles are more likely to be discharged to SNFs with low nurse-to-patient ratios and (2) dual-eligibles are more likely to become long-stay nursing home residents than Medicare-only beneficiaries if treated in SNFs with low nurse-to-patient ratios. We conclude that changes in the current SNF care referral process have the potential to reduce excess SNF utilization by dual-eligible beneficiaries and could help reduce spending by both Medicare and Medicaid."

One would hope that a corollary to reforming referral processes to "save money" would be improvements in the quality of life and care for dual-eligibles.  Additional analysis of the study is available at McKnights News. 

CPSC recalls adult bed handles due to danger of strangulation

The U.S. Consumer Product Safety Commission (CPSC) and Bed Handles Inc., of Blue Springs, Mo., are announcing the voluntary recall of about 113,000 adult portable bed handles. When attached to an adult’s bed without the use of safety retention straps, the handle can shift out of place creating a dangerous gap between the bed handle and the side of the mattress. This poses a serious risk of entrapment, strangulation and death. Three women died after becoming entrapped between the mattress and the bed handles. They include an elderly woman, age unknown, who died in an Edina, Minn. assisted living facility; a 41-year-old disabled woman who died in a Renton, Wash. adult family home; and an 81-year-old woman who died in a Vancouver, Wash. managed care facility.  The recall involves adult portable bed handles sold by Bed Handles Inc. from 1994 through 2007 that do not have safety retention straps to secure the bed handle to the bed frame to keep the bed handle from shifting out of place and creating a dangerous gap. Recalled models include the Original Bedside Assistant® (BA10W), the Travel Handles™ (BA11W) which is sold as a set of two bed handles, and the Adjustable Bedside Assistant® (AJ1).  Consumers should immediately stop using all recalled bed handles that were sold without safety retention straps. Contact Bed Handles Inc. for free safety retention straps to secure the bed handle to the bed frame, new assembly and installation instructions for models BA10W, BA11W and AJ1 and a warning label to attach to the bed handles. The bed handles should be used only with the safety retention straps securely in place attaching the bed handle to the bed frame in order to prevent a gap.

Source/more: CPSC/Bed Handles, Inc.

Who Bears the Risk of Declining Prices During a CCRC Market Downturn?

Continuing Care Retirement Communities (CCRCs) utilize a variety of payment arrangements to attract potential residents.  One option popular prior to the 2008 recession was a "100% refundable entrance fee" model, where the new resident was promised return of his or her upfront entrance fee upon "termination," subject to certain conditions, usually including re-occupancy of the unit in question by a new resident.  During good financial times, this refund option benefited both parties.  The company could rely on a quick "resale" of the unit, either for the same or a higher entrance fee.  Thus the company often took the position it was able to "use" the original resident's entrance fee immediately, subject to any state regulations for mandatory reserves or other repayment guarantees or restrictions.

But who bears the risk of a downturn in the senior living market, especially the dramatic downturn that accompanied the 2008-2010 recession? 

In Stewart v. Henry Ford Village, Inc., the issue was whether a departing resident must accept the company's offer of a lower refund, tied to what any new resident would pay as an entrance fee to reside in that unit. The difference was hefty, as the resident had paid $137k in 1998 when she moved in, but when she left the community in  2010, comparable units were reportedly going for $89k.

In a rare court decision analyzing a refundable fee, the Court of Appeals for Michigan ruled that the parties' contract language controlled, and in this contract the contract did not provide for a lower refund amount.  Further, the company's obligation to comply with the contract terms was subject to an implied obligation of good faith (a Contract Law concept my students would, I hope, recognize!) to promptly market and "resell" the unit, thus suggesting a CCRC would not be in good faith for delaying a unit's resale as a negotiation tool.  Here is the heart of the court's analysis:

