Elder Law Prof Blog

Check out the 2018 Profile of Older Americans

Yes, yes, we are almost half-way through 2019, but here is the 2018 Profile of Older Americans!   The Administration for Community Living (ACL) explains that "[t]he Profile of Older Americans is an annual summary of critical statistics related to the older population in the United States. Relying primarily on data offered by the U.S. Census Bureau, the Profile illustrates the shifting demographics of Americans age 65 and older. It includes key topic areas such as income, living arrangements, education, health, and caregiving. The 2018 Profile also incorporates a new special section on emergency and disaster preparedness." You can access the 20 page profile as a pdf here or access the data in a spreadsheet here.  You can also access the data for prior years from the landing page.

The highlights reveal some interesting stats, including

•Older women outnumber older men at 28.3 million older women to 22.6 million older men.

•In 2017, 23% of persons age 65 and over were members of racial or ethnic minority populations--9% were African-Americans (not Hispanic), 4% were Asian (not Hispanic), 0.5% were American Indian and Alaska Native (not Hispanic), 0.1% were Native Hawaiian/Pacific Islander (not Hispanic), and 0.8% of persons 65 and older identified themselves as being of two or more races. Persons of Hispanic origin (who may be of any race) represented 8% of the older population.

•A larger percentage of older men are married as compared with older women---70% of men, 46% of women. In 2018, 32% older women were widows.

•About 28% (14.3 million) of older persons lived alone (9.5 million women, 4.8 million men).

•Among women age 75 and over, 44% lived alone.

•Among adults age 75 and over, 42% report the television is their first source of emergency information as compared with 31% for the total population. The percentage of older adults receiving information from the internet (9%) is much lower than for the total population (31%).

Rocking On Regardless of Age!

Here's an inspiration for you. Whether you are a big band aficionado, love swing, rock 'n roll, metal, classical, rap, or something else, your appreciation of music has no age limit.  This story made me happy! 2 elderly men sneak out of nursing home to attend heavy metal festival covers the story.

You're never too old to rock on. Two elderly men managed to slip away from their nursing home in Germany to attend the Wacken Open Air, the largest heavy metal festival in the world, over the weekend, authorities said. 

According to Itzehoe police, the pair was eventually found Friday at 3 a.m. local time at the festival after their retirement home in Dithmarscher reported them missing. Police told the Deutsche Welle the men were found "disorientated and dazed."

The metalheads were apparently reluctant to leave the four-day festival in Wacken. They had to be escorted home with a taxi and a patrol car as a "precaution," police said.

Of course, safety is an issue.  I don't mean to make light of what might have happened. But dudes, rock on!  (P.S. One of my colleagues who is a big music fan offered to represent them for free if they need lawyers).

 

Denver's Dementia-Friendly Initiative

A number of cities have undertaken to become dementia-friendly as part of the dementia-friendly America initiative. Denver's efforts are aimed at "improv[ing] the quality of life for people with dementia and their families in the Denver area." The national initiative, started in 2015 is a "grass roots not for profit project [that] is spreading throughout the US with hundreds of cities participating and more joining every month."  The community's efforts are unique to the community and fall within these areas "Business, Legal, Financial, Government, Healthcare, Independent Living, Care Communities, Academia, Community Services, and the Faith Community."

Denver's projects range from community education to resource guides, to recognizing businesses that are making efforts and more.

 

End of Life Case in France

Dr. Jay Wolfson, who served as the guardian ad litem in the Schiavo case, recently sent me a link to a BBC story about Vincent Lambert. Vincent Lambert: Life support must resume after court reverses ruling explains that after the Paris Appeals Court ruling, doctors had to resume life support for Mr. Lambert, in a vegetative state since an accident in 2008. His spouse supports terminating life support, while his parents oppose it.  When reading the article, I couldn't help but notice the similarities to some occurrences in Schiavo.  

The dispute has spread beyond the family of Mr. Lambert.  "The UN's Committee on the Rights of Persons with Disabilities had called on France to intervene and delay the move to withdraw the life support while they investigated his case further. France's ministry of health said it was not bound by the committee."

