Wednesday, October 22, 2014
As South Korea ages more quickly than most other countries on the planet, it’s doing something new to help those in the twilight of their lives: slowing down changes in traffic signals to allow more time to cross the road. The Seoul city government said on Monday it will lengthen intervals between changes in traffic signals by the end of this year in 59 areas where welfare centers are located for the aged. Traffic signals in those areas will be adjusted for a walking speed of 0.8 meter per second, slower than the current speed of one meter per second. The new standard will allow people an additional 7.5 seconds to complete a 30-meter crosswalk. The city government said it also plans to make traffic lights transition more slowly from red to green in the same areas because the elderly react slowly to signal changes. South Koreans are known for a “pali-pali” (hurry up) culture and often walk quickly or run on the streets. “Most regular pedestrians, especially the young, may feel like the new traffic signal changes are too slow,” said Kim Kyoung-woo, a Seoul city government official in charge of the safety of pedestrians. The new policy is partly a response to an increasing number of senior citizens falling victim to the traffic accidents in recent years. Official data show the number of traffic accidents involving those aged 65 or older in the capital totaled 4,500 in 2013, up 20% from in 2011. Last year in Seoul, 34% of total deaths in traffic accidents were of people aged 65 or older.
We posted back in August about Glen Campbell's status with Alzheimer's disease. A recent story on NBC News, covering his status reported that he still plays guitar and his label released his last song, I’m Not Gonna Miss You.” .
His final tour was filmed and a documentary, Glen Campbell: I'll Be Me, will be released October 24th, 2014. The article explains that he was in stage 2 when the tour started and stage 4 when it ended. Throughout, though, he played a mean guitar.
The NBC story includes three video clips, one which shows his last recording session.
Thanks to law student Erica Munz for sending me the link to the story. Calendar October 24, 2014 and go see this movie.
Tuesday, October 21, 2014
A continuing care operator is fighting a recent ruling by Alberta’s information czar that would reveal how hundreds of millions in taxpayer dollars are spent each year at the province’s nursing homes and supportive living facilities. A continuing care operator is fighting a recent ruling by Alberta’s information czar that would reveal how hundreds of millions in taxpayer dollars are spent each year at the province’s nursing homes and supportive living facilities. Shepherd’s Care Foundation is asking the courts to overturn a decision by the Office of the Information and Privacy Commissioner ordering the release of the complete annual financial returns it and other operators file with Alberta’s health authority. In a notice seeking judicial review, the Edmonton-based organization says making the returns public under the province’s freedom of information legislation would cause significant harm to its business and labour relations interests. Filed as a condition of the facility’s contract with Alberta Health Services, the returns show the amounts a facility derives each year from the public purse and from resident fees. The document also details how much of that money is spent on care, food and administration and whether any surplus or profit is left over at the end of 12 months. The OIPC ruling stems from requests filed with AHS by the Alberta Union of Provincial Employees several years ago for the returns of 15 continuing care operators with which it was involved in collective bargaining on behalf of workers.
The New York Times ran a story on October 11, 2014 about the Dutch pension system. No Smoke, No Mirrors: The Dutch Pension Plan focuses on the straightforward way that the Netherlands runs their pension program. "The Dutch system rests on the idea that each generation should pay its own costs — and that the costs must be measured accurately if that is to happen." The Dutch system works well, but it isn't without costs. The workers put away almost 2% more than U.S. workers but the Americans are including Social Security, which is not intended to fully replace pre-retirement earnings, but instead should "provide just 40 percent of a middle-class worker’s income in retirement."
The article notes that Dutch employers, like those in the U.S., contribute as well, but usually with a ceiling on contributions. Seem odd to have it capped? The article offers that this is actually an incentive for employers to stay with the plans. There's also another advantage to the Dutch system-if the markets do well and the pension has a surplus, the employer can't access it.
There are additional provisions that ensure success and checks and balances put into the system. Check out the article.
