An estimated 1.5 million retirees have reentered the U.S. labor market over the past year, according to an analysis of Labor Department data by ... an economist.... That means the economy has made up most of the extra losses of retirees since February 2020, a Washington Post analysis shows.
Friday, May 20, 2022
Researcher Explains: Misuse of Data Can Lead to "Pariah-Tizing" the Elderly While Failing to Provide Key Information for All Ages
In September 2021, I listened to a great set of speakers at the Aging, Health, Equity and the Law Conference hosted by Touro College in New York. One session in particular captured my attention. Barbara Pfeffer Billauer, JD, MA (Occ. Health), PhD, who is currently Professor of Law and Bioethics at the University of Porto and Research Professor at the Institute of World Politics in Washington DC. spoke about the misuse of statistics regarding COVID-19 on an international scale. We exchanged emails, and it was clear she was deep into the emerging data from countries around the world.
Dr. Billauer's most recent analysis has received its first publication on May 19, 2022 by the American Council on Science and Health at ACSH.org, with the appropriate yet provocative title of Pariah-Tizing the Elderly: Another Casualty of COVID.
Here she takes on recent news media coverage, including the Washington Post, as well as some scientific community publications, to raise the significant concern that exaggerating the risk of COVID-19 stigmatizes one group -- here the elderly -- while failing to fully inform all age groups about the efficacy of vaccination. She opens with this explanation:
I call a mistaken, targeted focus and overemphasis on any population group “pariahtization.” As recent evidence demonstrates, this "pariah-tized” focus on the elderly regarding COVID-19 is certainly misplaced. It also has resulted in untoward policies that caused more deaths in both the younger segments of the population. . . .
Contrary to popular opinion . . . COVID is not a disease of the elderly—like dementia, or cataracts, or osteoarthritis. Indeed, older people are less likely to die of COVID than heart disease or cancer. This is not so for the younger cohort, for whom during several months last year COVID was the leading cause of death.
For six months of 2021—half the year, COVID was the leading cause of death in those 45-54. In three months of the year, COVID was the leading cause of deaths forages 55-64, but only in two months was it the leading cause of death for those 65-74, the same as for those 35-44; and only in one month was COVID the leading cause of death for those over 75. . . .
The misplaced focus [of the media] on the aged being especially vulnerable has led younger people to unwisely eschew vaccination on the grounds that the disease is not generous to them.
Dr. Billhauer clearly has a way with words and she makes effective use of data and charts to explain important data concerns. The implications of her findings go beyond the problem of the current crisis.
Wednesday, May 18, 2022
I get a lot of fun calls, both from attorneys and from law students, looking for the right employment match in "elder law." For lawyers who are looking for "new attorneys" to help staff their growing law practices, the calls sometimes come just after the law school year is over in early May, when the students have already scattered to the winds or to their homes to study for July Bar Exams. Law Schools' Career Services offices welcome these calls year-round, but we can often be of more help to both sides of the employment equation when people reach out early in the spring or fall semesters.
Nonetheless, one of my favorite "secret" ways for students and attorneys to find each other is through Bar Association programming and Continuing Legal Ed programs. While students usually roll their eyes when, for example, I suggest attending an "educational" program such as Pennsylvania's Elder Law Institute (July 21-22, 2022), most of the students who do attend soon realize that these offer multiple opportunities to get to knew great practitioners and to network. I often "sponsor" my own summer research assistants to attend at least one full day of programming, especially if there is a meet-and-greet lunch or reception at the end of the day. Elder Law attorneys are just plain friendly. This is a win-win for students and prospective employers.
But even beyond elder law, I also recommend that law students reach out during the summers to potential "employers" via State and County Bar organizations in the area of the country where they hope to practice. For example, I recently noticed that in Arizona, the Maricopa County (Phoenix area) Bar Association is hosting a 2022 Diversity Summer Social on June 9, 2022 expressly for "interns, externs, summer and first year associates." I'm sure that "prospective" interns, externs, summer and first-year associates would also be welcome to "mingle with other summer associates, local judges and bar leaders."
I know that one of Pennsylvania's very respected "young" Elder Law attorneys is someone I first got to know as a student because we were both attending a State Bar Association meeting while he was "just" a first year law student. That's the kind of smart networking that can take people very far.