"Given the totality of the circumstances, the status of the parties, and the rights and obligations as set forth in the Agreement, the Disclosure Statement, and the [state's Living Care Disclosure Act] we find no support for the conclusion that plaintiff should or is obliged to bear the risks of a declining real estate market. To the contrary, those risks would seem properly to fall to defendant. By way of example, when a lessee properly complies with his or her lease in vacating a rental property, the lessee bears no responsibility for the fact that the landlord may need to lower the rent to attract a subsequent tenant. Rather, it is the landlord alone who must bear the consequences of the existing market risks. Additionally, plaintiff notes that if the unit was subsequently reoccupied with a higher entrance deposit, defendant would not furnish additional monies to plaintiff. Defendant has not suggested otherwise.... It strikes us as incongruous, as unsupported contractually, and as of questionable good faith (without adequate disclosure), that plaintiff be held to bear the risks of a declining real estate market without the ability to reap the rewards of a booming one."

In the "unpublished" (and therefore nonprecedential) opinion, the Michigan appellate court remanded for an evidentiary hearing.  The ruling demonstrates the importance of the contract language, state regulations, and, I suspect, the likelihood that future refundable fee CCRC contracts will provide clearly that refunds will be tied in whole or in part to "resale" amounts, at least for any so-called 100% refundable fee agreements. 

It should also be noted that refundability of admission fees is potentially a separate issue from actuarially sound practices for CCRCs in the handling of such fees.  Along that line, I note that one of the residents who pioneered concerns about financial soundness in CCRCs, Charles Prine of Pittsburgh, passed away recently. Mr. Prine's articulate advocacy included testimony before the Senate Special Committee on Aging.  Chuck will be missed. 

Tobor to the Rescue? Home Medication Dispensers

When I was a child, there was a movie -- or maybe a tv show -- with a friendly robot named Tobor.  Tobor soon became an imaginary friend for the neighborhood children, and conveniently, someone we could blame when we forgot to close a door or knocked something over.  "Tobor did it!"

Fast forward many years and last week, during a meeting at my Area Agency on Aging, I learned the AAA had entered into a contract with a company that makes home medication dispensers to provide the devices at a modest cost to clients in the county.  "Tobor for the Boomer Generation!"

The device, about the size of a blender or coffee machine, can be pre-loaded with a large number of doses of different kinds of medications with different dispensing schedules, and with recorded messages such as "Drink with water."  The machine signals the client to take the revealed dose, and continues the signal until the medication is removed.  It can also be programmed to contact a family member about a missed dose.  Of course, there are limits to the utility of any automated device, as the client must still have the capacity to follow the directions and not simply discard the dose. 

It will be interesting to see, over time, whether (and which kind of ) Tobors are effective innovations with long-range satisfaction and utility.  I do seem to have a lot of ignored contraptions on my own kitchen counter. 

How Old Do You Want to Be?

I previously wrote about how old do you feel. Now I'm writing about how old do you want to be? You may have seen the story on 60 Minutes regarding a study of residents at a "retirement community" in California.  There are two parts to the story, videos and transcripts which can be accessed here.   There are several takeaways from the study-including the importance of exercise. So, stop reading right now, go for a walk and then come back and finish reading this post. 

 

Ok, you're back. Feel better don't you? Kurzweil AI also did a story about the study Want to live to 90?  “People who exercised definitely lived longer than people who didn’t exercise. As little as 15 minutes a day on average made a difference,” says Dr. Kawas. Keeping active in non-physical ways, such as socializing, playing board games, and attending book clubs, also was associated with longer life. “For every hour you spent doing activities in 1981, you increased your longevity, and the benefit of those things never leveled off,” she tells Stahl."

Das Messie Syndrom

Working with colleagues from other countries often reveals interesting or humorous uses of language.  Last week, while enjoying the visit of Prof. Dr. Dagmar Brosey from Cologne, I learned of "das messie syndrom" or as we might label it in the United States, "hoarding." I like the German label better....

Some intra-family feuds NEVER end...

