Elder Law Prof Blog

Hot Off the Press: 2019 Updates on Guardianship Legislation

The American Bar Association Commission on Law and Aging has released their annual update on guardianship legislation,  State Adult Guardianship Legislation Summary: Directions of Reform–2019 .

Here's the introduction of the Summary:

This 2019legislative summary reviews approximately 58enactmentsfrom 33states,as compared with 29 enactments from 18 states in 2018. An earlier version of this 2018 legislative summary [January –August] was published as part of the National Guardianship Association’s 2019 NGA Legal and Legislative Review, presented at the 2019 NGA National Conference. States were active on a variety of fronts, enacting a variety of significant changes to guardianship laws.Washington became the second state, after Maine in 2018, to adopt the Uniform Guardianship, Conservatorship, and other Protective Arrangements Act (UGCOPAA). Without adopting UGCOPAA in its entirety, Nevada and New Mexico enacted certain provisions of the model law.Iowa and Mississippi also included sections from UGCOPAA in sweeping statutory reforms.To rebuild its probate code, the Virgin Islands adopted five uniform laws –Nonprobate Transfer on Death, Real Property Transfer on Death, Disclaimer of Property Interest, Custodial Trust, and Partition of Heirs.Texas and New Mexico established new programs to address guardianship abuse. Texas founded a guardianship abuse, fraud, and exploitation detection program to review guardianships and identify issues, work with courts to develop best practices, and report concerns of potential abuse, fraud, or exploitation. New Mexico created a grievance procedure, which includes mandatory court review, for complaints against guardians and conservators. Indiana, North Dakota, Nevada, and Rhode Island recognized supported decision-making agreements, bringing the total to nine states that have made these agreements legally enforceable since 2015. The acts are not uniform;provisions such as governing who may serve as a supporter, the scope of the supporter’s duties, and indemnification of third parties vary among the state statutes. Since 2011, states have enacted a total of approximately 328 adult guardianship bills–ranging from a complete revamp of code provisions to minor changes in procedure. Most of these statutory changes have advanced guardianship reform by safeguarding rights, addressing abuse, and promoting less restrictive options. The real challenge lies in turning good law into good practice.

The prior summaries, dating back to 2013, can be accessed here.

Too Young for Senior Living?

My colleague and dear friend, Mark Bauer sent me this article, An orphaned teen is being forced out of his grandparents' senior community because he's too young.   Here's what happened. The kid's parents both died and he moved in with his grandparents in Prescott, Az, where they live in a 55+ community.  "[T]he homeowner's association said it could face legal issues if he stayed."  He has about 5 months to move out. Although younger folks can live there, the minimum age noted in the article is 19.  Both sides have representation and no solution was noted in the article.  My sense from the article is  the positions boil down to these: have some compassion from the one side, and from the other-there are rules and those who live there have an interest in the purpose of the rules.  The young man is 15 years old.  I do understand both sides of the argument-there are those who chose to live there because they wanted to live in a community with age restrictions. But on the other hand, both of his parents died.....  This is a great fact pattern for our students, and I'm planning to assign them to represent each of the sides and make their arguments.

Stay tuned.

 

Hot Off the Press: 2019 Updates on Guardianship Legislation

The American Bar Association Commission on Law and Aging has released their annual update on guardianship legislation,  State Adult Guardianship Legislation Summary: Directions of Reform–2019 .

