Elder Law Prof Blog

Ted Talk: Can Alzheimer's Disease be Prevented?

Neuroscientist Lisa Genova PhD, author of the novel Still Alice (that, in turn, became the movie with Julianne Moore in the leading role), has an encouraging new piece on Ted Talk on what all of us can and should do now to reduce the risk of Alzheimer's or even slow the disease after diagnosis. As she says, "DNA alone does not determine whether you will be symptomatic for Alzheimer's."  It is one of a multi-part feature on Ted Talk addressing various "Prevention" topics.  Here's and NPR link to the 14 minute podcast for Lisa's piece,  "What You Can Do to Prevent Alzheimer's?"

Correction:  My thanks to the readers who caught my typo -- it's "Still Alice," not Still Alive, for the title to the book and movie I've linked here!

 

FDA and the Right to Try

The GAO has issued a new report regarding the FDA's right to try approach to experimental drugs. Investigational New Drugs: FDA Has Taken Steps to Improve the Expanded Access Program but Should Further Clarify How Adverse Events Data Are Used reviews the FDA's increased access to experimental drugs.  Here's the findings from the report:

Under the Food and Drug Administration’s (FDA) expanded access program, patients with serious or life threatening ailments and no other comparable medical options can obtain access to investigational drugs outside of a clinical trial. Expanded access requests must be submitted to FDA but manufacturers must also grant permission for patients to access their investigational drugs. Of the nearly 5,800 expanded access requests that were submitted to FDA from fiscal year 2012 through 2015, FDA allowed 99 percent to proceed. Almost 96 percent of these requests were for single patients (either emergency or non-emergency). FDA’s review process for expanded access requests is designed such that all requests are either allowed or not allowed to proceed within 30 days of receiving each request. FDA typically responded to emergency single-patient requests within hours and other types of requests within the allotted 30 days.

FDA and other stakeholders, including a non-profit organization and a drug manufacturer, have taken steps to improve the expanded access process and patient access to drugs...  Some states have also enacted "Right-to-Try" laws to facilitate patient access to investigational drugs. These laws provide liability and licensing protections for manufacturers and providers under state law if an adverse event—such as an adverse reaction to the drug—occurs with patients who were allowed access to investigational drugs. However, some stakeholders GAO interviewed cited concerns that these laws may not help patients access drugs, in part because they do not compel a manufacturer to provide access.

Manufacturers sponsoring clinical trials must submit safety reports to FDA that include adverse events data resulting from clinical trials and any expanded access use, to be used in assessing the safety of a drug within the drug approval process... Further, some of the manufacturers told GAO the guidance was unclear. These manufacturers noted that the lack of clear information can influence their decision whether to give patients access to their drugs because of their concerns that an adverse event will result in FDA placing a clinical hold on their drug, which could delay its development. This could impact FDA’s goal of facilitating expanded access to drugs for treatment use by patients with serious or life-threatening diseases or conditions, when appropriate.

 

 

 

 

Distributive Justice and Donative Intent

Professor Alexander Boni-Saenz at Chicago-Kent College of Law has an interesting new article, Distributive Justice and Donative Intent, forthcoming in the UCLA Law Review.  From the abstract:

The inheritance system is beset by formalism. Probate courts reject wills on technicalities and refuse to correct obvious drafting mistakes by testators. These doctrines lead to donative errors, or outcomes that are not in line with the decedent’s donative intent. While scholars and reformers have critiqued the intent-defeating effects of formalism in the past, none have examined the resulting distribution of donative errors and connected it to broader social and economic inequalities. Drawing on egalitarian theories of distributive justice, this Article develops a novel critique of formalism in the inheritance law context. The central normative claim is that formalistic wills doctrines should be reformed because they create unjustified inequalities in the distribution of donative errors. In other words, probate formalism harms those who attempt to engage in estate planning without specialized legal knowledge or the economic resources to hire an attorney. By highlighting these distributive concerns, this Article reorients inheritance law scholarship to the needs of the middle class and crystallizes distributive arguments for reformers of the probate system.