A follow up article was published in the Sunday Times (subscription required).

The Science of Being Susceptible To Scams

Marketplace recently ran a story about fascinating research on whether there is a correlation between age and susceptibility to scams.  Age of fraud: Are seniors more vulnerable to financial scams? opens with the story of one individual who fell victim to a "gift card" scam of almost $200,ooo. Think it can't happen to you? Here is where the science comes in.

[A researcher] and his colleagues have put a label on what they see as an all-too common condition: “age-associated financial vulnerability.”

“We are learning that there are changes in the aging brain, even in the absence of diseases like Alzheimer’s disease or other neurodegenerative illnesses, that may render older adults vulnerable to financial exploitation.”

The science is showing that older folks

ability to detect sketchy situations may decline. Or, we may become prone to seeing the upside of a risky deal and blow off the downside. Some people are more inclined to believe the last person they spoke to. Others may lose the ability to push back on a high-pressure predator. Researchers emphasize that this phenomenon goes way beyond changes in the brain.

“It also involves all of these other social and environmental factors like social isolation, like cultural factors and societal factors, like older adults having more wealth compared to younger generations,” said Marti DeLiema, a research scholar at the Stanford Center on Longevity.

Still think it can't happen to you? The researchers are examining "age-related financial vulnerability[and]  are very interested in physical changes to the aging brain, the way eyesight and hearing can get less keen. In some cases, a new pattern of making mistakes with money may be a harbinger of cognitive bad things to come, the “first thing to go,” as it were"

Still think it can't happen to you? Read on.  The optimal age for money management is 53 years old, according to the article.  There is some advantage to age; the life experiences we acquire.  Now we all know, as the article reflects, that scams don't just target older persons.   There is no easy answer to the issue. How do you protect people from making bad decisions  or from falling for a scam?  The article references various state approaches and the federal Elder Abuse Prevention and Prosecution Act. FINRA is also asking brokers to "encourage customers to list the name of a trusted person to contact if something signals “scam.” Banks have no such rule."

The remainder of the article focuses on the responses and need for more work. Several experts offer suggestions for responses. I thought this one response was poignant: "abuse of the elderly is, at its core, lack of social support. The cure is social support. It’s possible that the best way to help vulnerable loved ones is just to be there, to be present in their lives."

Think this can't happen to you? Think again. And read this article.

Decision-Making Supports Guardianship Course

The National Center for State Courts has announced the release of a new guardianship course, Finding the Right Fit: Decision-Making Supports and Guardianship.

According to the press release, this interactive on-line course covers

• How to support friends and loved ones in making their own choices about their health, finances, and lifestyle.

• Legal options, including powers of attorney and advance directives. • How to become a guardian.

• How a guardian can support a person’s decision-making.

• Identifying and understanding the risk of abuse, neglect, and exploitation that comes with any of the above options.

The course takes about 2 hours to complete and you have to create an account to access it. Check it out!

Needing LTC but Unable to Afford It

The New York Times ran an article recently that doesn't bode well for many elder Americans.  Many Americans Will Need Long-Term Care. Most Won't be Able to Afford It reviews what is referred to as

the middle-class bind ... [where the elder has t]oo much money to qualify for Medicaid or subsidized housing, but not enough to pay for long-term care, an industry that has primarily pursued the well-off. ...

A recent analysis in Health Affairs, pointedly titled “The Forgotten Middle,” investigated how many middle-income seniors will be caught in that bind. The numbers were grim.

Using data from the national Health and Retirement Study, including personal income and assets and health status, the researchers defined the middle-income cohort as Americans from the 41st to the 80th percentile in terms of financial resources....

In 2029, for people 75 to 84 (ages when they’re likely to need long-term care), that would mean access to about $25,000 to $74,000 a year in current dollars. Over age 85, the middle-income category extends to $95,000.

