Saturday, June 11, 2022

Two Hundred Years of Guns.... What if you knew the outcome when you were writing the Second Amendment?

Alexander Merezhko, a good friend since he was a visiting Fulbright Scholar at Dickinson Law from his home country of Ukraine, is now a member of Ukraine's parliament and a senior legal advisor to President Zelenskyy.  We email regularly about events in our respective countries; of course, there is a lot for us to discuss.  Recently, Alexander mentioned that discussions were underway about legalizing individual gun ownership in his country.  Suffice it to say, Professor Merezhko is worried about what happens after the war.  It seems likely the assault by Russian forces motivates those debates in Ukraine, but what about the future?  A similar struggle, America's own then-recent war for independence, was part of the context for the language of the Second Amendment to the U.S. Constitution, beginning with the words, "A well regulated Militia, being necessary to the security of a free State...."  

Could America's Founding Fathers have dreamed that the contextual phrase would be dismissed as significant and the remaining words of the Second Amendment would be treated as a mandate that permits unrestricted sales of weapons to individuals who are not part of any well-regulated system?  There is a very interesting article with historical  details I've never considered in The New Yorker, titled How Did Guns Get So Powerful?From the article by Phil Klay:

We wonder how we got here. How did guns grow so powerful—both technically and culturally? Like automobiles, firearms have grown increasingly advanced while becoming more than machines; they are both devices and symbols, possessing a cultural magnetism that makes them, for many people, the cornerstone of a way of life. They’re tools that kill efficiently while also promising power, respect, and equality—liberation from tyranny, from crime, from weakness. They’re a heritage from an imagined past, and a fantasy about protecting our future. It’s taken nearly two hundred years for guns to become the problem they are today. The story of how they acquired their power explains why, now, they are so hard to stop.

Why am I writing about guns (again) in the Elder Law Prof Blog?  The need for better support for mental health for youth and elders is part of what needs to be addressed.  Sadly, guns are part of a larger story not just for 18 year-olds in New York or Texas, but also for older Americans, as "firearm suicides are one of the leading causes of death for older Americans."  See Firearm Suicides in the Elderly: A Narrative Review and Call for Action, published in 2021 in the Journal of Community Health.  

June 11, 2022 in Cognitive Impairment, Crimes, Current Affairs, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, International, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Monday, June 6, 2022

Call for Papers: Journal of Elder Policy Issue on Technology as an Underutilized Late-Life Resource

Distinguished Professor and Editor-in-Chief Eva Kahana at Case Western University has advised us of the the most recent "call for papers" for her Journal of Elder Policy.  As most of us who work in law and aging recognize, our field is inherently cross-disciplinary and that is why it is so nice to hear from the sociology field when it is seeking new articles.  The focus for the upcoming issue is Technology: An Underutilized Late-Life Resource.  

The journal, which is peer reviewed, is seeking papers that address policy challenges and implications related to technology use and older adults. They welcome both empirical and conceptual papers from diverse disciplines and have a preference for pieces that employ policy approaches. 

Topics may include but are not limited to:

  • Internet use/access
  • Digital exclusion/inclusiveness
  • Interventions using digital platforms
  • Intergenerational learning
  • E-Health Literacy
  • Cultural influences on technology use in later life
  • Digital monitoring of frail older adults
  • Digital data collection
  • Scams/Fraud

Now the important part: 

Abstracts due by August 15, 2022 (500 words)
Full papers due by October 31, 2022 (8,000-10,000 words)

June 6, 2022 in Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Grant Deadlines/Awards, Statistics | Permalink

Thursday, May 26, 2022

Cognitive Aging, Maturity and Guns

Yesterday I wrote a blog post about gun use that several of my friends correctly characterized as heartfelt.  Of course, legal research is merited, and I find that my view echoes what is written in a key section of a very recent opinion:

Beyond these significant safety concerns, contemporary scientific research increasingly sheds light on the relative immaturity and incomplete cognitive development of young adults. California cites to evidence that young adults are less mature than older adults, which leads them to take more risks and behave more reactively than their elders. Young adults are thus quicker to anger than older adults and more vulnerable to intense mood swings and to making instinctive, rather than considered, decisions. This cognitive immaturity makes young adults more likely to use firearms in situations of significant emotional arousal or perceived threat, or other situations that require rapid, complex information processing. Other Circuits have credited similar evidence to uphold regulations on firearms affecting 18 to 20-year-olds. NRA, 700 F.3d at 208; Horsley v. Trame, 808 F.3d. 1126, 1133 (7th Cir. 2015). The semiautomatic rifle regulation helps to “ensure that access to these weapons is restricted to mature individuals who have successfully completed safety training,” such as members of law enforcement and the military, “furthering the public safety objectives and ensuring that the Founding Era balancing of Second Amendment rights with safety concerns continues today.” Jones, 498 F. Supp. 3d at 1328.