When I teach Wills, Trusts & Estates, I always include a few of the latest news articles or case reports that focus on LegalZoom or other, less high-profile on-line document drafting venues that are used directly by consumers.  Alex's article examines the implications of formalism for this important reality.  Thanks, Alex!

Dementia Prospects Down?

Good news for all of us!  The July 2017 issue of Today's Research on Aging from the Population Reference Bureau reports a proportional decline in dementia. Dementia Trends: Implications for an Aging America explains that

While the absolute number of older Americans with dementia is increasing, the proportion of the population with dementia may have fallen over the past 25 years, according to a recent U.S. study (Langa et al. 2017). Researchers say this downward trend may be the result of better brain health—possibly related to higher levels of education and more aggressive treatment of cardiovascular risk factors such as high blood pressure and diabetes.

After discussing the research, the research report also notes this

The decline in dementia prevalence coupled with longer life expectancy may be contributing to another change: A growing share of older Americans are spending less of their lifetimes with cognitive impairments, another recent study based on HRS data and vital statistics shows (Crimmins, Saito, and Kim 2016). The gains in life expectancy between 2000 and 2010 represent more time older Americans spend cognitively intact, the researchers report. The share of Americans 65 and older without cognitive problems increased by 4.5 percentage points for men and 3.4 percentage points for women during the decade. At the same time, the average time older people spent with dementia or cognitive impairment shortened slightly.

The report discusses the various theories and work done to help  with "brain training", the correlations (if any) between certain diseases and dementia, and policy and budgetary implications. The report concludes:

Improvements in understanding, diagnosing, preventing, and treating Alzheimer’s disease and other dementias are top NIA priorities. The 2011 National Alzheimer’s Project Act and related legislation lay the foundation and provide new funding for “an aggressive and coordinated national plan to accelerate research.” This initiative includes research designed to better answer the following questions:

•What roles do education and intellectual stimulation play in delaying or preventing dementia?

•What are the connections among dementia, cardiovascular disease, obesity, and diabetes?

•What are the best ways to reduce the dementia risks that minority group members face?

Refining our understanding of the answers to these questions can enable policymakers and

planners to design and test prevention strategies that can contribute to continued future decline

in dementia prevalence.

 

Intervention as Mitigation of Elder Mistreatment?

The National Adult Protective Services Association (NAPSA) and the National Council on Crime and Delinquency announce a free upcoming webinar, The Abuse Intervention Model: A Pragmatic Approach to Intervention for Elder Mistreatment. Set for August 9, 2017 at 2 p.m. edt, the "webinar will present the Abuse Intervention Model (AIM), which is a simple, coherent framework of known risk factors of the victim, perpetrator, and environment that applies to all types of abuse. Dr. Laura Mosqueda will discuss the details of the AIM, and present case studies on how the AIM can be applied to APS work."  Click here to register.  To read more about the intervention model, click here.

Checking Yourself Out of the Hospital

Checking yourself out of the hospital, rather than being discharged, is known as DAMA (discharge against medical advice). The New York Times ran an article about the challenges in deciding to leave the hospital.  The Patient Wants to Leave. The Hospital Says ‘No Way.’ references a recent study that illustrates the issues that may occur for elders who want to leave the hospital. "Though A.M.A. discharges occur far more frequently in younger patients, a recent study in The Journal of the American Geriatrics Society analyzed a large national sample from 2013 and found that 50,650 hospitalizations of patients over age 65 ended with A.M.A. discharges." The article also discusses why folks choose to leave, for example, they feel better, they are worried about money, or they're afraid. The article also discusses the arguments against the DAMA and some confusion about the impact of DAMA on subsequent care.  The abstract of the article, Discharge Against Medical Advice of Elderly Inpatients in the United States, elaborates  "[d]ischarge against medical advice (DAMA) is associated with greater risk of hospital readmission and higher morbidity, mortality, and costs, but with a rapidly increasing elderly inpatient population, there is a lack of national data on DAMA in this subgroup...  Although DAMA rates in individuals aged 65 and older were one fourth of those found in individuals aged 18 to 64, an increasing trend was found in both groups..."  To order the article, click here.