Via the BBC: 

Distant relatives of King Richard III have lost their High Court battle over where his remains should be reburied.  His remains were found in a Leicester car park in 2012 and the city's cathedral was lined up for his tomb, but some wanted him reburied in York.  But a group claiming descent from the king's wider family were granted a judicial review, arguing more views should have been taken into account.  Judges at the High Court said there was "no duty to consult".  In the ruling, they added: "There was no public law grounds for the court to interfere.  Killed at the Battle of Bosworth in 1485, Richard III was buried in a Leicester church but the building was lost to later development.  Authorities in Leicester said they were delighted at the decision and they looked forward to reinterring the body with "dignity and honour".

 Read more here.

The Ultimate Compendium of Health Stats in the US

Centers for Disease Control

Health, United States, 2013

Nuff said!

 

New Report/Overview of Social Insurance Programs Around the World-Disability and Retirement, Part VI

“Social Security Programs and Retirement Around the World: Disability Insurance Programs and Retirement – Introduction and Summary,” by Courtney Coile, Kevin S. Milligan, and David A. Wise (w20120, May 2014, .pdf format, 49p.).

Abstract:

This is the introduction and summary to the sixth phase of an ongoing project on Social Security Programs and Retirement Around the World. The first phase described the retirement incentives inherent in plan provisions and documented the strong relationship across countries between social security incentives to retire and the proportion of older persons out of the labor force. The second phase documented the large effects that changing plan provisions would have on the labor force participation of older workers. The third phase demonstrated the consequent fiscal implications that extending labor force participation would have on net program costs–reducing government social security benefit payments and increasing government tax revenues. The fourth phase presented analyses of the relationship between the labor force participation of older persons and the labor force participation of younger persons in twelve countries. We found no evidence that increasing the employment of older persons will reduce the employment opportunities of youth and no evidence that increasing the employment of older persons will increase the unemployment of youth. The fifth phase on “Historical Trends in Mortality and Health, Employment, and Disability Insurance Participation and Reforms” was intended to set the stage for this current phase.

This sixth phase of the ongoing ISS project is particularly related to the fifth phase (Wise, 2012) and the second phase (Gruber and Wise, 2004) of the project. This volume continues the focus of the previous volume on DI programs while extending the methodology to study retirement behavior used in the second phase to focus in particular on the effects of the DI programs. The key question this volume seeks to address is: given health status, to what extent are differences in labor force participation across countries determined by the provisions of disability insurance programs?

GET IT HERE!

A National Disgrace: The State of Senior Hunger in the US

A new report prepared for the Prepared for the National Foundation to End Senior Hunger outlines the state of senior hunger in the US. 

Executive Summary

In this report we provide an overview of the extent and distribution of food insecurity in 2012 among seniors, along with trends over the past decade using national and state-level data from the December Supplements to the Current Population Survey (CPS). Based on the full set of 18 questions in the Core Food Security Module (CFSM), the module used by the USDA to establish the official food insecurity rates of households in the United States, our emphasis here is on quantifying the senior population facing the threat of hunger (i.e. marginally food insecure). A supplement to this report also presents evidence on seniors at risk of hunger (i.e. food insecure) and on seniors facing hunger (i.e. very low food secure).

This report demonstrates that seniors in 2012 continued to face increasing challenges meeting food need. Specifically, we find that

• 15.3% of seniors face the threat of hunger. This translates into 9.3 million seniors.
• Those living in states in the South and Southwest, those who are racial or ethnic minorities, those with lower incomes, and those who are younger (ages 60-69) are most likely to be threatened by hunger.
• Out of those seniors who face the threat of hunger, the majority have incomes above the poverty line and are white.
• From 2001 to 2012, the fraction of seniors experiencing the threat of hunger increased by 44%. The number of seniors rose by 98% which also reflects the growing population of seniors.
• Since the onset of the recession in 2007 until 2012, the number of seniors experiencing the threat of hunger has increased by 49%.