Monday, October 20, 2014
Earlier this month, CMS announced that it was going to update and improve the Nursing Home Compare site, which should result in more accurate information available for consumers. According to the October 6, 2014 press release, "the expansion and strengthening of the agency’s widely-used Five Star Quality Rating System for Nursing Homes will improve consumer information about individual nursing homes’ quality."
Starting in January, "CMS and states will implement focused survey inspections nationwide for a sample of nursing homes to enable better verification of both the staffing and quality measure information that is part of the Five-Star Quality Rating System." CMS is also adding to the quality measures used. Also CMS will be doing some "focused survey inspections" for verification purposes of the information that is being submitted.
According to the Center for Medicare Advocacy October 16, 2014 weekly alert, a new law, "[t]he Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act of 2014) ... supports one of the key changes –providing funding to implement a provision of the Affordable Care Act (ACA) that requires nursing home staffing data reported on Nursing Home Compare to be electronically-submitted and "based on payroll and other verifiable and auditable data."
Check it out!
Friday, October 17, 2014
With the mid-term elections in a few weeks away, there are some interesting proposals to watch, according to a series in Governing. A story that was published on October 16, 2014 focused on Arizona. Arizona Tests Popularity of the Dying's Right to Try Unapproved Drugs focuses on the ability of terminally ill individuals to try experimental drugs. Proposition 303 would allow the patients to not wait for FDA ok if the drug maker is willing to get the drug to the patient. Arizona is not the first state to consider this. Similar provisions have been approved in Colorado, Missouri, Michigan and Louisiana.
Even though FDA approval wouldn't be required, it still isn't the wild west of experimental drug use. "The drug must have passed initial toxicity and dosage testing under the FDA’s clinical trial process. Doctors also can’t prescribe an unapproved drug unless the patient has exhausted other options. Manufacturers are under no obligation to provide the drugs and insurers aren’t required to pay for them."
The article discusses the opposition to such laws, giving reasons such as providing false hopes and the likely decrease in clinical trials. Supporters refute the agrument, noting that the terminally ill folks are not typically eligible for clinical trials. These laws are different than the FDA's "compassionate use" provisions which "allows for experimental drugs for even seriously ill patients, and the program rarely denies an application, but “right-to-try” supporters again argue that the process is too complex and slow, as evidenced by application figures averaging about 1,000 a year."
One thing different about Arizona's proposal-the residents are voting on the provision.
Thursday, October 16, 2014
Planning for the 2015 White House Conference on Aging (WHCOA) is in full swing. The website has been launched and there is also a WHCOA blog available. You can also sign up for email updates to stay in the loop on WHCOA developments.
Wednesday, October 15, 2014
Governing ran a story about a recent court ruling, Mental Health Ruling in Washington State Could Reverberate through the Country. The article concerns the practice of "psychiatric boarding" or "[w]ith increased demand on proper mental health facilities, the practice known as psychiatric boarding -- temporarily holding mentally ill patients in hospital ERs until beds become available at certified treatment centers..." A national issue, the practice is unconstitutional in Washington state as a result of a lawsuit filed last year by a number of patients. Not only did experts testify that patients who are psychiatrically boarded get little, if any, mental health treatment, in fact, one government report shows that the patients will actually deteriorate. Implications of state laws that require involuntary detention: "states also regularly lack the space to place individuals in certified facilities. As a result, patients are held for days -- in some cases literally strapped to beds -- in emergency departments at acute-care hospitals until a bed opens up."
In August, the Washington State Supreme Court ruled this practice unconstitutional, despite the state's arguments regarding insufficient budgets and available beds. The article notes that Washington state is not alone in facing this issue, with a number of states admitting to psychiatric boarding. However, just increasing beds isn't the solution to this issue, the article goes on to discuss. Quoting the executive director of the Bazelon Center, the better solution is more beds plus broad-based community care.