The projection is that two-thirds are going to need some type of long-term care, yet "more than half will be unable to pay assisted living fees and medical costs in 2029, the study found." Even those owning a home aren't as house-rich as they may think.  Plus this group has a lot of debt, and not that much in savings.

Consider this:

The United States, unlike many Western democracies, has never created a broad public program covering long-term care. Medicare pays for doctors, hospitals, drugs and short-term rehab after hospitalization — not for independent or assisted living.

That could change one day — imagine a new Medicare Part LTC — but “that will be incredibly difficult to achieve politically,” [said one expert].

Policy types instead suggest more incremental changes by both government and industry. Perhaps Medicaid could cover seniors with slightly higher incomes, or modify its regulations to include housing costs along with health care.

Maps of America Aging

Professor Naomi Cahn sent us the link to this recent article, 7 maps that tell the incredible story of aging in America. "Census projections show a major demographic shift already underway and accelerating in the years to come. ...At the same time, populations are not aging evenly, and issues related to aging will impact individual communities in vastly different ways, boosting economic opportunity in some areas while putting a strain on social services in others."

One way to sort out who will be most impacted by aging is to look at age demographics across the country and how they will change over time. Using data from the U.S. Census Bureau and its own updated demographics, spatial-analytics firm Esri put together for Fast Company an exclusive map series that examines the issue from a number of angles, including a district-by-district breakdown of the median age in 2010 and the projected median age in 2023. The result is a compelling visual record of both who we are right now and where we are heading–a temporal snapshot for the ages, so to speak.

 

There are links to maps on the following topics:

• Population age 65+ (2010 – 2023)
• Change in population age 65+ (2010 – 2023)
• Median age (2010-2023)
• Change in median age (2010-2023)
• Spending on healthcare (2018)
• Relationship between healthcare spending and pop. 65+
• Contributions to pensions and social security

California ALF Resident Evicted for Not Paying Rent

That headline may have elicited a shoulder shrug from you and a fleeting thought as to why I thought this was newsworthy enough to be the subject of a blog post.  So how about if I add some info for you?  What if the story's title is this? Medi-Cal recipient, 101, evicted from Santa Rosa assisted living facility for being unable to pay. This is a situation where the elder outlived her savings. As the story explains

[The resident] like most people, probably never thought she’d live to be 101, and she clearly did not expect to be paying nearly $7,000 a month to be living in a senior residential care facility.

The expense drained her of all the money she had after selling her modest home in Santa Rosa’s Holland Heights neighborhood in 2013. By November of last year, all [the resident] could afford to give ...  the assisted living facility, was her monthly Social Security check of about $1,300 — it wasn’t enough. ...

On April 18, [the resident], who suffers from dementia, was wheeled into Sonoma County eviction court on Cleveland Avenue. With her bank account drained, the former real estate agent was now receiving Medi-Cal, the state’s version of Medicaid health insurance, which the private-pay [ALF] le did not accept.

The story ultimately has an ending-a Medi-Cal bed was located for the resident. The story goes on to focus on the lack of beds in the area, the cost of long-term care, and the problem for folks like the elder in this story who outlives her savings.

Thanks to Julie Kitzmiller for alerting me to this story.

Florida is #1.... in Fraud Reports

There are a lot of great things about Florida and a lot of wacky things (don't believe me about the wacky things? check out "A Florida Man") One of the sad things recently about Florida is our #1 ranking for fraud in the U.S. 

Security.org crunches the numbers from the Federal Trade Commission and comes up with a report on the common frauds by state. In addition to the frauds by state, they also report on the top scams for the year. The #1 scam in the U.S. for the last year is impostor scam, followed by debt collection, identity theft, telephone/mobile sales, catalog/shop-at-home, banks/lenders, credit info, the old standard--lotteries, cars and internet.

So when I looked at Florida, here we are ranked #1 in the nation for fraud and other reports according to the Consumer Sentinel Network Data Book 2018  (issued by the FTC in February 2019).  There's a lot of good info in the Data Book, beyond individual state rankings.