Unfortunately, this is from the dissenting opinion in Jones v. Bonta, decided by the 9th Circuit with an opinion issued less than two weeks before the shooting in Uvalde, Texas.  Sigh.  

Or, as the always astute Professor Naomi Cahn observes, "The irony of the timing of such a ruling is beyond distressing." 

May 26, 2022 in Crimes, Current Affairs, Ethical Issues, Federal Cases, Science, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Wednesday, May 25, 2022

When It Comes to Guns, Age Matters

I suspect I'm not alone in thinking about guns this morning in the wake of the Texas shooting at a grade school in Uvalde Texas.  This post reflects matters I've been thinking about for a long time.  Indeed, thirty years ago I considered making gun violence a core academic research topic, until I realized how potent is the lobby supporting gun sales, and therefore gun ownership.

First, this morning I listened to a young man, David Hogg, speaking to an NPR interviewer about his own frustrations in opposing gun violence.  He urged legislators at state and national levels to do at least "one thing" to move forward on gun safety legislation.  My first reaction was "one thing?"  How is that going to help?  

Second, I heard a bit more about the background of the 18 year old shooter in Texas, as well as the background of the similarly-aged shooter in Buffalo New York.   More memories.  In one of my previous lives, I volunteered for a neighborhood tutoring program in New Mexico.  My first two students, in high school, had been sent to the program by judges trying to help youths in crime-related incidents.  One young man attended once -- and then disappeared.

I managed to have a good session with the other student, a junior in high school, who at my request wrote a short essay about what he saw as his future.  The 500 word piece was quite well written, and gave us something we could definitely use to gently work to improve his reading and writing skills.  The focus, however, proved to be a window into the bleak outlook of a young man who was involved in a so-called gang.  To put it simply, he saw no future for himself after high school.  He said with utter confidence that his high school "had" to graduate him regardless of whether he did any more work, as long as he merely attended class.  I didn't want to believe that, but he had plenty of evidence to support his hypothesis. He didn't have any post graduation plans.  He had equal confidence that he probably wasn't going to make it to age 21.  The following week during our tutoring session, he was creative in his resistance to my role as a tutor.  He turned in his next essay, but it was written entirely in what was some sort of "tagger's script," the stylized script he used when spray-painting his messages on public building.  Tagging was his only crime at that moment.  

I eventually decided to volunteer for younger students, and in fact I had a two-year working student-tutor relationship with a grade school boy who was in the program at his mother's insistence.  Actually, I got to know the whole family, including his parents and a sister who also sometimes attended our reading sessions (and she helped turn reading into a competitive adventure).  To mark the success of his "graduation" from the program, we went to a Phoenix Suns basketball game, because the opposing team that day had a player much admired by my student.  At his comparatively "youthful" age, he had written about his plans for the future, including somehow, against all genetic odds, planning to "grow" tall enough to be a professional basketball player, like his idol, Nate Archibald.  We talked about coaching as an alternative -- just in case.

I remember the difference in these individuals as I listen to the troubled histories of the two "boys" who bought guns as part of their 18th birthday celebrations.  I don't know what happened to most of the other the students involved in the tutoring program.  The second student dropped out of the program for reasons I never learned, but I later saw his name in the newspaper when he was accused of being the driver in a car-jacking where his "friend" shot the woman who resisted having her car taken.  Sadly, that student's essay was prophetic, as any true dreams for a future may have ended with that crime.

So, if we are going to do at least "one thing," could we -- should we -- focus on raising the threshold age for gun ownership?  Should we give young people in their late teens more  time to grow older (and "taller" or more mature) and thus to reach a point where the future seems brighter?  I'm not suggesting they cannot participate in shooting sports, hunting, and the military, where we hope their use and skill building would be supervised by knowledgeable people. I am suggesting making it unlawful for them to "own" or at least to purchase guns until they are older. Research suggests that substantially more crimes of gun violence against others are committed by individuals between the ages of 17 and 21.  There is research to support restricting gun ownership (and therefore gun sales) to individuals over 21 as one step forward in terms of safety. 