Here's the introduction of the Summary:

This 2019legislative summary reviews approximately 58enactmentsfrom 33states,as compared with 29 enactments from 18 states in 2018. An earlier version of this 2018 legislative summary [January –August] was published as part of the National Guardianship Association’s 2019 NGA Legal and Legislative Review, presented at the 2019 NGA National Conference. States were active on a variety of fronts, enacting a variety of significant changes to guardianship laws.Washington became the second state, after Maine in 2018, to adopt the Uniform Guardianship, Conservatorship, and other Protective Arrangements Act (UGCOPAA). Without adopting UGCOPAA in its entirety, Nevada and New Mexico enacted certain provisions of the model law.Iowa and Mississippi also included sections from UGCOPAA in sweeping statutory reforms.To rebuild its probate code, the Virgin Islands adopted five uniform laws –Nonprobate Transfer on Death, Real Property Transfer on Death, Disclaimer of Property Interest, Custodial Trust, and Partition of Heirs.Texas and New Mexico established new programs to address guardianship abuse. Texas founded a guardianship abuse, fraud, and exploitation detection program to review guardianships and identify issues, work with courts to develop best practices, and report concerns of potential abuse, fraud, or exploitation. New Mexico created a grievance procedure, which includes mandatory court review, for complaints against guardians and conservators. Indiana, North Dakota, Nevada, and Rhode Island recognized supported decision-making agreements, bringing the total to nine states that have made these agreements legally enforceable since 2015. The acts are not uniform;provisions such as governing who may serve as a supporter, the scope of the supporter’s duties, and indemnification of third parties vary among the state statutes. Since 2011, states have enacted a total of approximately 328 adult guardianship bills–ranging from a complete revamp of code provisions to minor changes in procedure. Most of these statutory changes have advanced guardianship reform by safeguarding rights, addressing abuse, and promoting less restrictive options. The real challenge lies in turning good law into good practice.

The prior summaries, dating back to 2013, can be accessed here.

Boomer Myths??

It may just be me, but it seems there are a lot of stories about Boomers recently. I guess it makes sense, given the ages of boomers. Some of the stories may be a bit more tongue-in-cheek, or cultural illustrations rather than substantive, (see, e.g. Chief Justice Roberts: Is 'OK, Boomer' Evidence Of Age Discrimination?  and Saturday Night Live-Undercover Boss: Where are they now).  A recent article in the New York Times reviewed a myth about boomers living in urban environments.  The Myth of the Urban Boomer  Baby boomers are actually less drawn to urban living than previous generations.

Baby boomers are such a large group that you can find them practically everywhere in great numbers, including in urban areas. Today in cities, for example, you’re more likely to run into a 54-to-72-year-old with your bike or scooter (please be careful!) than you would have in the past.

Maybe that’s the reason many news media accounts have promoted the idea that boomers are returning to cities at a rapid rate.

It seems to make sense. Many downtowns are safer and livelier than they were 30 years ago. At a certain point, downsizing and moving back to the city has appeal — it’s closer to work and all those interesting things to do, and the children might have finally left the nest.

There’s one problem. The story line is wrong: Boomers today are actually less urban than previous generations of older people.

The article has some interesting data regarding housing preferences and trends for boomers. The article's closing paragraph gives a good snapshot for those who don't have time to read the entire article: "[f]or developers and public officials in cities, the rising number of older city dwellers is real, and it matters. There is growing demand for the housing features and public services that many older adults prefer. More of the urban housing stock will need to be homes that work for seniors. But that’s not because boomers love cities or are more drawn to urban living than previous generations — just the opposite. It’s simply that there are more of them, almost everywhere." (As an aside, the article at one point refers to some boomers as "the urban oldster.")

The Limits of Hospice Home Care?

Kaiser Health News ran a story about hospice for individuals dying at home and the role of families. Patients Want A ‘Good Death’ At Home, But Hospice Care Can Badly Strain Families explains how Hospice home care works:

Hospice allows a patient deemed to have fewer than six months to live to change the focus of their medical care — from the goal of curing disease to a new goal of using treatments and medicines to maintain comfort and quality of life. It is a form of palliative care, which also focuses on pain management, but can be provided while a patient continues to seek a cure or receive treatments to prolong life.

But the Hospice folks don't do all of the caregiving, with "many family caregivers [responsible for] most of the physical work to [the family, with one daughter noting] that during the final weeks of her mother’s life, she felt more like a tired nurse than a devoted daughter."