 

Central States Law School Association (CSLSA) Annual Scholarship Conference

I received a notice about the upcoming CSLSA annual conference. Here's the info:

Registration is now open for the Central States Law Schools Association 2017 Scholarship Conference, which will be held on Friday, October 6 and Saturday, October 7 at Southern Illinois University School of Law in Carbondale, Illinois. We invite law faculty from across the country to submit proposals to present papers or works in progress. CSLSA is an organization of law schools dedicated to providing a forum for conversation and collaboration among law school academics. The CSLSA Annual Conference is an opportunity for legal scholars, especially more junior scholars, to present working papers or finished articles on any law-related topic in a relaxed and supportive setting where junior and senior scholars from various disciplines are available to comment. More mature scholars have an opportunity to test new ideas in a less formal setting than is generally available for their work. Scholars from member and nonmember schools are invited to attend.  Please click here to register. The deadline for registration is September 2, 2017.   Hotel rooms are now available for pre-booking.  The conference hotel is the Holiday Inn Conference Center in Carbondale.  To reserve a room, call 618-549-2600 and ask for the SIU School of Law rate ($109/night) or book online and use block code SOL.  SIU School of Law will provide shuttle service to and from the Holiday Inn & Conference Center for conference events.  Other hotel options (without shuttle service) are listed on our website.  Please note that conference participants are responsible for all of their own travel expenses including hotel accommodations. For more information about CSLSA and the 2017 Annual Conference please subscribe to our blog.

Central States Law School Association (CSLSA) Annual Scholarship Conference

I received a notice about the upcoming CSLSA annual conference. Here's the info

Registration is now open for the Central States Law Schools Association 2017 Scholarship Conference, which will be held on Friday, October 6 and Saturday, October 7 at Southern Illinois University School of Law in Carbondale, Illinois. We invite law faculty from across the country to submit proposals to present papers or works in progress. CSLSA is an organization of law schools dedicated to providing a forum for conversation and collaboration among law school academics. The CSLSA Annual Conference is an opportunity for legal scholars, especially more junior scholars, to present working papers or finished articles on any law-related topic in a relaxed and supportive setting where junior and senior scholars from various disciplines are available to comment. More mature scholars have an opportunity to test new ideas in a less formal setting than is generally available for their work. Scholars from member and nonmember schools are invited to attend.  Please click here to register. The deadline for registration is September 2, 2017.   Hotel rooms are now available for pre-booking.  The conference hotel is the Holiday Inn Conference Center in Carbondale.  To reserve a room, call 618-549-2600 and ask for the SIU School of Law rate ($109/night) or book online and use block code SOL.  SIU School of Law will provide shuttle service to and from the Holiday Inn & Conference Center for conference events.  Other hotel options (without shuttle service) are listed on our website.  Please note that conference participants are responsible for all of their own travel expenses including hotel accommodations. For more information about CSLSA and the 2017 Annual Conference please subscribe to our blog.

Filial Friday: Elderly NJ Parents Held Not Liable to Pay Care for Disabled Adult Son in PA

In the latest chapter of an ongoing dispute between a specialized care facility, Melmark, Inc., and the older parents of a disabled adult son, Pennsylvania's intermediate Superior Court of Appeals has ruled in favor of the parents.  

The July 19, 2017 appellate decision in Melmark v. Schutt is based on choice of law principles, analyzing whether New Jersey's more limited filial support law or Pennsylvania's broader filial law controlled.  If applied, New Jersey law "would shield the [parents] from financial responsibility for [their son's] care because they are over age 55 and Alex is no longer a minor." By contrast, "Pennsylvania's filial support law...would provide no age-based exception to parental responsibility to pay for care rendered to an indigent adult child."