For example, in June 1999, a "collaborative report" under the auspices of the U.S. Department of Justice noted in part:

In 1996, 26,040 people in the United States were killed with guns.  In 1997, offenders age 18, 19, and 20 ranked first, second, and third in the number of gun homicides committed.  Of all gun homicides where an offender was identified, 24 percent were committed by this age group, which is consistent with the historical pattern of gun homicides over the past 10 years.  

Other statistics suggest that gun-related suicide death rates are highest for females age 45 to 64 and for males age 75 and older, statistics that point to another form of age-specific gun tragedies. Age matters.

That first boy who "disappeared" after the first tutoring session?  I later learned he had been killed in a neighborhood shooting.  Would younger adults support delayed lawful-ownership as one form of protection against gun violence?   Certainly, more is needed on so many other levels including mental health supports. But could "one thing" -- at least -- include blocking gun sales to people who are still in the process of learning to plan for the future, for their futures?  

 

May 25, 2022 in Cognitive Impairment, Crimes, Current Affairs, Ethical Issues, Federal Statutes/Regulations, Science, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (0)

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.  

May 20, 2022 in Consumer Information, Current Affairs, Ethical Issues, Health Care/Long Term Care, Science, Statistics | Permalink | Comments (0)

Friday, April 29, 2022

Filial Friday: Virginia Governor Blocks Attempt to Repeal Virginia Filial Support Law

As is true with several U.S. states, Virginia has a filial support statute that can obligate adult children to support their parents.  The key language of VA Code Ann. Section 20-88 provides:

It shall be the joint and several duty of all persons eighteen years of age or over, of sufficient earning capacity or income, after reasonably providing for his or her own immediate family, to assist in providing for the support and maintenance of his or her mother or father, he or she being then and there in necessitous circumstances. 

 

If there be more than one person bound to support the same parent or parents, the persons so bound to support shall jointly and severally share equitably in the discharge of such duty. . . .

 

This section shall not apply if there is substantial evidence of desertion, neglect, abuse or willful failure to support any such child by the father or mother, as the case may be, prior to the child's emancipation or, except as provided hereafter in this section, if a parent is otherwise eligible for and is receiving public assistance or services under a federal or state program. . . . 

There are few modern cases applying this law. In Peyton v. Peyton, an "unreported" Virginia chancery court decision from 40 years ago, the court applies the law to obligate one brother to reimburse another brother $8,000, representing half of the past out-of-pocket expenses for their mother's care in a nursing home. A careful reading of the Peyton case reveals one of the challenges of applying filial support laws when used to collect "back" expenses; here the second son was willing to pay a portion of their mother's monthly costs going forward but he was not successful in arguing a statute of limitations should apply to prevent liability for multiple years of back claims. 

As with other American states that have had forms of filial support laws, Virginia's law was enacted as an alternative to public welfare laws because the common law generally found no legal duty for adult children to support indigent parents.  But, in Virginia, again as in most American states, the filial support laws are largely dormant, misunderstood or ignored, especially after Social Security, Medicare, and Medicaid laws were enacted on a federal level beginning in the 1960s.  

Virginia's  statute was amended decades ago to restrict use of the law by the state to seek reimbursement for its costs in providing public services (such as "medical assistance" a/k/a Medicaid).  However, unlike the filial laws of most states, Virginia's law permits criminal prosecution as a misdemeanor for "any person violating the provisions of an order" of support under this statute, with a fine not exceeding $500 or imprisonment in jail for up to 12 months.  I find no reported cases of criminal enforcement actions.

Recognizing that other states (including neighboring Maryland in 2017) had recently taken formal action to repeal filial support laws as outdated or impractical, Virginia Senator Adam Ebbin introduced 2022 Senate Bill 389 to repeal Virginia's law. Senator Ebbin's bill passed with no dissenting votes in the Virginia Senate.  The final vote in the Virginia House, on March 11, 2022, supported repeal with 81 voting in favor, and only 16 members voting in opposition to repeal. In other words, repeal was not a controversial measure; rather it appeared to be part of an attempt to clean-up hoary laws, and it attracted strong bipartisan support.

Nonetheless, Virginia Governor Glenn Youngkin (sworn into office in January 2022) vetoed the repeal on April 11, 2022.  His reasoning for preserving filial support laws is unique, at least in my 20-some years of experience researching filial support laws (see e.g., Filial Support Laws in the Modern Era: Domestic and International and International Comparison of Enforcement Practices for Laws Requiring Adult Children to Support Indigent Parents, 20 Elder Law Journal 269 (2013)).  