Acknowledging that more and more folks want to die at home, the article notes the tasks that fall to family members caring for the person in the final days of life.  "Hospice agencies primarily serve in an advisory role and from a distance, even in the final, intense days when family caregivers, or home nurses they’ve hired, must continually adjust morphine doses or deal with typical end-of-life symptoms, such as bleeding or breathing trouble. Those decisive moments can be scary for the family... "said one expert.  From personal experience, I can confirm that this happens and it is scary. We were lucky-one of our family  was a nurse. I'm not sure how we would have gotten through the process without her. But not everyone has their own family medical professional.

Here's the thing.  The person needs 24 hours care but that may not be something Hospice will provide because "hands-on help is scarce. According to Medicare, hospice benefits can include home health aides and homemaker services. But in practice, that in-person help is often limited to a couple of baths a week. Medicare data reveals that, on average, a nurse or aide is only in the patient’s home 30 minutes, or so, per day."

The article looks at the costs and Medicare coverage rates, Hospice residences and nursing home care.  There's something of a Catch-22 happening.  "As researchers in the field look to the future, they are calling for more palliative care, not less — and, at the same time, they are advocating for more support for the spouses, family members and friends tasked with caring for the patient."  As one expert noted, there's a real need "to expand — in general — our approach to supporting caregivers, [pointing out] that some countries outside the U.S. pay for a wider range and longer duration of home health services."

 

 

Aging in This Decade Starting in 2020

Kaiser Health News  published an interesting piece a few days ago, What The 2020s Have In Store For Aging Boomers  opens with some interesting data. "Within 10 years, all of the nation’s 74 million baby boomers will be 65 or older. The most senior among them will be on the cusp of 85. ... Even sooner, by 2025, the number of seniors (65 million) is expected to surpass that of children age 13 and under (58 million) for the first time, according to Census Bureau projections." The author interviewed a number of experts to get a sense of what this decade will look like for the boomers and the trends they will face.

1. Care Crisis:  "Never have so many people lived so long, entering the furthest reaches of old age and becoming at risk of illness, frailty, disability, cognitive decline and the need for personal assistance."
2. Living longer and "better, " with a focus on quality of life.
3. "Altering social infrastructure" such as more easily accessible transportation, increased affordable housing,  making existing housing more appropriate for aging in place, and inter-generational programs.
4. Flipping the perceptions of aging from negative to positive.
5. "Advancing science", that is “advances in genetic research and big data analytics will enable more personalized — and effective — prescriptions” for both prevention and medical treatments ...."
6. Responding to inequalities in aging.
7. Longer careers in the work force

A new decade with ongoing challenges and a chance for progress!

Medicare Part D Donut Hole-Gone or Not?

The New York Times an an article scrutinizing the status of the Part D coverage gap (a/k/a the Donut Hole), in Medicare’s Part D Doughnut Hole Has Closed! Mostly. Sorta.

The donut hole  was weird and unlike other types of insurance and as the article explains, "“designed that way because Congress had a self-imposed budget target,” said Tricia Neuman, who directs the Medicare policy program at the Kaiser Family Foundation.... In order to afford a low deductible, catastrophic coverage and protection for those with low incomes, lawmakers agreed to the doughnut hole. But what other kind of insurance works like that?"

The Affordable Care Act (ACA) contained a provision that gradually closed  the donut hole. "The final reduction, for generic drugs, slid into place on Jan. 1. Now, supposedly, there is no coverage gap. Federal regulations require that your plan (most Medicare beneficiaries can choose from nearly 30) average 25 percent cost-sharing for any drug."  But remember closing the donut hole is not the same as reducing the cost of prescription drugs.

There's still remaining weirdness with the Part D program, as the article highlights:

• This year, after meeting the $435 deductible, you generally pay a flat price for each covered drug during the so-called initial coverage period. Different plans assign drugs to different tiers for which you pay specified amounts.