Monday, October 13, 2014
We have blogged in the past about the topic of the aging of the prison population. A report was released in August that focused on the issue in the federal prison system. Aging Behind Bars: Trends and Implications of Graying Prisoners in the Federal Prison System was released in August of 2014 by the Urban Institute. Unsurprisingly, the report notes the growing cohort of prisoners who are elderly. From the executive summary this is one conclusion that surprised me "[t]he proportion of older female prisoners is growing faster than that of older male prisoners, and providing health care services to aging women generally costs substantially more." In addition to aging and rate of growth, the report looks at costs, with a substantial cost based on age, including "[t]he fiscal burden of aging prisoners is applicable to a wide range of prison operations (e.g., medical supplies, welfare services, treatment, training), not just the upkeep of medical housing units."
Among the conclusions and recommendations, (1) "[c]losely monitor the growth of the older prisoner population, as recent years have witnessed a considerable demographic shift in the BOP population, and it is expected to continue in the near future." (2) "[d]evelop an empirically driven definition of older prisoners."
Elder Law profs will be interested in the need for this definition because
[t]here is no definitive consensus as to the definition of older or “geriatric” prisoners, typically ranging from 50 to 65. Given that one of the primary motivations for examining aging prisoners is the economic burden facing all levels of governments, we recommend using data to empirically identify the age threshold at which older prisoners pose minimal risk of recidivism and can be more cost-effectively managed through noncustodial means."
Another recommendation also calls for better data collection, since "[t]he risk of recidivism drops as prisoners get older, and there will come a time when an additional year of prison time no longer yields a meaningful reduction in the risk of recidivism among older prisoners. Identifying such a point in one’s incarceration history would have direct policy implications for the management of aging prisoners."
The report includes a recommendation for "cost-effective management plans..." The report also addresses to some extent the policy issues of incarceration.
Raising awareness of the needs of aging prisoners and equipping BOP with policy options to address such needs may not closely conform to some of the fundamental principles of punishment, such as retribution. However, it is important to recognize that poor management of prison systems can affect the rest of the criminal justice system, responsible for ensuring public safety, and potentially lead to a violation of prisoners’ constitutional or statutory rights. These concerns are increasingly more relevant and should be balanced with the question of how well our prison system serves the principles of punishment.
Know a caregiver who inspires you? Nominate that caregiver for recognition. Huff/Post50, in recognition of National Family Caregivers Month in November is seeking nominations for inspirational caregivers. Rita Wilson, editor at large for Huff/Post50 explains this in her letter to readers
In 2011, we made clear our generation was not ready to "go gentle into that good night." Our belief is that age doesn't define us -- and that we can still accomplish great things while also having a lot of fun whether we're 21 or 51 or 81. But our focus on the positive doesn't exclude reality. And the reality is that many people over 50 have become caregivers to elderly parents, unhealthy partners or ailing friends.
The deadline for nominations is October 22, 2014 at 11:59 p.m. edt. To nominate someone send an email to Shelley.Emling@huffingtonpost.com, subject line: caregivers, and include the name, contact info and hometown of nominee as well as a narrative (up to 500 words) of why this person is an inspiring caregiver. Include a photo or a video of the nominee. Selected caregivers will be featured in November issue of the Huffington Post.
Our friends at National Senior Citizens Law Center, in cooperation with the Assisted Living Consumer Alliance, are hosting a free webinar on Wednesday, October 22 on "Assisted Living State by State."
The program will offer several perspectives on regulatory systems that may affect the range of care options that are not defined as "skilled care." The program will use California has part of the focus, while explaining what regulations are already in use and whether improvements are needed across the nation.
Sunday, October 12, 2014
NPR's Weekend Edition Sunday highlighted a new study that suggests people with Alzheimer's may hold on to happy or sad emotions beyond the event that triggers those feelings. Here's the link to the audio.