The governor's veto statement explains:

"Primarily, the Commonwealth's filial responsibility law supports those who care for their elderly parents.  In establishing a bankruptcy budget, the court allows for necessary and reasonable expenditures and the repeal of Section 20-88 could prevent an individual from covering these expenses within the budget of their debtor.  For those undergoing bankruptcy proceedings, there is a grave risk of unforeseeable and unintended consequences, which may harm people going through some of the most difficult times in their lives."

On the one hand, in today's torn asunder political scene, no one should be surprised that a newly elected governor of one party would be vetoing legislation sponsored by a member of the other party -- and that is true here, with a Republican governor vetoing a bill proposed by a Democrat.  

But what about the proffered reason for the veto?  Virginia's law does not "primarily" support those who care for their elderly parents.  Rather, it creates an obligation for adult children. Is there any precedent for a theory that Virginia's filial support law permits some type of sheltering of assets for a debtor in bankruptcy court, to provide a means of financial support for the (also) destitute parent?  Certainly I find no modern cases on Lexis or Westlaw suggesting such use or even a need for such use.  

There is a reported case from 1938 in Virginia.  In Mitchell-Powers Hardware Co. v. Eaton, 198 S.E. 496 (Supreme Court of Appeals, VA 1938), the court addressed a question of whether a transfer of valuable stock by a debtor to his sister was voidable as an invalid gift.  Was this an invalid attempt to defeat a legitimate creditor's lien against the asset? The court recognized that under Virginia's predecessor version of Statute 20-88, the debtor "could" have an obligation to assist his sister in the care of their elderly mother. The appellate court remanded the case for a jury determination of whether the mother was actually destitute and in need of the son's financial support. (The sister had further transferred the stock in question onward to the debtor's son).  This hardly seems a persuasive case for characterizing filial support laws as necessary "support for those who care for their elderly parents."

April 29, 2022 in Crimes, Current Affairs, Estates and Trusts, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Tuesday, April 26, 2022

What Are Your Examples of Scarecrow Laws?

I'm working on a book chapter about filial support laws, where families (usually adult children) may be surprised to learn that their state or their country has a seldom-used law that mandates financial support or maintenance for indigent family members. In working on this chapter, I was considering using the concept of "scarecrow laws" as a metaphor.  This label can apply to laws which are seldom enforced but legislators resist repeal because the very existence of the law might serve as a warning -- a scarecrow -- about the consequences of bad behavior.

While working on the metaphor, I came across an interesting application from Shakespeare's play, Measure for Measure.  In Act 2, Scene 1, we hear a harshly ambitious deputy administrator calling for the ultimate punishment -- beheading -- of Claudio, a man convicted of a crime.  But the law in question, prohibiting sexual relations outside of sanctioned marriage, is "rarely enforced."  One of Angelo's subordinates objects to the harsh sentence. Angelo responds:

We must not make a scarecrow of the law,

Settling it up to fear the birds of prey,

And let it keep one shape, till custom make it 

Their perch and not their terror.

The irony is that Angelo also seeks to violate the same law with a woman who has attracted his attention, but he discounts his own admission as, so far, mere temptation.  

Shakespeare's use of the scarecrow characterization raises a legitimate question.  Should laws, little known and rarely enforced, be removed from the books, or allowed to remain, perhaps on the justification they serve as moral guidance?  

April 26, 2022 in Books, Crimes, Current Affairs, Discrimination, Ethical Issues | Permalink | Comments (0)

Saturday, April 9, 2022

What's A Neighbor to Do? When friends need assistance....

This tends to happen in waves, but I've been receiving a lot of calls lately from people who are concerned about an aging neighbor or a casual friend. 

For example, in one communication, the caller was worried about a neighbor lady in her 80s who had stopped her on the sidewalk recently to ask for a recommendation for an attorney to come to her house.  She seemed to want help "working out a proper arrangement" for a younger person to live in her house on a rent-to-own type of contract.  The older neighbor didn't seem to have money to maintain the house.  A complication -- more than a solution -- was the fact the woman had adult children, but didn't want to "bother" them and they lived out-of-town.

In the second situation, it was an early morning text, asking for help for a friend, where an agent, operating under a "new" Power of Attorney, was denying permission for the live-in Significant Other to visit the friend now that she was in assisted living.  Apparently the SO was raising objections about  the quality of care (or maybe just the lack of appropriate care) in AL.  Suddenly a POA surfaced, purporting to give authority for an out-of-state relative to direct the AL to deny the SO's visits because they were disturbing the patient.   