But once your total drug expenditures hit $4,020, you’re responsible for 25 percent of the plan’s negotiated cost per drug — not a gap, exactly, but a shift.

If you were paying $45 for a prescription that costs $200, your share is now $50 — not a major change. But for a $500 drug, you’ll owe $125 until you reach the catastrophic threshold.

 . .

• It will now take longer to climb out of the not-exactly-a-hole.

Last year, you qualified for catastrophic coverage when your out-of-pocket expenditures reached $5,100.

This year, you don’t qualify until they hit $6,350, a big jump. The Affordable Care Act had maintained a lower threshold; this year, that provision ended.

Once there, your co-payment is a flat $3.60 to $8.95, or 5 percent of the drug’s cost, whichever is higher. (Not lower.)

• Part D has never capped out-of-pocket costs, even when you reach the supposedly safe shore of catastrophic coverage. Your 5 percent co-payment lasts the rest of the year.

. . .

All of this takes place against the backdrop of rising drug prices generally. From 2015 to 2017, more than a million Medicare beneficiaries each year passed the threshold for catastrophic coverage — more than twice the number when Part D began, according to a Kaiser Family Foundation analysis.

Oh and choosing the right Part D program is complicated.  The article notes that Congressional action is needed to reduce the drug prices. And what if the ACA is repealed??

Dispute Resolution Issue on Eldercaring Coordination

The latest issue of the magazine for the Association of Conflict Resolution is devoted to eldercaring coordination. Twelve articles make up the issue. Check it out!

 

Indiana House Bill 1020 on Physician Aid-in-Dying

Indiana House Bill 1020, which was recently introduced recently, if passed, would legalize physician aid-in-dying in Indiana effective July 1, 2020. Here's the synopsis

End of life options. Allows individuals with a terminal illness who meet certain requirements to make a request to an attending physician for medication that the individual may self-administer to end the individual's life. Specifies requirements a physician must meet in order to prescribe the medication to a patient. Prohibits an insurer from denying payment of benefits under a life insurance policy based upon a suicide clause in the life insurance policy if the death of the insured individual is the result of medical aid in dying. Establishes a Level 1 felony if a person: (1) without authorization of the patient, willfully alters, forges, conceals, or destroys a request for medication or a rescission of a request for medication with the intent or effect of causing the individual's death; or (2) knowingly or intentionally coerces or exerts undue influence on an individual to request medication to end the individual's life or to destroy a rescission of a request for medication to end the individual's life.

The bill includes a sample form for requesting the medication, found in proposed  IC 16-36-7 I, sec. 3(e).

Stay tuned.

 

HHS 2020 Poverty Guidelines

HHS has released the 2020 Poverty Level Guidelines.

2020 POVERTY GUIDELINES FOR THE48 CONTIGUOUS STATES AND THE DISTRICT OF COLUMBIA

Persons in family/household Poverty guideline

1 ..................................................$12,760

2 ..................................................17,240

3 ..................................................21,720

4 ..................................................26,200

5 ..................................................30,680

6 ..................................................35,160

7 ..................................................39,640

8 ..................................................44,120

"For families/households with more than 8 persons, add $4,480 for each additional person."

Alaska and Hawaii are also available in the publication.

Forgetfulness is Not Just for the Old

I always talk with my students about memory loss and what it might signal--but always when we talk about memory loss, or for them, forgetfulness, every one of them has experienced an episode of forgetfulness, whether misplacing their phones or losing their keys.   I was pleased to read a recent editorial in the New York Times by neuroscientist, Daniel J. Levitin.   Everyone Knows Memory Fails as You Age. But  Everyone Is Wrong.

Short-term memory contains the contents of your thoughts right now, including what you intend to do in the next few seconds. It’s doing some mental arithmetic, thinking about what you’ll say next in a conversation or walking to the hall closet with the intention of getting a pair of gloves.