Monday, May 9, 2022
The Washington Post recently published Millions retired early during the pandemic. Many are now returning to work, new data shows. Although a significant number of folks retired early,
Many retirees are being pulled back to jobs by a combination of diminishing covid concerns and more flexible work arrangements at a time when employers are desperate for workers. In some cases, workers say rising costs — and the inability to keep up while on a fixed income — are factoring heavily into their decisions as well.
But those reentering the work force are not just those who retired during the pandemic.
The percentage of retirees returning to work has picked up momentum in recent months, hitting a pandemic high of 3.2 percent in March, according to Indeed. In interviews with nearly a dozen workers who recently “un-retired," many said they felt comfortable returning to work now that they’ve gotten the coronavirus vaccine and booster shots. Almost all said they’d taken on jobs that were more accommodating of their needs, whether that meant being able to work remotely, travel less or set their own hours.
The article provides a number of interesting examples of individuals who are "unretiring" and why they chose to do so.
Sunday, May 8, 2022
The Inspector General of HHS recently released this report, Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care.
Here's the OIG explanation why they did the study:
A central concern about the capitated payment model used in Medicare Advantage is the potential incentive for Medicare Advantage Organizations (MAOs) to deny beneficiary access to services and deny payments to providers in an attempt to increase profits. Although MAOs approve the vast majority of requests for services and payment, they issue millions of denials each year, and CMS annual audits of MAOs have highlighted widespread and persistent problems related to inappropriate denials of services and payment. As Medicare Advantage enrollment continues to grow, MAOs play an increasingly critical role in ensuring that Medicare beneficiaries have access to medically necessary covered services and that providers are reimbursed appropriately.
What the OIG found shows that "MAOs sometimes delayed or denied Medicare Advantage beneficiaries' access to services, even though the requests met Medicare coverage rules. MAOs also denied payments to providers for some services that met both Medicare coverage rules and MAO billing rules." They also found that 13% of denied prior authorizations met the coverage rules and that additionally some denials were made based on lack of documentation but OIG found sufficient documentation had been provided. 18% of payment request denials met the Medicare coverage rules.
Here are their recommendations
Our findings about the causes and circumstances under which MAOs denied prior authorization or payment for requests that met Medicare coverage and MAO billing rules provide an opportunity for improvement to ensure that Medicare Advantage beneficiaries have timely access to all necessary health care services, and that providers are paid appropriately. Therefore, we recommend that CMS:
issue new guidance on the appropriate use of MAO clinical criteria in medical necessity reviews;
update its audit protocols to address the issues identified in this report, such as MAO use of clinical criteria and/or examining particular service types; and
direct MAOs to take additional steps to identify and address vulnerabilities that can lead to manual review errors and system errors.
The full report is available here.
It is Sunday, and I'm looking at a long list of things to do next week, with grading exams at the top of my list. Significantly, however, in the last six to eight months, at increasing rates, I'm hearing from current and prospective residents of Continuing Care Retirement Communities (CCRCs, also sometimes called Life Plan Communities). Here are examples of some of the most often asked questions:
- "The company that runs my CCRC is about to engage in development of a new CCRC. Is the money I've already paid in the form of an admission fee, or the money I continue to pay as monthly service fees, going to support this new development?"
- "During the lock-down associated with protecting residents and the public from COVID-19, we were asked to give up services that were the very reason we choose this community. But now that we are no longer locked down, the services either are not returning or the fees we are charged are actually increasing. Is there some effective way to object to this disconnect between the promises and the delivery of services?"
- "My parents are thinking about moving into a CCRC. On the one hand, I like the idea of the active community they are choosing. But on the other hand, the amount they are expected to pay in the form of an admission fee is astounding. Why are some communities calling this a refundable fee and others are saying it isn't a refundable fee? What are the protections for the 'refundable' fee?"
- "We have just learned that our nonprofit CCRC is being transferred to a for-profit company as the owner-operator. How is this likely to impact my wife and I as residents?"