The parents and the son were all, as stipulated to the court, residents of New Jersey.  New Jersey public funding paid from the son's  specialized care needs at Melmark's Pennsylvania facility for some 11 years.  However, when, as part of a "bring our children home" program, New Jersey cut the funding for cross-border placements, the parents, age 70 and 71 year old, opposed return of their 31-year old son, arguing lack of an appropriate placement.  Eventually Melmark returned their son to New Jersey against the parents' wishes, with an outstanding bill for unpaid care totaling more than $205,000, incurred over his final 14 months at Melmark.

Both the Pennsylvania trial and appellate courts ruled against the facility, concluding that "the New Jersey statutory scheme reflects a legislative purpose to protect its elderly parents from financial liability associated with the provision of care for their public assistance-eligible indigent children under the present circumstances."  The courts rejected application of Pennsylvania's law as controlling.

This is a tough case, with hard-line positions on the law staked out by both sides.  One cannot expect facilities to provide quality care for free.  On the other side, one can empathize with families who face limited local care choices and huge costs.

Ultimately, I anticipate these kinds of cross-border "family care and cost" disputes becoming more common in the future for care-dependent family members, as the impact of federal funding cuts trickle down to states with uneven resources of their own.  Some of these problems won't see the courtroom, as facilities will likely resist any out-of-state placement where payment is not guaranteed by family members, old or young.  

Kupuna Caregivers Act of Hawai'i

In early July, the Governor of Hawai'i signed into law the Kupuna Caregivers Act,  According to a story about the law, Hawaii Passes Law to Ease Responsibility of Elder Care, the law "provides qualified caregivers with a voucher of up to $70 per day that can be used toward services that they would otherwise perform themselves, including adult day care and assisted transportation." The first law of its type in the U.S. rather than benefitting the recipient of care, the law benefits the caregivers: by paying  "working family caregivers, who can be caring for family members who are above the Medicaid eligibility threshold. While the amount provided does not cover the entire cost of care families need, it does allow them to provide more hours of in-home care and other services...."  The text of the law is available here.

Webinar on Elder Abuse-Insight into Victims of Crimes Act (VOCA)

Justice in Aging has announced a free webinar on Juhttp://www.justiceinaging.org/webinar-elder-abuse-insight-victims-crimes-act-voca/ly 31, 2017 at 2:00 p.m. edt, Elder Abuse-Insight into Victims of Crimes Act (VOCA). Here is a description of the webiniar

The Victims of Crimes Act (VOCA) supports crime victims programs that assist victims of sexual assault, spousal abuse, child abuse, or other previously underserved victims of crimes. In recent years, VOCA has supported elder abuse programs, including certain specified legal assistance expenses that help crime victims.

Legal aid programs play a crucial role in accessing justice for elder abuse victims. In this webinar, Elder Abuse-Insight into Victims of Crimes Act (VOCA) and Legal Aid Support, Steve Derene, Executive Director of the National Association of VOCA Assistance Administrators (NAVAA), will explain VOCA and its potential for supporting elder justice initiatives in legal services programs. Kathy Buckley, Manager of the Victim’s Services Program at the Pennsylvania Commission on Crime and Delinquency will provide insight into the programs the Commission supports through VOCA.

The webinar will emphasize key details legal aid programs should understand when applying for VOCA funding to support elder justice work.

And did I mention, it's free? To register, click here.

Paying for Help at Home

Governing ran a recent story about how states will pay for in-home care for their residents who are elders. As Demand for At-Home Care Grows, States Debate How to Pay for It  considers that aging Boomers may not want to reside in nursing homes and if they stay at home, they will need care at  home.  With a likely greater demand for inhome care, how will it be delivered and who will pay?