Read the full report, The State of Senior Hunger in America 2012: An Annual Report

International Elder Law and Policy Conference July 10-11 in Chicago

John Marshall Law School and Roosevelt University, both in Chicago, and East China University of Political Science and Law in Shanghai, are jointly sponsoring an International Elder Law and Policy Conference in Chicago on July 10-11.

Keynote speakers include Professor Israel Doron of the University of Haifa in Israel and Dr. Ellinoir Flynn and Professor Gerard Quinn, both from National Unviersity of Ireland, Galway School of Law.

Scheduled panel topics include:

• Dignity and Rights of the Elderly
• Elimination of Age Discrimination
• Caregivers and Surrogate Decision Makers
• Social Security, Pensions and Other Retirement Financing Approaches
• Prevention of Elder Abuse
• Access to Justice

Here's the link to the Registration website.

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Talking About Tech for Savvy Seniors

We have posted a number of times on technology for elders and the use of technology by elders.  The American Society on Aging ran a post on the blog Aging Today Online last month Where's Technology Headed in 2014?   Since we are about 1/3 of the way through 2014, I thought it would be a good idea to see where we are headed. Ginna Biak authored the post, looking at the trends and what we learned from technology use in 2013.  Wearable technology, smart phones, tablets and monitoring technology all seem to be "hot."

The author cites to an article in Forbes that the "boomers represent the biggest growth market for digital medical technologies.” The author also mentions technology that keeps us conencted, healthy and safe.  The tech industry will recognize the value of the boomer market with "designs [that] will be less intimidating and interfaces will be easy to use and adopt for older populations. Smart phones, e-readers and tablets will continue to evolve to meet the needs of elders."

The author writes that the iPad continues its popularity due to the accessibility features it offers for users who have vision issues and hearing loss.  As well, the free training is an attractive plus.  Larger seems to be better, according to the author, although "[t]he iPhone’s simple interface, consistent on all Apple products, is very popular with older adults. Samsung’s Galaxy Note is also rapidly becoming a favorite with older adults because of its large screen and functions."

Do you use social media?  A lot of boomers do.  The author offers this data point:

in 2013 people older than age 50 were the largest growing user population adopting Facebook, which explains the app Facebook for Seniors. This trend is expected to continue in 2014, with more elders adopting smartphones, uploading and viewing photos on their favorite social networking site. There are also expected to be more grandparents Skypeing and Facetiming this year than in years past.

And voice mail-so last century.  Is anyone besides me thinking about the use of monitoring technologies for those with dementia, and considering the consent and privacy issues? I think it would make a fascinating paper topic for a student!

How Much Choice is Too Much Choice?

Hmm, you are thinking. How are options a bad thing? Options aren't necessarily a bad thing, but if a person has too many options, does that become a bad thing, impairing the person's ability to make a choice?  This is the subject of an article and report about the choices with which  beneficiaries on Medicare are faced.

Phil Galewitz writes for the May 14, 2014 Kaiser Health Network (KHN) Capsules blog  on Short Takes On News & Events, Do Seniors Have Too Many Medicare Plans to Choose From?  There are on "average ... 18 health plans and 31 prescription drug plans. In South Florida, ... [there are] 88 plan choices altogether."  The article references a recent report that shows that because of the number of choices, it becomes onerous for beneficiaries to try to compare plans, so they stick with their current plan, regardless of whether it is the best one for them.  At a briefing on the report,  the author of a book about choice explained that younger people strive for "the perfect choice" while elders will take the "good enough" choice. The article quotes my good friend, former NAELA president, knowledge queen of all things Medicare and the executive director of the phenemonal Center for Medicare Advocacy (full disclosure---I'm on the CMA board), Judy Stein that "good enough" for a well beneficiary may not be "good enough" when that same beneficiary becomes ill.