Short-term memory is easily disturbed or disrupted. It depends on your actively paying attention to the items that are in the “next thing to do” file in your mind. You do this by thinking about them, perhaps repeating them over and over again (“I’m going to the closet to get gloves”). But any distraction — a new thought, someone asking you a question, the telephone ringing — can disrupt short-term memory. Our ability to automatically restore the contents of the short-term memory declines slightly with every decade after 30.

Given that everyone has forgetfulness, the author's next point is important:

The relevant difference is not age but rather how we describe these events, the stories we tell ourselves about them. Twenty-year-olds don’t think, “Oh dear, this must be early-onset Alzheimer’s.” They think, “I’ve got a lot on my plate right now” or “I really need to get more than four hours of sleep.” The 70-year-old observes these same events and worries about her brain health. This is not to say that Alzheimer’s- and dementia-related memory impairments are fiction — they are very real — but every lapse of short-term memory doesn’t necessarily indicate a biological disorder.

So, why might we focus on this with elders?  The author suggests elders have more memories to get through-it's going to take more time to remember a specific and generally it may take older folks a bit longer to remember things. 

This is a very interesting article that I plan to reference when I'm discussing issues regarding memory loss and dementia with my students.

International Federation on Aeging Webinar on 1th Session of the UN Open-Ended Working Group on Ageing

The UN Open-Ended Working Group on Ageing has its 11th Session coming up.  Prior to that meeting, the International Federation on Aeging, along with  the Global Alliance For the Rights of Older People (GAROP) are offering an upcoming webinar on National Advocacy ahead of the 11th Session of the United Nations Open-Ended Working Group on Ageing.is holding a webinar on National Advocacy Ahead of the 11th Session of the UN Open-Ended Working Group on Ageing on January 22, 2020 at 7 a.m. est. This webinar will

• Provide information for all NGOs engaging in the UN Open-ended Working Group on Ageing (OEWG) process at the national level.

• Focus particularly on what national advocacy NGOs can do to influence their governments ahead of the 11^thOEWG session in April.

• Include updates and insights from a UN perspective and concrete examples of national advocacy from GAROP members. 

Click here to register for this program.

Summaries of the prior meetings of the U.N. Working Group can be accessed here.

Recent Interesting Cases

Getting ready for the start of the Spring 2020 semester.  I was looking through a list of recent cases from the AARP Foundation  in which they had filed amicus briefs. Docket: Recent or Open Amicus Cases includes  citations to the cases, summaries of the cases and copies of the amicus briefs. I think these are useful to give us some up-to-date info about litigation issues, and can also serve to provide topic ideas for our students who might be writing scholarly papers on an elder law topic. Check it out!

DOJ Elder Justice Initiative Resources for Law Enforcement

The Department of Justice Elder Justice Initiative has some great resources for all of us. The EJI recently released a number of resources for law enforcement, located here.

The resources include information about an online training from the National White Collar Crime Center (NW3C),  downloadable fliers, data, the Elder Abuse Guide for Law Enforcement (EAGLE), roll call videos and more.

Although the resources are targeted for law enforcement, they are still very helpful to others. In particular, I thought this chart showing how the different departments within law enforcement might encounter victims of elder abuse. I think this will help my students more fully understand the numerous ways these cases come to light. Check it out!

 

PACE Program and Adult Day Care

Kaiser Health News (KHN) recently published a story about a PACE program, Government-Funded Day Care Helps Keep Seniors Out Of Nursing Homes And Hospitals.

The services provided by PACE, a national program primarily funded by Medicaid and Medicare, are intended to keep people 55 and older who need nursing home levels of care at home as long as possible and out of the hospital.

The program is more important than ever as baby boomers age, its proponents say.

“The rapidly growing senior population in California and across the country will put enormous strain on our current fragmented, and often inefficient, health care delivery system,” said Tim Lash, president of Gary and Mary West PACE. California officials consider PACE an integral part of the state’s strategy to upgrade care for aging residents.