[F]iguring out how to pay for more home-based care is mostly left up to the states. Medicaid is the primary payer for home- and community-based care, although states can decide whether or not they’ll offer the coverage. All 50 states and the District of Columbia do have home- and community-based programs of some type, but most states have waiting lists for their programs. Meanwhile, 59 percent of Medicaid funding goes to nursing homes, where about half of those in long-term care receive their services. “Nursing home institutions are a powerful player in the health-care setting, so there’s long been political pressure to not pay for more home health care,” says [Kevin] Prindiville [, executive director of Justice in Aging].

The article highlights California and Washington state, at opposite ends of the spectrum in handling this issue. Waivers may help, or shifting money through legislation that gives flexibility.

Nursing Home Quality of Care An Ongoing Issue for Some Facilities

I read this article last week in the New York Times (also published by the Kaiser Health News), the topic of which is something we should consider seriously.  Poor Patient Care at Many Nursing Homes Despite Stricter Oversight discusses Medicare's Special Focus status.

While special focus status is one of the federal government’s strictest forms of oversight, nursing homes that were forced to undergo such scrutiny often slide back into providing dangerous care, according to an analysis of federal health inspection data. Of 528 nursing homes that graduated from special focus status before 2014 and are still operating, slightly more than half — 52 percent — have since harmed patients or put patients in serious jeopardy within the past three years.

The article highlights some individuals' experiences, with the basis of the article concerning the Special Focus program. 

Special focus facility status is reserved for the poorest-performing facilities out of more than 15,000 skilled nursing homes. The Centers for Medicare and Medicaid Services, or C.M.S., assign each state a set number of slots, roughly based on the number of nursing homes. Then state health regulators pick which nursing homes to include.

More than 900 facilities have been placed on the watch list since 2005. But the number of nursing homes under special focus at any given time has dropped by nearly half since 2012, because of federal budget cuts. This year, the $2.6 million budget allows only 88 nursing homes to receive the designation, though regulators identified 435 as warranting scrutiny.

The article also discusses lapses by those facilities once on the watch list, how a facility earns its way off the watch list and how long it typically takes to do so and the staffing ratios in such facilities.

Background information about the special focus initiative can be found on the CMS website. You can find the list of special focus facilities on CMS website. For example, here is the one published in June of 2017.

It's Here, Too. The 2017 Medicare Trustees' Report

The Medicare Trustees have also released their annual report on the health of Medicare  J Medicare offers some helpful information about how to read the report

The Trustees Report is a detailed, lengthy document, containing a substantial amount of information on the past and estimated future financial operations of the Hospital Insurance and Supplementary Medical Insurance Trust Funds (see the links in the Downloads section below). We recommend that readers begin with the "Overview" section of the report. This section is fairly short, is written in "plain English," and summarizes all the key information concerning the expected financial outlook for Medicare. Substantial additional material is available in the later sections for those wishing to delve more deeply into the actuarial projections.

The report is downloadable as a pdf here. This report runs 263 pages (just a tiny bit shorter than the one from the SSA Trustees).  Again, what do we want to know? We want to know whether Medicare is on sound financial footing. So let's get right to the bottom line (or pages 40-42). Here are the relevant portions of the conclusion in Section II

Total Medicare expenditures were $679 billion in 2016, and the Board projects that they will increase in most future years at a somewhat faster pace than either aggregate workers’ earnings or the economy overall. The faster increase is primarily due to the number of beneficiaries increasing more rapidly than the number of workers, coupled with a continued increase in the volume and intensity of services delivered. Based on the intermediate set of assumptions under current law, expenditures as a percentage of GDP would increase from the current 3.6 percent to a projected 5.9 percent by 2091.

The HI trust fund fails to meet the Board of Trustees’ short-range test of financial adequacy. In addition, as in past reports, the HI trust fund fails to meet the Trustees’ long-range test of close actuarial balance.