Here's the executive summary from the Data Book

Overview

During 2018, the Consumer Sentinel Network took in nearly 3 million reports, an increase from 2017. - Fraud: 1.4 million (48% of all reports) - Identity theft: 444,602 (15%) - Other: 1.1 million (38%).

Imposter Scams are the top report category in 2018 (18% of all reports). Debt collection reports declined by 24% percent in 2018 (16% of all reports) and moved to #2. Identity theft (15% of all reports) rounds out the top three reports to Sentinel.

Fraud

There were over 535,000 imposter scam reports to Sentinel. Nearly one in five of those also reported a dollar loss, totaling nearly $488 million lost to imposter scams. These scams include, for example,romance scams, people falsely claiming to be with the government, a relative in distress, a well-known business, or a technical support expert, to get a consumer’s money.

Of the 1.4 million fraud reports, 25% indicated money was lost. In 2018, people reported losing nearly$1.48 billion to fraud – an increase of $406 million over what consumers reported losing in 2017.

The median loss for all fraud reports in 2018 is $375. The median individual losses were highest in these fraud categories: - Mortgage Foreclosure Relief and Debt Management ($1,377) - Business and Job Opportunities ($1,304) - Foreign Money Offers and Counterfeit Check Scams ($1,214).

Telephone was the method of contact for 69% of fraud reports with a contact method identified. Only eight percent of those people reported losing money to the scammer – but that 8% reported an aggregate loss of $429 million, and an $840 median loss.

Wire transfers continue to be the most frequently reported payment method for fraud, with a reported aggregate loss of $423 million.

Of people who reported their age, those aged 20-29 reported losing money to fraud in 43% of reports filed with the FTC, while people aged 70 – 79 reported losing money in 15% of their reports and people80 and over reported losing money in just 13% of their reports. But when they did experience a loss,people aged 70 and older reported much higher median losses than any other age group.

Identity Theft

Credit card fraud tops the list of identity theft reports in 2018. The FTC received more than 167,000reports from people who said their information was misused on an existing account or to open a new credit card account.

Military

Military consumers reported more than 59,000 fraud complaints, including over 36,000 imposter scams that cost them $34 million in 2018. Imposter scams were the largest single category of reportsfrom military consumers.

Top States

The states with the highest per capita rates of reported fraud in 2018 were Florida, Georgia, Nevada,Delaware, and Maryland. For reported identity theft, the top states in 2018 were Georgia, Nevada,California, Florida, and Texas.

 

 

Dementia-Friendly Communities

City Lab wrote about an interesting concept whose time is past-due. Dementia-Friendly Cities Prepare for an Aging Populace explains "a movement [that] is growing across the country to create dementia-friendly communities. Business owners, police officers, bank tellers, college students, and others are training to learn to recognize signs of cognitive impairment, and how they can assist someone who is demonstrating impairment." Look at Middleton, Wisconsin, which was part of the leading edge of this trend, starting with "a resolution to become dementia-friendly, working with the Alzheimer’s and Dementia Alliance of Wisconsin. The city trained its employees and more than 50 businesses soon followed." 

Here in the U.S., the efforts  "to create dementia-friendly communities gained traction in 2015 with the launch of Dementia Friendly America at the White House Conference on Aging. Modeled after a successful program in Minnesota, the newly minted initiative announced pilot programs in six cities and communities, among them, Denver." This is no cookie cutter project, although there are some commonalities amongst the various projects.

The article notes that it's hard to measure success of the various projects, with various obstacles, including  "reaching a critical mass of business owners, particularly in larger cities. Also, as many as 40 percent of people living with Alzheimer’s or dementia do not have an official diagnosis—making them, or their caregivers, unlikely to seek out the kind of services or respite care from which they could benefit."

Thanks to my colleague and dear friend, Professor Bauer, for sending me this article.