Answers to many of these questions depend on the state's laws governing this form of senior living operation and, even more, on the particular contracts between the resident and the provider. State regulators have concerns here too. For those looking for legal assistance in their particular community, I sometimes recommend looking for attorneys in the caller's home state, someone who understands CCRCs from a resident perspective. I first wrote about the need for attorneys who understand resident perspectives in 2006.
Sometimes "elder law" attorneys have this expertise, but not always. Plus, it can be important to consult with an attorney who understands consumer protection laws, and not "just" CCRC law. Finally, if litigation is actually on the horizon, the choice for legal advice can depend on whether the attorneys have expertise in litigation or dispute resolution and not "just" contract law.
So, all of this is a short way of saying that even though, as an legal academic, I often write about the importance of resident rights in CCRCs, and even though I believe the future of CCRCs is very much tied to the answers, I'm not in a position to respond to individual questions. The very fact that I'm writing this Blog Post is a potential indication that something important could be going on in the industry. Perhaps that "something" should be addressed by the industry itself, especially if it wants the CCRC concept not just to survive, but thrive. In my opinion, it is not enough for the industry to say that "every CCRC is different."
Tuesday, May 3, 2022
RFP: Washington State Seeks Expert Consultation to Develop CCRC Regulations with Heightened Consumer Protections
I'm always interested when I start getting lots of calls or emails about a certain topic in aging. Today I was hearing from a lot of people wanting to talk about Continuing Care Retirement Communities (CCRCs, sometimes also called Life Plan Communities or LPCs). It is safe to say that all forms of senior living operations are facing new challenges after being hit hard by the lockdowns and staffing problems of the last two years with COVID-19.
But one of the most interesting set of calls was from the State of Washington, where residents have been using their time together during COVID to think carefully about the need for certain key protections for consumers who put their money and trust into CCRCs. The Washington Continuing Care Residents Association (WACCRA) has worked carefully, calmly and diligently to reach the ears of legislators and regulators in the state. I had the pleasure of hearing from members and residents of CCRCs in Washington last October and speaking at their annual meeting.
Today, I heard that the Office of Insurance Commissioner in Washington has initiated a Request for Proposals for a time-sensitive research project:
This project is designed to assess federal and state authorities regulating continuing care retirement communities (CCRCs) and provide a report with recommendations on creating a legal framework for shared regulatory oversight of CCRC products under Chapter 18.390 RCW, which may achieve heightened consumer protections.
Interested researchers -- with background in regulatory systems for CCRCS -- should act quickly as the deadline for submissions is May 23, 2022.
Last month, the Washington Post ran this article, Caring for aging parents, sick spouses is keeping millions out of work.
Even as the job market rapidly approaches the levels last seen before the coronavirus pandemic, a lack of affordable care for older and disabled adults is keeping many out of the workforce. At least 6.6 million people who weren’t working in early March said it was because they were caring for someone else, according the most recent Household Pulse Survey from the Census Bureau.Whether — and when — they return to work will play a role in the continued recovery and could reshape the post-covid labor force.
Read these next two paragraphs from the article very carefully:
For all the attention on parents — and mothers in particular — who stopped working to care for children during the pandemic, four times as many people are out of the work force, caring for spouses, siblings, aging parents and grandchildren, according to the Federal Reserve’s latest Monetary Policy Report.
Caregiving is the second-largest factor keeping people out of work, behind early retirements, at a time when job openings continue to outnumber potential workers. That mismatch is contributing to labor shortages around the country and playing a role in overall inflation. Roughly one-quarter of the workers missing from pre-pandemic levels are on the sidelines for caregiving reasons, according to the report. Overall, the economy is still short 1.6 million workers, two-thirds of them women, from early 2020.
Did you catch those numbers? 4x as many folks are not working because of caregiving responsibilities, and caregiving is the 2nd most common reason why folks aren't working.
Read the article. It's important!
Monday, May 2, 2022
- Medicaid beneficiaries should make sure their Medicaid agency has their current contact information. They should check their mail and be sure to mail back any Medicaid forms they receive.
- All renewal forms and notices must be accessible to people with limited English proficiency and people with disabilities.
- Many people who are no longer eligible for Medicaid will have other coverage options.
- If someone is disenrolled or their Medicaid coverage changes and they disagree with their state Medicaid agency’s decision, they can appeal.