HI experienced deficits from 2008 through 2015, but annual surpluses are expected from 2016 through 2022 before deficits return for the remainder of the 75-year projection period. The projected trust fund depletion date is 2029, one year later than estimated in last year’s report. Actual HI expenditures in 2016 were slightly lower than the previous estimate. The projections are lower throughout the short-range period due to lower utilization and provider update assumptions. HI taxable payroll in 2016 was slightly higher than previously projected, and projections for HI tax income are lower after 2017 due to slower real-wage growth assumptions.

The HI actuarial deficit in this year’s report is 0.64 percent of taxable payroll, down from 0.73 percent in last year’s report. This result is due primarily to lower-than-estimated spending in 2016 and lower projected inpatient hospital utilization.

The financial outlook for SMI is fundamentally different than for HI due to the statutory differences in the methods of financing for these two components of Medicare. The Trustees project that both the Part B and Part D accounts of the SMI trust fund will remain in financial balance for all future years because beneficiary premiums and general revenue transfers are assumed to be set at a level to meet expected costs each year. However, SMI costs are projected to increase significantly as a share of GDP over the next 75 years, from 2.1 percent to 3.7 percent under current law. The projected Part B costs in this report are slightly higher over the short-range and long-range periods than the comparable projections in the previous report due to higher-than-expected actual spending for outpatient hospital services and physician-administered drugs in 2016 and a methodological change resulting in higher drug spending for patients with end-stage renal disease. The Part D short-range and long-range projections are lower than in past years’ reports, largely due to the increase in drug manufacturer rebates and lower utilization of hepatitis C drugs.

The financial projections shown for the Medicare program in this report reflect substantial, but very uncertain, cost savings deriving from provisions of the ACA and MACRA that lower increases in Medicare payment rates to most categories of health care providers. Without fundamental change in the current delivery system, these adjustments would probably not be viable indefinitely.

* * *

Policy makers should determine effective solutions to the long-range HI financial imbalance. Even assuming that the provider payment rates will be adequate, the HI program does not meet either the Trustees’ short-range test of financial adequacy or long-range test of close actuarial balance. HI revenues would cover only 88 percent of estimated expenditures in 2029 and 81 percent in 2050. By the end of the 75-year projection period, HI revenues could pay 88 percent of HI costs. Policy makers should also consider the likelihood that the price adjustments in current law may prove difficult to adhere to fully and may require even more changes to address the financial imbalance.

The projections in this year’s report continue to demonstrate the need for timely and effective action to address Medicare’s remaining financial challenges—including the projected depletion of the HI trust fund, this fund’s long-range financial imbalance, and the rapid growth in Medicare expenditures. Furthermore, if the growth in Medicare costs is comparable to growth under the illustrative alternative projections, then these further policy reforms will have to address much larger financial challenges than those assumed under current law. The Board of Trustees believes that solutions can and must be found to ensure the financial integrity of HI in the short and long term and to reduce the rate of growth in Medicare costs through viable means. Consideration of such reforms should not be delayed. The sooner the solutions are enacted, the more flexible and gradual they can be. Moreover, the early introduction of reforms increases the time available for affected individuals and organizations—including health care providers, beneficiaries, and taxpayers—to adjust their expectations and behavior. The Board recommends that Congress and the executive branch work closely together with a sense of urgency to address these challenges.

 

It's Here! The 2017 SSA Trustees Report

The SSA Trustees released the 2017 annual report on July 13, 2017.  You can download the 269 page report as a pdf here or you can contact the Office of the Chief Actuary for a hard cc of the report.  There is a lot of information in this report, but of course, what everyone wants to know is whether Social Security is running out of money. Section II, the Highlights, offers this conclusion

Under the intermediate assumptions, DI Trust Fund asset reserves are projected to become depleted in 2028, at which time continuing income to the DI Trust Fund would be sufficient to pay 93 percent of DI scheduled benefits. Therefore, legislative action is needed to address the DI program’s financial imbalance. The OASI Trust Fund reserves are projected to become depleted in 2035, at which time OASI income would be sufficient to pay 75 percent of OASI scheduled benefits.