Identity Theft Placemat & Guide

The Consumer Financial Protection Bureau released two items to help us in the fight against identity theft. The first is a bit unique-a placemat, "Identity protection crossword puzzle" which is described as an "interactive educational placemat is for meal sites, senior centers, and other places older adults gather and are a great way to share information at mealtime in groups of all sizes." The second is the Identity Protection Guide, Protect Your Identity: What Older Adults Should Know providing "steps to help you protect your personal information and explores several options to help you decide what’s right for your situation. The guide can be ordered separately and should be included with each Identity Theft Placemat."

Caregivers and Positive Attitudes Study

NPR's recent story, From Gloom To Gratitude: 8 Skills To Cultivate Joy reports on a new study of caregivers "all of whom had the stressful job of taking care of a loved one with dementia. The study found that following a five-week course, participants' depression scores decreased by 16 percent and their anxiety scores decreased by 14 percent. The findings were published in the current issue of Health Psychology."  The lessons taught "include mindfulness and deep breathing, setting an attainable daily goal, keeping a gratitude journal and — yes, it works — performing small acts of kindness."

Here's a quick summary of the eight techniques used in Moskowitz' study:

1. Take a moment to identify one positive event each day.

2. Tell someone about the positive event or share it on social media. This can help you savor the moment a little longer.

3. Start a daily gratitude journal. Aim to find little things you're grateful for, such as a good cup of coffee, a pretty sunrise or nice weather.

4. Identify a personal strength and reflect on how you've used this strength today or in recent weeks.

5. Set a daily goal and track your progress. "This is based on research that shows when we feel progress towards a goal, we have more positive emotions," Moskowitz says. The goal should not be too lofty. You want to be able to perceive progress.

6. Try to practice "positive reappraisal": Identify an event or daily activity that is a hassle. Then, try to reframe the event in a more positive light. Example: If you're stuck in traffic, try to savor the quiet time. If you practice this enough, it can start to become a habit.

7. Do something nice for someone else each day. These daily acts of kindness can be as simple as giving someone a smile or giving up your seat on a crowded train. Research shows we feel better when we're kind to others.

8. Practice mindfulness by paying attention to the present moment. You can also try a 10-minute breathing exercise that uses a focus on breathing to help calm the mind.

   There is also an audio of the story, available here.Thanks to Professor Naomi Cahn for sending us the link to this story.

Correlation to Medicare Ratings & Staffing

Kaiser Health News ran a story, Short-Staffed Nursing Homes See Drop In Medicare Ratings.  "In its update in April to Nursing Home Compare, the Centers for Medicare & Medicaid Services gave its lowest star rating for staffing — one star on its five-star scale — to 1,638 homes. Most were downgraded because their payroll records reported no registered-nurse hours at all for four days or more, while the remainder failed to submit their payroll records or sent data that couldn’t be verified through an audit." The payroll records analyzed provide a good picture of various nursing homes and how they comply with the regulations. "CMS has been alarmed at the frequency of understaffing of registered nurses — the most highly trained category of nurses in a home — since the government last year began requiring homes to submit payroll records to verify staffing levels." In addition KHN has an interactive tool, Look-Up: How Nursing Home Staffing Fluctuates Nationwide.

Unable to Afford Housing and Health Care

Kaiser Health News ran a sobering story last week. In 10 Years, Half Of Middle-Income Elders Won’t Be Able To Afford Housing, Medical Care reports on a recently published study by Health Affairs that concluded "In 10 years, more than half of middle-income Americans age 75 or older will not be able to afford to pay for yearly assisted living rent or medical expenses, according to a study published ...  in Health Affairs." Here is the abstract for the article, The Forgotten Middle: Many Middle-Income Seniors Will Have Insufficient Resources For Housing And Health Care.