The University of Iowa researchers published their article in the September 2014 issue of the journal Cognitive and Behavioral Neurology, and it follows preliminary studies they published in 2010. The study used 20 minute movie clips with "happy" or "sad" themes with test groups. As summarized by Iowa Now:
About five minutes after watching the movies, the researchers gave participants a memory test to see if they could recall what they had just seen. As expected, the patients with Alzheimer’s disease retained significantly less information about both the sad and happy films than the healthy people. In fact, four patients were unable to recall any factual information about the films, and one patient didn’t even remember watching any movies.
Before and after seeing the films, participants answered questions to gauge their feelings. Patients with Alzheimer’s disease reported elevated levels of either sadness or happiness for up to 30 minutes after viewing the films despite having little or no recollection of the movies.
Quite strikingly, the less the patients remembered about the films, the longer their sadness lasted. While sadness tended to last a little longer than happiness, both emotions far outlasted the memory of the films.
The studies suggest the importance of positive stimuli from caregivers. The researchers emphasized that their findings "should empower caregivers by showing them that their actions toward patients really do matter." Researcher Edmarie Guzman-Velez said "Frequent visits and social interactions, exercise, music, dance, jokes, and serving patients their favorite foods are all simple things that can have a lasting emotional impact on a patient's quality of life and subjective well-being."
Friday, October 10, 2014
Although some think substance abuse is a problem for the young, a recent story in the New York Times dispels that thought. More Older Adults Are Struggling With Substance Abuse ran October 3, 2014 looks at the number of elders who are substance abusers-whether drugs or alcohol. The numbers are surprising:
An estimated 2.8 million older adults in the United States meet the criteria for alcohol abuse, and this number is expected to reach 5.7 million by 2020, according to a study in the journal “Addiction.” In 2008, 231,200 people over 50 sought treatment for substance abuse, up from 102,700 in 1992, according to the Substance Abuse and Mental Health Services Administration, a federal agency.
Although alcohol abuse seems to rank first, the "rate of illicit drug use among adults 50 to 64 increased from 2.7 percent in 2002 to 6.0 percent in 2013" according to the story. The article mentions several studies, not only looking at the extent of the abuse, but the reasons behind these addictions. Although for some, retirement may be a catalyst, many times it is not the sole reason, "'with the conditions leading to retirement, and the economic and social nature of the retirement itself, having a far greater impact on substance use than simple retirement itself..."' Some of the "firsts" experienced in later life, such as deaths of spouses and friends, may be a contributing factor that requires "coping skills" these folks haven't had to yet possess.
The article also touches on the potential lack of doctor training on dealing with elder patients with substance abuse issues, and notes some symptoms associated with dementia may have similar symptoms to those of addictions.
Thursday, October 9, 2014
Kurzweil Accelerating Intelliegence (Kurzweil AI) ran a story that got my attention. The signature of aging in the brain reports on the results of a study that looks at a "signature" in the brain "that may be the “missing link” between cognitive decline and aging and that may in the future lead to treatments that can slow or reverse cognitive decline in older people..."
This is a technical article and perhaps not the type we typically cover in our blog, but I thought it important enough to mention. Since I don't have a scientific background, I decided to excerpt some of the findings
they identified a unique “signature of aging” that exists solely in the choroid plexus. They discovered that one of the main elements of this signature was interferon beta, a protein that the body normally produces to fight viral infection.
Turns out this protein also appears to have a negative effect on the brain. When the researchers injected an antibody that blocks interferon beta activity into the cerebrospinal fluid of the older mice, their cognitive abilities were restored, as was their ability to form new brain cells.
Why this is important? It may lead to different treatments to help with cognitive decline-the researchers "hope that this finding may, in the future, help prevent or reverse cognitive decline in old age by finding ways to rejuvenate the immunological age of the brain."