The Trustees also project that annual cost for the OASDI program will exceed non-interest income throughout the projection period, and will exceed total income beginning in 2022 under the intermediate assumptions. The projected hypothetical combined OASI and DI Trust Fund asset reserves increase through 2021, begin to decline in 2022, and become depleted and unable to pay scheduled benefits in full on a timely basis in 2034. At the time of depletion of these combined reserves, continuing income to the combined trust funds would be sufficient to pay 77 percent of scheduled benefits. Lawmakers have a broad continuum of policy options that would close or reduce Social Security's long-term financing shortfall. Cost estimates for many such policy options are available at www.ssa.gov/OACT/solvency/provisions/.

The Trustees recommend that lawmakers address the projected trust fund shortfalls in a timely way in order to phase in necessary changes gradually and give workers and beneficiaries time to adjust to them. Implementing changes sooner rather than later would allow more generations to share in the needed revenue increases or reductions in scheduled benefits and could preserve more trust fund reserves to help finance future benefits. Social Security will play a critical role in the lives of 62 million beneficiaries and 173 million covered workers and their families in 2017. With informed discussion, creative thinking, and timely legislative action, Social Security can continue to protect  future generations.

 

Issue Brief: Medicare Savings Program

Justice in Aging has released a new issue brief for July about Medicare Savings Programs (MSP).  Proposed Cuts to Medicaid Put Medicare Savings Programs At Risk explains the importance of the MSP for many Medicare beneficiaries, including paying their premiums. If the MSP program were cut or eliminated, many beneficiaries may no longer be able to afford Medicare. 

Many low-income older adults are only able to participate in Medicare because Medicare Savings Programs help with their Medicare premiums, deductibles and co-pays. These critically important programs reach over 7 million people with Medicare, including 1.7 million older adults who are too poor to be able to afford Medicare but do not qualify for other Medicaid programs.1 With $772 billion in Medicaid cuts, the Better Care Reconciliation Act now being considered in the Senate could knock many older adults and people with disabilities off these programs, making Medicare unaffordable. As a result, those with the greatest needs will lose access to Medicare benefits because they will be unable to shoulder Medicare costs.

The brief explains QMBs, SLMBs, and QIs. It also explains the relationship between MSP and "Extra Help".  Regardless of the Senate vote (maybe this week) on repeal and replace, the information in the brief about MSP and the other programs is really helpful. Check it out!

If 60 is the new "40" is 70 the new 60?

The Stony Brook U newsroom released a story recently, New Measures of Aging May Show 70 is the New 60.

Here are some excerpts from the story about the study:

new measures of aging with probabilistic projections from the United Nations to scientifically illustrate that one’s actual age is not necessarily the best measure of human aging itself, but rather aging should be based on the number of years people are likely to live in a given country in the 21^st Century.

The study also predicts an end to population aging in the U.S. and other countries before the end of the century. Population aging – when the median age rises in a country because of increasing life expectancy and lower fertility rates – is a concern for countries because of the perception that population aging leads to declining numbers of working age people and additional social burdens.

You'll recall the three cohorts of "old" 65-74, the "young old", 75-84, the old, and 85+ the old-old.  According to this study, "[t]raditional population projections categorize “old age” as a simple cutoff at age 65. But as life expectancies have increased, so too have the years that people remain healthy, active, and productive. In the last decade, IIASA researchers have published a large body of research showing that the very boundary of “old age” should shift with changes in life expectancy, and have introduced new measures of aging that are based on population characteristics, giving a more comprehensive view of population aging."

The study focuses on the US, China, Iran and Germany.  The study is available here.