As people age and require more assistance with daily living and health needs, a range of housing and care options is available. Over the past four decades the market for seniors housing and care—including assisted living and independent living communities—has greatly expanded to accommodate people with more complex needs. These settings provide housing in a community environment that often includes personal care assistance services. Unfortunately, these settings are often out of the financial reach of many of this country’s eight million middle-income seniors (those ages seventy-five and older). The private seniors housing industry has generally focused on higher-income people instead. We project that by 2029 there will be 14.4 million middle-income seniors, 60 percent of whom will have mobility limitations and 20 percent of whom will have high health care and functional needs. While many of these seniors will likely need the level of care provided in seniors housing, we project that 54 percent of seniors will not have sufficient financial resources to pay for it. This gap suggests a role for public policy and the private sector in meeting future long-term care and housing needs for middle-income seniors.

A pdf of the article is available here.

Want to Live to Be 100?

If you answered yes to the title question, you are not along. Last month, Financial Advisor published an article, More Than Half Of Americans Want To Live To 100 reporting on a survey by AIG Life & Retirement.  Why does someone want to live to be 100?  Why not? There are various reasons, and the respondents offered these: "Thirty-nine percent of respondents cited deeper family relationships as the main reason for wanting to live 100 years. Another 32 percent said they wanted to see the world change, and 17 percent wanted to remain productive."

The respondents note that longevity can be accompanied by various issues. "Of the 53 percent whose goal is to be a centenarian, 51 percent are worried that their savings won't last for that long a life." As well, the likelihood of significant health issues took first place among concerns "(35 percent) ...  followed by the likelihood of burdening their family (27 percent) and running out of the money needed to live comfortably in retirement (25 percent)."  Planning for longevity is important.  Although aging happens organically, planning for longevity is responsible aging.

Tech to Block Spam Calls

Phone companies are developing tech that will block spam calls. Yes, please and right away! (BTW, how do the spammers know the most inopportune time to call?) The New York Times explains the work in this article, Phone Companies Are Testing Tech to Catch Spam Calls. Let’s Hope It Works.

This data ought to frighten you:  "[t]he seemingly endless stream of robocalls reached a new monthly high of 5.23 billion nationwide in March, according to the call-blocking service YouMail. Some were spammy pitches for unwanted vehicle warranties or debt-relief services. Nearly half were straight-up scams. And there was often one common thread: They frequently came from somewhere other than they said they did."

But the article tells us there is hope for us.  "New technology is providing a glimmer of hope that, someday, you might be able to safely pick up your phone again. Mostly, you’ll now be more likely to know callers are who they say they are." But wait, now for some bad news. "[D]on’t expect any silver bullets that will put an end to robocalls. Pending regulatory changes could even add to the flood." 

The anti-spoofing technology is already being used by T-Mobile ("known by the acronym Stir/Shaken, a tortured reference to James Bond and martini preparation — in January, although it’s currently compatible only with certain devices. ") AT&T and Comcast have been doing some work on caller verification and Verizon should have theirs available by early fall.

But wait-do you have a land-line? This need tech won't help you then. There are also limits on tracing calls from abroad.  Congress is also helping.

A Senate bill that would establish a deadline has gained bipartisan traction. The Traced Act, introduced by Senators John Thune, Republican of South Dakota, and Edward J. Markey, Democrat of Massachusetts, passed a committee vote this month. Along with stiffening penalties and giving the F.C.C. more time to punish perpetrators, the bill would require all voice service providers — including those over the internet, such as Skype and Google Voice — to adopt call authentication technology within 18 months of the bill’s enactment. 

Watch for new regs coming from the F.C.C., especially the one on the definition of auto-dialers, the article explains. There is the potential for opening us to even more spam calls.  Here's how the two sides see that issue

“If they define auto-dialer the way the industry wants it defined, it will be so narrow it won’t cover any of the auto-dialers out there,” said Margot Saunders, senior counsel at the National Consumer Law Center. “The scourge of robocalls will skyrocket.”

The F.C.C. said those concerns were speculative. The agency has solicited public comments on the issue twice lastyear, but declined to say how long it might take to come up with a new definition. A spokesman said the commission “will continue to combat all illegal robocalls with every tool we have.”

I don't know if you do like I do now--when my phone rings-if I don't recognize the number I don't answer it. Is that how we have to operate now? Do the folks at the F.C.C. get all of these spam calls too?