Wednesday, October 8, 2014
A few blogs ago, I posted about the Florida "Grey Belt". This blog is about the value of a grey economy to the states. The story in the Tampa Bay Times, was about a new study from Florida AARP: AARP study: Older workers, retirees Florida's biggest economic generators focuses on the positive financial impact that elders can have on an economy, at least in Florida:
The older generation generates 54 percent of the state's economic output, works in 58 percent of the state's jobs, and pays 67 percent of state and local taxes. It also accounts for 58 percent of total consumer spending, the chief driver to keep the economy churning.... Those numbers ... are part of a concerted effort to tout the value of Florida's so-called "Longevity Economy" and urge state leaders to do more to support and attract the 50-and-up set.
Although Florida still is one of the top retirement destinations, it does have competition. Other states have realized the economic value of retired individuals and have marketing campaigns to attract those individuals to their states.
How much does this segment of the population bring to the Florida economy? A LOT, as in $429 BILLION to Florida's gross domestic product (GDP) and 6 MILLION jobs according to a story about the study that is posted on the Florida AARP website.
The full report is available here.
Monday, October 6, 2014
Remember as little kids our parents taught us that sharing was a good thing? Sharing has its benefits, as we all know, and I'm sure we have all talked about shared housing in our classes. One of the hottest trends right now is car sharing.
There is an organization that is devoted to shareablity. The website, Shareable "is an award-winning nonprofit news, action and connection hub for the sharing transformation. What’s the sharing transformation? It’s a movement of movements emerging from the grassroots up to solve today’s biggest challenges, which old, top-down institutions are failing to address."
It appears that Seoul, South Korea has taken sharing to an entirely new dimension as they are the "sharing city." Sharing City Seoul: A Model for the World reports on Seoul's Sharing City initiative, started in 2012. The story Is Seoul the Next Great Sharing City? explains that city leaders determined to position "it... to be a model city for sharing. A new, city-funded project called Sharing City, Seoul aims to bring the sharing economy to all Seoul citizens by expanding sharing infrastructure, promoting existing sharing enterprises, incubating sharing economy startups, utilizing idle public resources, and providing more access to data and digital works." The laudable goals of becoming the model sharing city include "to create jobs and increase incomes, address environmental issues, reduce unnecessary consumption and waste, and recover trust-based relationships between people."
How does this connect to elder law? The Next Great Sharing story explains that part of the sharing initiative includes shared housing, "connecting senior citizens who have extra rooms with students who need a room." There is also information about shared meals and other initiatives. Think how the sharing model could help eliminate isolation amongst elders!
Is it working? The Model story from June of 2014 provides an update: Housing and Inter-generational Connection: To address the housing crisis and reduce the social isolation of seniors, a program was created to match young people with idle rooms in seniors’ houses. There have been 28 matches to date."
Thanks to my dear friend and colleague, Professor Mark Bauer, for sharing the article with me.
Sunday, October 5, 2014
I've been posting quite a bit about end of life issues. I wanted to be sure everyone saw the story in the NY Times on September 25, 2014 about one child's struggle to honor her dad's wish to die at home. Unfortunately, this isn't a new issue, and clearly one that isn't near resolution. The story, Fighting to Honor a Father’s Last Wish: To Die at Home tells the story of Joseph Andrey and his daughter's efforts "to fulfill her father’s dearest wish, the wish so common among frail, elderly people: to die at home...But it seemed as if all the forces of the health care system were against her — hospitals, nursing homes, home health agencies, insurance companies, and the shifting crosscurrents of public health care spending." On many occasions her dad had been discharged from the hospital to a SNF for rehab. This time she wanted to have him discharged to home, but was unsuccessful and her dad was transferred to a SNF, again.
The blog post illustrates the catch-22 within which Mr. Andrey and his daughter found themselves. The post also explains the recently-released Institute of Medicine report on Dying in America (we blogged about it earlier). Returning to Mr. Andrey's story, the article includes a short biography of his life (including a brief tenure as a child in Vaudeville), his wife's decline from Alzheimer's, his up close and personal...and ongoing...experience with the U.S. health care system, and ends with his final years. He had frequent stays at SNFs because of the inability to secure home health care in a system where there were financial incentives for SNFs but not the same profitability, if you will, for the home health agencies.