The article references the 5-star rating system from CMS, but notes that seems to have little impact on beneficiary choice.  An investment analyst was quoted that

the fastest-growing plans have been those with just three stars – many of which have seen 12 percent enrollment growth. He added that price,  particularly monthly premiums, often drive seniors’ choices...[b]ut one reason why seniors have not flocked to the best-rated plans may be because there are so few of them.For 2014, the Centers for Medicare and Medicaid Services awarded five-star ratings to 14 health plans and 5 prescription drug plans.... About 75 percent of Medicare’s 54 million beneficiaries are enrolled in a private health or drug plan. The rest get traditional Medicare.  [The investment analyst] said because health insurers know seniors are most likely to pick plans based on price, they are hesitant to charge a monthly premium if they have not had one, or to implement a major rate hike.

The Kaiser report, released May 13, 2014, How are Seniors Choosing and Changing Health Insurance Plans?, may be accessed here.  The report offers 4 key findings:

• Seniors cited a number of factors that were important in choosing a plan when they first enrolled in Medicare, including: premiums and out-of-pocket costs, access to desired providers, familiarity with the name of the company offering the plan (such as AARP), favorable experience with a plan representative, and adequate coverage for their health care needs. Some also said they enrolled in a particular Part D or Medicare Advantage plan in order to have the same coverage as their spouse. Star quality ratings of plans did not play a role in seniors’ plan choices. In the case of seniors choosing among Part D plans, some wanted to be sure the specific drug they were taking was covered by the plan before signing up.
• Seniors say they found it frustrating and difficult to compare plans due to the volume of information they receive in the mail and through media (television and radio) and their inability to organize the information to determine which plan is best for them. Most seniors did not use the "Medicare Compare" tool available on the medicare.gov website, and many of those who did said they found it confusing, lacking information, and poorly constructed for comparisons on their desired factors. For this reason, many rely on insurance agents as trusted advisors or receive suggestions from friends, family, doctors’ offices and/or pharmacists to help them narrow down their options. 
• Many senior Medicare beneficiaries said they did not want to switch plans because the process of their initial plan selection was so frustrating. They believed they did their homework the first time and most did not want to revisit the decision. In general, they did not view the annual open enrollment period as a time to review their health plan options and confirm they were still in the plan most likely to meet their needs. Instead, they feared that a change in plan may disrupt their care or lead to an unforeseen increase in out-of-pocket costs, and require them to learn a daunting new set of rules and requirements. To many senior beneficiaries, the grass was not necessarily greener in other plans, and other plans could be worse. They were skeptical that any other plan would be much better, even if they were less than satisfied with their coverage or costs. Most viewed premium increases as inevitable, and were reluctant to switch plans unless premiums rose considerably. For these reasons, many will go to considerable lengths to make their existing plan work.
• Among the relatively small number of seniors in the focus groups who said they did switch plans, some cited a desire to stay with a particular health care provider. Seniors would consider switching plans in response to a significant change in their personal health care needs, a major modification to their coverage or provider network, or, in the case of Part D plans, a big increase in the cost of a particular drug that they take, or a change in their plan’s formulary or utilization management requirements.

The conclusions offered in the executive summary are particularly instructive. Although the beneficiaries surveyed

appreciated being able to choose among many plans, and did not want their number of choices to be limited ... they also felt unqualified to choose among plans and would like the process to be easier. Beneficiaries wanted to make well-informed and financially sound decisions but did not feel confident in their ability to do so under the current system. While they tried to compare costs, coverage, and provider networks, [they] found the process frustrating and confusing. Many said they wanted advice from experts, so they relied on input from an insurance agent or a plan representative, or suggestions from family, friends, and medical professionals.

The results of the research showed "a high demand for clear, concise, and easily comparable information presented in a digestible format focusing on the factors most important to consumers, namely cost, provider networks, and coverage."  This may or may not surprise you, but "[f]ew [beneficiaries] described the materials they have received as easy to use, and even fewer said they would turn to Medicare Compare... Making it easier for beneficiaries to compare and switch plans, ... would help achieve the goal of having consumers choose a plan that best meets their ... needs and preferences."  Additionally, if a less costly plan is a better fit for the beneficiary, then the beneficiary could save money, as could Medicare.