Red flags everywhere in these fact patterns.

Both of these fact patterns are variations on a theme.   Protective service units (if they have sufficient staffing) and long-time Elder Law attorneys can often respond effectively.  But one of the biggest changes I've found since the pandemic is finding "live" people who might be available and willing to help. Shortages of staff, overworked solo attorneys, budget cutbacks -- all play a part of the challenges to find effective services to assist older adults.

All of this puts a premium on advance planning -- for more than "just" wills or trusts.

When we wait until we are already seriously ill or until we are in our 80s, we are running a huge risk that we won't get the advice and counsel we need to make sound, effective choices.  We need to make these plans while we still "clearly" have capacity.  If the person with cancer had added instructions and her preferences about visitors before surgery, it would be less likely she is denied time with someone who cares enough to seek better care.  

 

April 9, 2022 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Estates and Trusts, Ethical Issues, Health Care/Long Term Care | Permalink | Comments (0)

What's A Neighbor to Do? When friends need assistance....

This tends to happen in waves, but I've been receiving a lot of calls lately from people who are concerned about an aging neighbor or a casual friend. 

For example, in one communication, the caller was worried about a neighbor lady in her 80s who had stopped her on the sidewalk recently to ask for a recommendation for an attorney to come to her house.  She seemed to want help "working out a proper arrangement" for a younger person to live in her house on a rent-to-own type of contract.  The older neighbor didn't seem to have money to maintain the house.  A complication -- more than a solution -- was the fact the woman had adult children, but didn't want to "bother" them and they lived out-of-town.

In the second situation, it was an early morning text, asking for help for a friend, where an agent, operating under a "new" Power of Attorney, was denying permission for the live-in Significant Other to visit the friend now that she was in assisted living.  Apparently the SO was raising objections about  the quality of care (or maybe just the lack of appropriate care) in AL.  Suddenly a POA surfaced, purporting to give authority for an out-of-state relative to direct the AL to deny the SO's visits because they were disturbing the patient.   

Red flags everywhere in these fact patterns.

Both of these fact patterns are variations on a theme.   Protective service units (if they have sufficient staffing) and long-time Elder Law attorneys can often respond effectively.  But one of the biggest changes I've found since the pandemic is finding "live" people who might be available and willing to help. Shortages of staff, overworked solo attorneys, budget cutbacks -- all play a part of the challenges to find effective services to assist older adults.

All of this puts a premium on advance planning -- for more than "just" wills or trusts.

When we wait until we are already seriously ill or until we are in our 80s, we are running a huge risk that we won't get the advice and counsel we need to make sound, effective choices.  We need to make these plans while we still "clearly" have capacity.  If the person with cancer had added instructions and her preferences about visitors before surgery, it would be less likely she is denied time with someone who cares enough to seek better care.  

 

April 9, 2022 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Estates and Trusts, Ethical Issues, Health Care/Long Term Care | Permalink | Comments (0)

Wednesday, March 30, 2022

Victoria Law Foundation Hosts International Access to Justice and Legal Services Forum in Australia March 30 through April 1

Victoria Law Foundation International Access to Justice and Legal Services Forum
I had the unique privilege of joining an interdisciplinary team of professionals discussing timely concerns about access to justice for older persons, not only in the host country of Australia but around the world.  Our session, entitled Legal Need, Empowerment and Older People, began with Susannah Sage Jacobson and Eileen Webb, academics from the University of South Australia, who addressed ageism and specific examples of abuse, followed by Frances Batchelor, Acting Director of the Australian National Ageing Research Institute, discussing new consumer-based research on quality of residential care.  The International Access to Justice Online Forum is hosted by the Victoria Law Foundation and the UCI Law Civil Justice Research Initiative, with panelists across the three days of programming from Australia, the U.S, Canada, New Zealand and the U.K.  There is still time -- depending on which side of the international date line you reside -- to catch more presentations as the event runs through April 1, 2022.

In addition, research papers and reports and video captures of the program are being posted online.  Take a good look!  