- The end of the Public Health Emergency may lead to an increase in utilization of services provided by Older Americans Act programs, Centers for Independent Living, Assistive Technology Act programs, and other ACL grantees.
The fact sheet contains useful explanations and is available for download.
Friday, April 29, 2022
Earlier this month, Forbes ran this article, American Elders Are Short-Changed 5 Years Of Healthy Retirement, which explains that
America’s elders die sooner and are sicker than their counterparts in other rich nations. American elders also must work longer than their cohort abroad. These trends mean that Americans get fewer years of healthy retirement life than elders in comparable wealthy nations—five years less, in fact.
One reason for this big gap in healthy retirement is the pressure for American elders to work longer. Among major rich nations, Americans work longer than anyone except the Japanese, who retire at age 67.9 while Americans work until age 65 on average; but the Japanese live longer, so experience more healthy retirement time.
Consider this from the author: "It's sad to know that America’s de facto plan for retirement is working longer and dying sooner. This inequality of retirement time is caused by the crossing of two swords: the growing inequality of retirement wealth and the growing inequality of longevity. These inequities are deeply connected. If people who die younger could retire earlier than those with longer and healthier lives, retirement time could at least be distributed more equally."
The full article discussing life expectancy in the U.S. and abroad, as well as work histories, is available here.
Thursday, April 28, 2022
PHI has released a new report, State Policy Strategies for Strengthening the Direct Care Workforce.
Recognizing the urgency of the crisis in direct care, states are taking action—collaborating with diverse stakeholders to tackle entrenched workforce challenges in bold, innovative ways. To leverage this historic moment, PHI has compiled 24 specific policy strategies—with concrete examples—for improving direct care job quality and stabilizing the workforce. The strategies are organized according to the eight comprehensive solutions outlined in PHI’s signature report, Caring for the Future: The Power and Potential of America’s Direct Care Workforce.
Here are 3 takeaways from the report:
This guide provides 24 specific policy strategies for improving direct care job quality and stabilizing the workforce.
State leaders around the country are taking action to tackle entrenched workforce challenges in direct care.
By implementing a tailored combination of strategies, state leaders will help resolve the direct care workforce crisis in their own states.
The full report is available here.
Wednesday, April 27, 2022
On April 11, CMS announced it was proposing a decrease in Medicare funding to SNFs, according to an article in Skilled Nursing News. CMS’s Proposed $320M Decrease in Nursing Home Medicare Funding Could Be ‘Ruinous’ for Struggling Operators
The federal government on Monday proposed its payment rate update to nursing home reimbursements for fiscal 2023, which includes a 4.6% cut related to the Patient-Driven Payment Model.
That cut from the Centers for Medicare & Medicaid Services (CMS) amounts to a total loss of $320 million, according to the agency.
CMS – in its SNF Prospective Payment System proposed rule – recommended a 3.9%, or $1.4 billion, payment increase to the industry. The government agency arrived at that number by raising the market basket rate for skilled nursing facilities by 2.8%, a 1.5 percentage point forecast error adjustment and a 0.4-percentage-point multifactor productivity adjustment.
The article goes into detail about the CMS position, what is driving it and the impact it would have on the industry. The CMS release about their proposal and the comment period is available here: Fiscal Year (FY) 2023 Skilled Nursing Facility Prospective Payment System Proposed Rule (CMS 1765-P).
The Skilled Nursing News article also notes that CMS is looking for feedback on the issue of staffing standards. For more info on the staffing standards, see the CMS news release, HHS Takes Actions to Promote Safety and Quality in Nursing Homes.
Tuesday, April 26, 2022
showcases the highlights of the Fourth National Guardianship Summit and the 22 recommendations to reform and improve state guardianship systems. The video also addresses the history of these national summits, the importance of the Fourth Summit and the main topics discussed during the Summit:
Rights of Persons Subject to Guardianship
Limited Guardianship, Protective Arrangements, and Guardianship Pipelines
Rethinking Monitoring and Addressing Abuse by Guardians
Fiduciary Responsibilities and Tensions
Developing a Guardianship Court Improvement Program
To view the video, click here.