Cyber-Safe When On Line

Kiplinger ran a story for elders about staying cyber-safe online. Beware Fraudsters When You Go Online discusses cybersecurity safety.  The tips include a strong password (I know we've heard this before, but it's so important) ,using tw0-factor authentication and even fingerprint ID to log on.  Do this for every one of your online interfaces: for your email, your financial accounts and your social media.  Keep your software and anti-virus updated (include your smart phone-update those apps!).  Backup critical data (even a hard copy), don't share your passwords, don't use the same password for everything, keep a hard copy of your passwords, don't click on links in emails and remember your bank,  Social Security and the IRS will not email you. You didn't really win a foreign country's lottery. Don't open attachments.  Be mindful when on your computer. Think before you click!

New Report: Restoration of Rights: Adult Guardianship

The ABA Commission on Law & Aging and the Virginia Tech Center for Gerontology have released a report, Restoration of Rights in Adult Guardianship: Research & Recommendations. The report is divided into four parts: (1) introduction & background,  (2) research on restoration of rights, (3) discussion & recommendations on key issues to restoration, and (4) conclusion.   The report runs 69 pages and is available for download as a pdf. Section 3 covers a number of topics, including lack of knowledge of the availability of restoration, review by courts re: continuing need for guardianship, court access, attorney representation (and the attorney's role),  the guardian's role, supports available to the person, evidence and evidentiary standards, and data and research.  Here is the conclusion

The time is ripe for restoration of rights to be become a viable option for people subject to guardianship. In the context of the emergent paradigm of supported decision-making, restoration can be a path to self-determination and choice. For courts, attention to restoration can weed out unnecessary cases from dockets, allowing a stronger focus on problems needing judicial intervention, and saving administrative costs of carrying unnecessary cases.

To make restoration work:

• State legislation must ensure sufficient notice that the option exists, provide for regular court review of the continuing need for guardianship, afford the right to counsel, and set workable evidentiary standards.

• Courts must assess cases for possible restoration, find ways to make individuals and families more aware of the option, make the process more accessible, take into account available supports in making determinations, and track data on restoration.

• Guardians must perceive their role as enhancing self-determination and working toward termination of guardianship with sufficient support – more as "supporters" guided by the person’s expressed wishes if possible. There must be sufficient legal decision-making tools, family supports, technological supports, and community supports readily available to bolster functional abilities.

• Lawyers must recognize and act on the potential of restoration in guardianship cases.

This study has set the stage for such actions, bringing to life the possibility that guardianship is not automatically an end but can be "a way station and not a final destination."

 

 

In Memory of Alfred "Chip" Chiplin

A wonderful human being and dear friend, Chip Chiplin has died  after a long illness. Chip was just the best; there are not enough superlatives to describe him.  He tirelessly advocated for elders, especially Medicare beneficiaries. I was so lucky to know him. Here is his bio:

Alfred J. Chiplin, Jr., Esq. is a Senior Policy Attorney with the Center for Medicare Advocacy, Inc. in its Washington, DC office. His practice is devoted primarily to health care matters, with a concentration on Medicare and managed care coverage and appeal issues. He is also a specialist in legal assistance development and services under the Older Americans Act. Mr. Chiplin served as a consulting attorney with the Consumer Coalition for Quality Health Care and, for over 10 years, as a staff attorney for the National Senior Citizens Law Center, where he focused on the Medicare program and on developments in managed care. He also coordinated Older Americans Act programs for the National Senior Citizens Law Center, including planning and developing the annual Joint Conference on Law and Aging (JCLA). He currently serves on the planning committee for the annual National Aging and Law Conference.  Mr. Chiplin is the immediate past chair of the Public Advisory Group (PAG) of the Joint Commission on Accreditation of health care Organizations (JCAHO).  Along with Judith A. Stein, Mr. Chiplin is co-editor-in-chief of the Medicare Handbook (Aspen Publishers, Inc., updated annually).

Mr. Chiplin received his J.D. degree from the George Washington University and his M. Div. from Harvard University.  He is a Fellow of the National Academy of Elder Law Attorneys and a former member of its board of directors, including its executive committee.  He is also a member of the National Academy of Social Insurance (NASI), and served on its "Medicare and Markets" study panel.