March 30, 2022 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Crimes, Current Affairs, Dementia/Alzheimer’s, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, International | Permalink | Comments (0)

Wednesday, March 2, 2022

Reconsidering the Implications of Togetherness As Couples Get Older

I have a fondness for California Rock & Roll from a certain era -- also known as my youth.  One of my favorites, Warren Zevon, is probably mostly remembered as a singer/songwriter, and he penned some great songs such as Hasten Down the Wind (performed by another favorite, Linda Ronstadt, who, like me was born next door to California in Arizona).  Some of his lyrics work equally well as poetry.  Right now I'm thinking to the opening lines to Reconsider Me, recorded and released by Zevon in 1987:   

If you're all alone

And you need someone

Call me up

And I'll come running

Reconsider me

Reconsider me

Those lines seem to echo in an article from the New York Times today, describing a trend among older singles -- they are willing to love again, but at least one half of the couple isn't willing to live together.  The article begins by describing a 78 year-old widow's friendship with a a widowed man that was turning romantic.   He wanted them to move into together.  She wasn't eager and she admits that his health woes were part of the concern.  She is quoted as saying "He was not in great shape."  Eventually, when he had surgery and needed recuperative care, she followed his directions and "using his funds, hired a live-in caregiver for him."  Once he recovered, they spent more time together.  

The NYT writer, Francine Russo, observes:

With greater longevity, the doubling of the divorce rate since the 1990s for people over 50 and evolving social norms, older people like Ms. Randall are increasingly re-partnering in various forms.  Cohabitation, for example, is more often replacing remarriage following divorce or widowhood, said Susan L. Brown, a sociologist at Bowling Green State University in Ohio.

 

These older adults are seeking (and finding) love, emotional support and an antidote to loneliness.  But many older women, in particular, fear that a romantic attachment in later life will shortly lead to full-time caregiving.

The New York Times article also echoes topics addressed in the article I linked to last week by Cahn, Huntingdon and Scott, Family Law for the One-Hundred Year Life.  For more from the Times, if you have a subscription, see Older Singles Have Found a New Wat to Partner Up:  Living Apart.  

 

 

March 2, 2022 in Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Housing, Retirement | Permalink | Comments (2)

Friday, February 25, 2022

Adapting Family Law to Recognize Importance Of Older Members and Significance of Aging

Naomi Cahn of University of Virginia School of Law Law joins Clare Huntington, of Fordham Law  and Elizabeth Scott, Emerita Professor at Columbia Law, to propose needed changes in family law to reflect the impact of aging.  In their forthcoming article for Yale Law Journal (Vol. 132) titled Family Law for the One-Hundred Year Life, they contend family law must address the interests and needs of families across the life span, and not just those of younger people.  They point to three areas for focus: the dignity and autonomy interests of older persons, structural inequalities, and the need for legal mechanisms that are efficient and accessible.  An example of their calls for legal reform is the discussion of intrafamily personal care contracts:

The response of regulators and courts to intrafamily personal care contracts illustrates well the law’s failure to support family care, especially for low-income families. In arranging in-home care, older adults sometimes contract with service providers, but they also contract with family members. A care contract is especially helpful when an older adult wants to receive these services from a family member but the family member cannot provide care without compensation. But these agreements run into problems. If the older adult is trying to qualify for Medicaid, many states scrutinize the contracts to ensure they are not simply a means for transferring assets from the older adult to the younger relative, helping the older adult satisfy Medicaid’s means-tested eligibility requirements. Partly based on the assumption that familial care is provided altruistically, state regulators regularly find that the agreements are, indeed, fraudulent transfers. This is an example of class-based discrimination: intrafamilial contracts for care are not scrutinized by public authorities unless the care recipient seeks to qualify for public support through Medicaid.

Equally interesting is their discussion of "opt-in or opt-out" concepts for the definition of family.  All-in-all, this article looks to the future of judicial, regulatory and legislative legal systems, while also offering ways to challenge our students in the classroom now.  

 

February 25, 2022 in Current Affairs, Discrimination, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, State Cases | Permalink | Comments (0)

Saturday, January 8, 2022

Sad News: The Passing of Civil Rights Advocate Lani Guinier, Reportedly of Complications of Alzheimer's

I read the news late on Friday of the passing of Lani Guinier and it was especially sad to learn that family members reported her death, at just 71, was due to "complications of Alzheimer's disease."  That report made me realize that I hadn't heard from her on the important civil rights issues of the last few years -- and this history probably explains why.  Nonetheless, her teaching, her writing, her advocacy in court and in the field on behalf of civil rights, on voting rights, on student empowerment (often on behalf of women in law school classrooms, urging them them to speak out) will continue to impact the nation.  In her 2002 book, The Miner's Canary -- sitting nearby on my shelf --  cowritten with Gerald Torres, the conclusion resonates with equal strength in 2022:   

We credit the civil rights movement and the liberal legal model to the extent that each created a space for progressive politics and reduced racism as conventionally defined.  This tolerance model has made alliance possible that were once unthinkable.  But the civil rights movement too often seems to measure progress by looking backward; we want to shift the focus to where we are going, not how far we have come.  In the past, conventional ideas of race were deliberately tied to issues of social policy in order to make programs of general concern sound like special pleading.  Our response is to reclaim race in order to "complete" democracy."  