Consider the cost-savings to states with PACE programs, as well as the number of folks, typically dual eligibles, who participate. According to the story,

The National PACE Association said data it collected for 2019 shows seniors enrolled in PACE cost states 13% less on average than the cost of caring for them through other Medicaid-funded services, including nursing homes.

. . .

PACE participants who do not receive government medical benefits can pay out of their own pockets. At Gary and Mary West, the tab ranges from $7,000 to $10,000 a month, depending on the level of care.

Nationally, 50,000 enrollees participate in PACE programs at over 260 centers in 31 states. In California, PACE serves nearly 9,000 vulnerable seniors at 47 locations.

PACE provides the same services as under Medicare and Medicaid, and use of team from various disciplines to provide care. Patients often have chronic conditions and  almost 2/3 of them have some level of cognitive difficulty.

Check it out.

 PACE enrollees commonly have conditions such as vascular disease, diabetes, congestive heart failure, depression and bipolar disorder.

Report from 2020 AALS Annual Meeting Section on Aging and the Law

For the last few years, I've found myself with conflicts during semester breaks that interfered with attending the AALS Annual Meeting.  So I was especially happy this year to attend and catch up with long-time and new friends, especially those who work in fields relevant to elder law.  

The annual meeting kicked off for me with a Joint Session hosted by the Sections on Aging and the the Law, Civil Rights, Family & Juvenile Law, Employee Benefits & Executive Compensation, and Immigration Law.  The collaborative event offered lots of interesting "Emerging Issues in Elder Law," with speakers including:

Mark Bauer, Stetson Law, who spoke about recent enforcement efforts to combat elder exploitation, and pointed to a lingering weakness associated with banks that make SARS reports that never go beyond the regulatory body, and therefore never reach first responders, such as local police.  He talked about support for a state-wide effort in Florida to improve police reports to make it easier to identify abusers who target older persons.  He also called for better record-keeping for sales of gift cards, as these have become the number 1 method that telephone scammers get older adults to send them money.  

Wendy Parmet, Northeastern University School of Law, who focused on the impact of immigration laws and policies on the health of older adults, including attempts by the current administration to change the definition of "public charge" to include anyone who could receive any public benefits whatsoever,  thereby expanding the the pool of inadmissible immigrants and further restricting eligibility for legal permanent residency.  She traced the impacts of such policies on older adults once eligible for family reunification, on older citizens overall, and on a nation that once took pride in providing help to immigrants who were "tired and poor."

Jalila Jefferson-Bullock, Duquesne Law, who talked about how some states are not applying sentencing reforms to elderly offenders, even though such inmates statistically are at the least risk of reoffending and, at 19% of the total prison population, are often generating care costs that are unsustainable.  I learned, sadly, that my own state of Pennsylvania is one of the states that is not yet making significant progress on sentencing reforms for older adults.

Rachel Lopez, Drexel University Law, who is director of Drexel's Stern Community Lawyering Clinic, carried forward the theme of needed prison reforms for older inmates, reporting the latest events that follow the Graterford Think Tank Prison Project in Pennsylvania, and making the sobering observation that the most effective argument may not be one that sounds in human rights or human dignity, but the demonstration that return to the community for aging and ill residents saves the state money.  

Naomi Cahn, George Washington Law, who is also the incoming chair for the AALS Section on Law and Aging, presented facts and figures on "gray divorce," especially with respect to financial impacts on women.  She urged a de-coupling of Social Security benefits from marriage (or perhaps marriage longevity requirements), arguing that Social Security credits should be available for time spent as caregivers.  

Browne Lewis, Cleveland-Marshall College of Law, pointed to the emerging issue of "reproductive rights" for older individuals, identifying jurisdictions that restrict women's access to assisted reproductive technologies (ART) including placing age or time restrictions on use of banked or stored eggs.

For faculty members who would like to be part of next year's Law and Aging program at the 2021 AALS Annual meeting in San Francisco, contact Naomi Cahn with your topics and interest.  