Despite all of his daughter's efforts, Mr. Andrey didn't die at home, but in a hospice within a hospital. If you read the entire article, by turns you will be appalled and saddened. If you assign this to your students, there are many opportunities for discussion about the U.S. health care system as well as end of life care in our country.
Friday, October 3, 2014
A new report launched today by the Intellectual Disability Supplement to TILDA (The Irish Longitudinal Study on Ageing) conducted by academics from the School of Nursing and Midwifery, Trinity College Dublin, Ireland, has highlighted the serious, complex and unique health and social challenges facing Ireland's intellectual disability population. The IDS-TILDA study is the first study of its kind in Europe and the only one in the world with the ability to compare the ageing of people with intellectual disability directly with the general ageing population. For the first time in history, people in Ireland with an intellectual disability are growing old in considerable numbers. The IDS-TILDA Wave 2 Report, entitled Advancing Years, Different Challenges, looked at how the ageing process is affecting the physical wellbeing and mental health of the more than 30,000 people in Ireland with an intellectual disability. Among the key findings from the report which was launched today are a marked increase in the prevalence of dementia for people with Down syndrome, particularly in comparison to the general ageing population; a range of stark findings relating to the levels of genuine connectedness to local communities among even those people with ID who had been moved to more community based residential settings as part of the Irish Government's health policy; and 50% lower rates of hypertension and three times lower rate of heart attack for people with ID compared to the general population despite having a higher risk profile than the general population.
Dean of the Faculty of Health Sciences in Trinity and Principal Investigator of IDS-TILDA, Professor Mary McCarron said: "This is the first time in history we have ever had a population of people with an intellectual disability who have reached old age and this is something that we should celebrate. However, there are a number of very serious health concerns that we need to better understand in this population. Unless we can address some of these challenges older people with ID are likely to live a poor quality of life as they grow older and ageing in poor health is an empty prize."
Yesterday I published a post on assisted dying "tourism" in Switzerland. Following up that story is another story on a related topic. Reported in the Daily Mail Online, Elderly couple to die together by assisted suicide even though they are not ill focuses on a Brussels couple in their late 80s who, despite not being terminally ill, plan to die together because they "fear loneliness if the other one dies first from natural causes" and the couple's 3 adult children have said they would be unable to care for the surviving parent when the first one died. The kids have found a doctor to help on the basis of the parents' "mental anguish constituted the unbearable suffering needed to legally justify euthanasia."
The couple has selected the date and the method of euthanasia. Although double euthanasia may seem novel, theirs will not be the first time this has occurred. However, their request has created something of a stir in the UK, according to the story. The story notes that in Brussels, evidently mental anguish is becoming a more accepted basis for a euthanasia request.
Thanks to Sushil Preet Cheema, one of my elder law concentration students, for sending me the link to this story.
Thursday, October 2, 2014
Afghanistan is the worst country to live in as an older person, an annual index on the wellbeing of the elderly showed on Wednesday. The Asian country was ranked bottom for the second consecutive year in HelpAge International's Global AgeWatch Index, its health situation in particular the poorest in the world. Norway topped the index - up one place from last year - followed by Sweden, Switzerland, Canada and Germany, all of which remained in the top 10. Apart from Japan - ranked ninth - the 10 best performers were again in western Europe, North America and Australasia. The report, which focused on pensions and warned that half the world’s population faces a bleak future without one, comes at a time when life expectancy continues to rise. Toby Porter, chief executive of HelpAge International, said governments worldwide need to implement specific policies to respond to "this unequovical demographic shift". "Only if they act now will they have a chance to meet the needs of their citizens and keep their economies going," Porter told the Thomson Reuters Foundation.