Monday, April 25, 2022
The sandwich generation, those who are raising kids and caring for their parents, continues on, as noted in the data from a recent Pew Research Fact Tank report, More than half of Americans in their 40s are ‘sandwiched’ between an aging parent and their own children.
As people are living longer and many young adults are struggling to gain financial independence, about a quarter of U.S. adults (23%) are now part of the so-called “sandwich generation,” according to a Pew Research Center survey conducted in October 2021. These are adults who have a parent age 65 or older and are either raising at least one child younger than 18 or providing financial support to an adult child.
Americans in their 40s are the most likely to be sandwiched between their children and an aging parent. More than half in this age group (54%) have a living parent age 65 or older and are either raising a child younger than 18 or have an adult child they helped financially in the past year. By comparison, 36% of those in their 50s, 27% of those in their 30s, and fewer than one-in-ten of those younger than 30 (6%) or 60 and older (7%) are in this situation.
The full report is available here.
Friday, April 22, 2022
The Washington Post recently published this article, Aging in place can be so much easier with smart home technology. "Supporting health, safety and security are important components of successfully aging in place. So are home management systems that maintain a comfortable environment, and communication and recreation systems that enable social engagement, stimulation and entertainment." As the article notes, the type and amount of tech is vast, ranging from pretty simple types that do just a little, to more comprehensive setups that integrate into much of every day life. The article focuses on two couples who added tech to their homes. It also looks at the pros and cons, as well as advances and includes a list of recommendations. The article also mentions concerns about privacy and how to mitigate that. I would also add the topic of consent, when family want to install the tech in the home of the elder. Lots of good info in the article.
Thursday, April 21, 2022
Yesterday I blogged about Dr. Levy's new book on ageism. Now, continuing that theme, I wanted to be sure you saw this article in Healthline, Do We Become Invisible As We Age? Mentioning Dr. Levy's book as well as other factors, the article explains that
"Ageism — prejudice, discrimination, and stereotyping based on age — is sometimes called society’s last acceptable “ism.” It happens at work, to celebrities, and in everyday ways. And it can make people feel invisible as they get older... A 2020 University of Michigan National Poll on Healthy Aging found that 82 percent of adults 50 to 80 surveyed reported regularly experiencing at least one form of “everyday ageism.” ... And, according to the World Health OrganizationTrusted Source, “Every second person in the world is believed to hold ageist attitudes, leading to poorer physical and mental health and reduced quality of life for older persons.” ... Plus, the pandemic has only made ageism worse, by increasing the physical isolation and accordant invisibility of older adults... So, where exactly do we see ageism and what can we do about it?
The article addresses ageism by where it occurs: in the workplace, in health care, in popular culture, and exams ageism's impact on people. The article discusses why some folks have ageist views and quotes one expert who identifies two types of folks who have ageist views: "The first type are “egoistic ageists” who fear aging and consider old people both repulsive and irrelevant... The other type, ..., “compassionate ageists,” view old people as “pathetic and needy” and believe that they must be served and protected." As far as kids and young adults, yep it happens there, according to the article, noting "that ageism 'starts in childhood and is reinforced over time.'"
The article discusses the respect for elders, the importance of self-perception, the work being done to fight ageism, and what still needs to be done. This is a great article to assign to students!
Wednesday, April 20, 2022
Professor Richard Kaplan sent me a link to a recent book review in the Wall Street Journal ‘Breaking the Age Code’ Review: Riding High Into the Sunset.
Social psychologist Becca Levy spends much of “Breaking the Age Code” doing exactly that, weaving together case studies and her own research to demonstrate that old age doesn’t have to suck at all. The expectation that aging means decay, Ms. Levy shows, is actually a major reason it so often does—our negative view of aging is literally killing us. Chipping away at this widespread and deeply ingrained conviction has a measurable effect on health after just 10 minutes. ... n 2002 Ms. Levy combined results from the Ohio Longitudinal Study on Aging and Retirement with data from the National Death Index to reveal that, on average, people with the most positive views of aging were outliving those with the most negative views by 7½ years—an extraordinary 10% of current life expectancy in the United States.
The author discusses factors that make us prone to negative views of aging, and in particular, the prevalence of ageism. However, the author goes on to address how to change our thinking to "break the age code."