Elder Justice Mapping Webinar

Register now for an upcoming webinar from the Department of Justice webinar on Mapping Elder Justice Networks.  The webinar is scheduled for January 21, 2020  at 2 p.m. est.   Here is info about the webinar

Join us for the webinar, Mapping Elder Justice Networks, where we will introduce the new Elder Justice Networks Locator. 

The Locator is a map designed to help elder justice professionals to locate and collaborate with elder justice networks/teams across the nation.  Networks will be added in an on-going fashion.

This webinar will discuss the development of this resource, walk through how to find and use the Locator, and explain how to submit your network for inclusion.

Mapping Elder Justice Networks

Talitha Guinn-Shaver, Presenter

The Locator represents the teams that have provided information to participate in this project. Networks interested in being included in the Locator may submit their network name, type, address, web address and email to [email protected]. Please note that for-profit organizations and dot coms cannot be included.  Other rules may apply.  Submission is not a guarantee of inclusion in the Locator.

To register for this webinar, click here.

Catching Up on Some News

Two articles, updating us on two topics important to all of us.

First, statistics. We know women statistically live longer than men,and a recent data report from Pew updates us that this still is true and in many instances women are younger than their husbands.  That it means that late in life, many women will be alone. Globally, women are younger than their male partners, more likely to age alone tells us that "[t]he pattern of spousal age gaps – and the fact that women tend to live at least a few years longer than men – helps explain another universal theme: Across the world, women are about twice as likely as men to age alone. One-in-five women ages 60 and older live in a solo household (20%), compared with one-in-ten men (11%)."  The report looks at religion and geography to measure the extent of this trend. "Rates of living alone over the age of 60 are tied to many factors, including cultural norms, economic development, levels of education and life expectancy. In countries where governments offer fewer retirement benefits or other support systems for older adults, families may face a greater responsibility to provide care."

The next article is from Sunday's New York Times, on the continuing shortage of geriatricians.Older People Need Geriatricians. Where Will They Come From?  notes the long-term shortage of geriatricians and explains their importance, using one real-life example to "spotlight the rising need for geriatricians. These doctors not only monitor and coordinate treatment for the many ailments, disabilities and medications their patients contend with, but also help them determine what’s most important for their well-being and quality of life." There's very little progress on closing this gap, according to the article. "An analysis published in 2018 showed that over 16 years, through academic year 2017-18, the number of graduate fellowship programs that train geriatricians, underwritten by Medicare, increased to 210 from 182. That represents virtually no growth when adjusted for the rising United States population."

The article explains why there aren't more doctors going into the field, including the economics realities.  One measure to address the shortage is cross-training.

Medical associations representing cardiologists and oncologists have begun focusing on older patients...

Health systems are adopting age-friendly approaches, like specialized emergency rooms. The American College of Surgeons’ new verification program sets standards hospitals should meet to improve results for older patients.

Last month the Senate Committee on Health, Education, Labor and Pensions voted to reauthorize a $41 million program that educates health professionals in geriatrics; it awaits a floor vote. A companion bill has already passed the House of Representatives.

Health professionals increasingly recognize that if they’re not in pediatrics, they will be seeing lots of seniors, whatever their specialty. A 2016 American Medical Association survey, for example, found that close to 40 percent of patients treated by internists and general surgeons were Medicare beneficiaries.

Pay attention to these issues. They will affect all of us either directly or through a family member.

 

Reframing Elder Abuse on Social Media-New Webinar

National Adult Protective Services Association (NAPSA) and National Center on Elder Abuse is offering a webinar on Friday January 24, 2020 at 2:00 p.m. est, on How to Reframe Elder Abuse on Social Media.