With grateful feelings, and remembering her as a role model for so many, we will miss her.  

January 8, 2022 in Books, Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Ethical Issues | Permalink | Comments (0)

Monday, December 13, 2021

Who Has Been Most Affected by COVID-19?

The New York Times reports that even through people in the US aged 65 and older are the "most" vaccinated of all age groups, they still comprise "three-quarters of the nation's coronavirus death toll."  Of course, the impact has not been "just" in terms of the greater risk of serious illness and death.  I think it is pretty clear there has been an age-related leveraging of fear and isolation with each news story that reports another surge in outbreaks.  

One in 100 older Americans has died from the virus. For people younger than 65, that ratio is closer to 1 in 1,400.

 

The heightened risk for older people has dominated life for many, partly as friends and family try to protect them. “You get kind of forgotten,’’ said Pat Hayashi, 65, of San Francisco. “In the pandemic, the isolation and the loneliness got worse. We lost our freedom and we lost our services.” 

 

....

In both sharp and subtle ways, the pandemic has amplified an existing divide between older and younger Americans.

COVID-19 is now "the third leading cause of death among Americans 65 and older, after heart disease and cancer.  It is responsible for about 13 percent of all deaths in that age group since the beginning of 2020, more than diabetes, accidents, Alzheimer's disease or dementia." 

For more, including the difficult choices some older adults have encountered, only to find that all their efforts failed to keep them safe, read the full NYT article, "As U.S. Nears 800,000 Virus Deaths, 1 in Every 100 Older Americans Has Perished." 

 

December 13, 2021 in Current Affairs, Ethical Issues, Health Care/Long Term Care, Statistics | Permalink | Comments (1)

Tuesday, December 7, 2021

What Do We Mean by Care? Heather McGhee Interviews Ai-Jen Poo

The New York Times is a host for The Ezra Klein Show, a podcast (and short written commentary) with episodes that generally appear on Tuesdays and Fridays each week. Ezra Klein is on paternity leave right now, and in his absence, Heather McGhee, author of The Sum of Us, interviewed Ai-jen Poo, MacArthur grant winner and author of The Age of Dignity: Preparing for the Elder Boom in a Changing America.  The discussion is timely.

Interestingly, the title assigned by the NYT to this podcast is "Every 8 Seconds, an American Turns 65.  How Do We Care for Everyone?"  

Use of that statistic seems to be intended to shock, or at least, to cause a nervous, worried reaction.  Yet the "8 Second" rate is also used for new births in the U.S.  At the outset of the interesting interview, Heather asks Ai-jen for a definition of "care."  Ai-jen responds in her usual fashion -- thoughtfully and carefully -- and says, in essence, "Care is the most fundamental form of support we offer others.  We both offer and rely on care; care is essential." She adds, however, that for most families, private care is unaffordable, whether the need is for child care, disabled family member care, or elder care.

I wonder why it is that we so often ask whether "we can afford" the care of older adults?  That implies the public form of "we." Yes, too often the response (if not the answer)  is "no," but I tend to think that one of the reasons for that fact is that we continue to think that we, as individuals, have some "right" to stay in our homes no matter how long we live, and no matter how much this becomes impossible to manage.  Is it just "too" hard as individuals to plan for alternatives? I think the answer is "yes," but if we aren't going to plan as individuals, it seems likely that the costs will always be treated as unaffordable by "the public."

December 7, 2021 in Consumer Information, Current Affairs, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Cases, Health Care/Long Term Care, Housing, Retirement | Permalink | Comments (0)

How Does Your Hospital's Average Wait Time Compare?

Following my post urging new approaches to "waiting room" protocols, I received several direct replies. I think I've touched a nerve.  First, the fact that the replies were sent directly to my email address probably reflects a little "wait time" problem for the Typepad Blog Platform itself. More than one reader commented on the difficulty of logging in to submit their own responses to a Blog post.  My apologies!  