Ms. Levy finishes with a vision of paradise: “A place where ageism does not exist.” But this is no idle fantasy, it’s Greensboro, Vt. She stops for homemade lemonade with an 81-year-old writer for the local paper and swims at Caspian Lake with a real-estate agent in her 80s. When older people and society around them are “harmonized in a productive way,” Ms. Levy continues, it shows how “aging can become a homecoming, a rediscovery, a feast of life.” Or—as Grandpa Eddie puts it after his adventure has left him closer to Spencer than ever before—“Getting old is a gift.”
I'm ordering the book!
Monday, April 18, 2022
NPR among other news agencies, reported on a new law signed by the Florida governor about 2 weeks ago, New laws let visitors see loved ones in health care facilities, even in an outbreak. As the U.S. News article, DeSantis Signs Hospital Visitation Bill, Other Legislation, explains, "[t]he visitation bill requires that health care facilities, including nursing homes, allow in-person visits during end-of-life situations and in most other cases. DeSantis and other state health officials said the measure was inspired by hospitals limiting visits during the coronavirus pandemic... Under the law, health care facilities have to establish visitation rules that include infection control and education policies for visitors. The policies cannot be more stringent than safety rules applied to the facility's staff and may not require proof of any vaccination or immunization. A health care center can suspend in-person visitation for specific people if they violate rules."
Sunday, April 17, 2022
Professor Naomi Cahn sent me the link to this recent article in the New York Times, Reverse Mortgages Are No Longer Just for Homeowners Short on Cash. "Until recently, it was conventional wisdom that a reverse mortgage was a last-resort option for the oldest homeowners who desperately needed cash. But a growing number of researchers say these loans could be a good option for people earlier in their retirement like [those] who are not needy at all."
The article offers the basics about reverse mortgages and offers some insights into the thinking about greater utility of reverse mortgages:
Homeowners in their 60s and early 70s could use cash from a reverse mortgage to protect investment portfolios during market downturns, to delay claiming Social Security benefits or to pay large medical bills.
“The best use of this tool is to provide and supplement income during retirement,” said ... the director of the financial planning program at the University of Illinois, Urbana-Champaign. “A younger retiree can stay in the house while turning equity into an income stream.”
The article discusses downsides for folks to consider as well. Read it!
Thursday, April 14, 2022
AARP has launched a new initiative to fight gift card scams. This is a super important project! According to the website,
With gift card fraud, a scammer may pretend to be someone they are not in an attempt to convince the unsuspecting person to pay them in gift cards. This type of scam can take many forms: • The scammer, claiming to be from “tech support,” says there is something wrong with a person’s computer, and that the person will need to pay in gift cards in order for tech support to fix the problem. • Posing as a user of a dating site, the scammer says they have an emergency and need another site user to help them by buying them gift cards. • Through a phone call the scammer pretends to be a relative in trouble who needs their target to send them gift cards. • Claiming to be from the IRS or Social Security, the scammer states that the person has a fine or owes back taxes that can only be paid by gift card. • The scammer impersonates the target’s utility company and threatens to shut off service unless they pay an overdue bill with gift cards.
More information about the scam and the training of retail employees is available here.
I've been a bit behind on posting and although this report was released 8 days ago, I wanted to be sure readers were aware of it. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff was released by the National Academies on Sciences, Engineering, and Medicine. Here is the description
Nursing homes play a unique dual role in the long-term care continuum, serving as a place where people receive needed health care and a place they call home. Ineffective responses to the complex challenges of nursing home care have resulted in a system that often fails to ensure the well-being and safety of nursing home residents. The devastating impact of the COVID-19 pandemic on nursing home residents and staff has renewed attention to the long-standing weaknesses that impede the provision of high-quality nursing home care.
With support from a coalition of sponsors, the National Academies of Sciences, Engineering, and Medicine formed the Committee on the Quality of Care in Nursing Homes to examine how the United States delivers, finances, regulates, and measures the quality of nursing home care. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff identifies seven broad goals and supporting recommendations which provide the overarching framework for a comprehensive approach to improving the quality of care in nursing homes.
Thanks to Morris Klein for alerting me to the release of this report.