Over the past few years, the NCEA’s Reframing Elder Abuse project, an initiative to change the way we talk about elder abuse with the public has built momentum. The project aims to demonstrate how we can restructure our communities to put elder abuse on the public agenda, generate a sense of collective efficacy on the issue, and boost support for systemic solutions to prevent and address it. Social media can be the first, and in some ways, the easiest place to begin to reframe how the public thinks about elder abuse. During this webinar, participants will review best practices in public communications on elder abuse based on an evidence-based strategy and receive tips and resources in social media application.

Click here to register for this webinar.

Guest Blog on The Greying of HIV of America

I had blogged previously about meeting with two professors from the School of Social Work at the U. of Missouri.  One, Dr. Erin Robinson, was kind enough to write the following blog on this important topic.

The Greying of HIV in America

By: Dr. Erin L. Robinson, MSW, MPH

Assistant Professor, University of Missouri School of Social Work

Email: [email protected]

My name is Dr. Erin Robinson and much of my research focused on older adults, sexual health, and the prevention of HIV. I get a lot of questions about my research, including the need for such research, therefore I am going to share some information with you about the ‘greying of HIV’ in the United States. Over the past decade, older adults have been one of the fastest growing population groups affected by HIV/AIDS in the United States. Currently, 17% of all new HIV infections in the U.S. occur among people ages 50 years and older. This age group also accounts for nearly half of all people currently living with HIV. While the routes of HIV transmission in older adults is similar to that of their younger counterparts, there are some unique factors that contribute to the ‘greying of HIV’ in the U.S. Below are some interesting facts:

Facts about HIV and Aging:

• Older men are disproportionately impacted by HIV, however rates of older heterosexual women becoming newly infected are rapidly growing. This has led to specialized prevention interventions for older, heterosexual women.
• Older African American and Hispanic men and women are disproportionately impacted by HIV.
• 60% of all older adults living with HIV are virally suppressed, which means they have no risk of sexually transmitting the disease to others.
• Older adults are more likely to be diagnosed when HIV is further along in the disease progression (i.e. late-stage HIV). This means treatment options may not be as effective and mortality rates increase. Many of the symptoms for HIV can be similar for other illnesses, therefore if an older person does not test for HIV then they (and their healthcare provider) may attribute the symptoms to other causes.
• HIV can cause dementia-like symptoms, this is called HIV-associated neurocognitive disorders (HAND), AIDS dementia complex, or HIV-associated dementia. However, those symptoms can be reversed with proper HIV medications.
• Over the past few years, new HIV infections have decreased among the aging population. This is due, in part, to tailored prevention interventions among public health officials. However, we still have progress to make in order to curb the disparities.

Why are we seeing this ‘greying of HIV’ in the U.S.?

• Historically, older adults today have higher divorce rates than previous generations. This means older adults are engaging in new romantic relationships at higher rates as well.
• Our older generation today has lived through major historic events that have helped shape their outlook on themselves, their relationships, and their sexuality. This includes the industrial revolution, the 2^nd wave of the women’s rights era, the Civil rights movement, the sexual revolution, the gay rights movement, and others.
• Older adults are healthier now than ever before, allowing them to experience sexually satisfying relationships later in life. Over the past 20 years, erectile dysfunction medications have also enabled men to engage in sexual relationships well into their later years.
• After women have reached menopause and can no longer get pregnant, we see lower levels of condom use. This is true for both committed relationships and new sexual encounters with a casual partner.
• Older adults do not perceive themselves to be at risk for STIs and HIV, therefore are less cautious in avoiding transmission.
• A lot of stigma exists around older adults and their sexuality. Many people like to believe that older adults do not engage in sex. Therefore, this creates an environment where older adults feel like they have to hide or deny their sexuality, which exacerbates STI and HIV infection and diagnosis rates.
• Healthcare providers have a difficult time talking to their older patients about their sexual health and HIV. In fact, when there is an age differential and a gender differential between the provider and the older patient, providers report being uncomfortable prompting such conversations. Providers also report that time is a big barrier in initiating such conversations, especially when their older patient has other health concerns.

Source: https://www.cdc.gov/hiv/group/age/olderamericans/index.html