But, I'm always happy to read commentary, no matter the means of communication.  Some people wrote to report innovations in their own communities.  Among the most interesting have been people who reported "pop-up clinics," especially on the outskirts of larger cities or even more rural areas.  These clinics are a direct response to COVID-19 pressures on hospitals -- and they make a lot of sense.  Other suggestions have included the option of "beepers" being provided to waiting patients so that they have the option of moving outside the crowded waiting room without fear of losing their spot.  If restaurants can do this, why can't hospitals!  

I also heard from two friends who are physicians.  Both reported their own frustrations.  They can end up facing patients and family members who are worn out or angry by the time they reach the person who can diagnose and offer treatment.  One doctor speculated on the trend of ordering diagnostic tests such as CT scans before the doctor's first communication with the patient, echoing some patients' suspicion that the tests increase the cost of the visit, and the question is necessity.  

A newspaper that serves a nearby Pennsylvania county (York) also carried a story over the weekend reporting on average wait times at various regional hospitals -- and one large, high volume hospital was reporting waits of almost 5 hours.  Could ERs publish this kind of information at the door, so that families understand that challenges ahead, and can consider options before checking in?  Heck, Departments of Motor Vehicles routinely post waiting times!

And it turns out that a Medicare.gov Care Compare website, in addition to offering comparative information on nursing homes, also offers information about other health care providers including hospital emergency rooms.  Evaluative items related to "quality" include reports on "timely & effective care, complications & deaths, unplanned hospital visits, psychiatric units services, and payment & value of care."  Under  the first category, when I searched a local hospital's data, I learned that Medicare considered this hospital to have a "medium" volume of patients, but the average ER wait time of 207 minutes was similar to much larger volume hospitals.  I don't think anyone is likely to access this website while headed to the emergency room, but perhaps the information does facilitate better advance planning before an emergency to identify nearby options for the future.

 

December 7, 2021 in Consumer Information, Current Affairs, Ethical Issues, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Saturday, December 4, 2021

It is Time to Rethink "Waiting Rooms"

Today I read an interesting Washington Post article about a judge in a northern New Mexico town who has been willing to rethink criminal justice for drug-related offenses.  The approach this judge is taking goes beyond the "drug court model, once widely viewed as a progressive alternative to jail." As described in The Judge Who Keeps People Out of Jail Judge Jason Lidyard meets directly with participants in his program, outside the court house, to discuss progress one-on-one:  

He does not expect his clients to abstain from using -- in fact, he assumes the contrary. 'I don't care if you're high, so long as you show up here,' he tells one.  And informed by childhood memories of his own father's addiction, he categorically refuses to use jail as a sanction. 'Only two things will get you kicked out,' he explains. If you don't show up, or if you commit new crimes.

My own work doesn't focus on criminal justice.  But I am ever more intrigued by the willingness of some prosecutors, jurists and court systems to rethink solutions to different forms of problematic behaviors.

This article also intrigued me because I had recently spent an evening in an emergency room of a small town hospital. An older friend -- in her 90s -- had been waiting since early afternoon for diagnosis of symptoms of light-headedness, "waves" of confusion, and sudden inability to walk normally.  Her symptoms were serious.  After more than an hour at an urgent care facility, transfer by ambulance and 3 hours in the hospital's ER, some tests had been conducted.  But when I arrived the results were not available and she had yet to see a doctor.  Friends and then her daughter (driving several hours from her home in a large city) had been taking turns sitting with her and hoping to get some recommendation about how best to handle these worrisome symptoms. 

Over the last few years, as I suspect is also true for many of our readers,  I've done this same sort of "camping out" in ERs in multiple hospitals with aging friends and family members.

But that evening was startling in the intensity of what I was observing.  Every chair in this relatively new hospital was taken, and even more patients were sitting in wheelchairs.  There was only one person at the "intake desk" and it is an understatement to say that person was suffering from front-line burn out.  Rather, she was in full flame.  

At least a third of the patients I was seeing were "older."  Some of them had no family members with them.  One woman, with no family and clearly deeply affected by some form of dementia, was wrapped in a blanket, no shoes, and, I realized, no clothes on under the blanket. She was wandering, and moaning, very unstable on legs that appeared distorted by cellulitis.  Another patient was holding one of his legs in the air with his own hands, as he was in such pain that he couldn't stand to have his foot touch anything -- and no wonder, as I could see a large, weeping hole in the center of the foot.  I was moving in and out of that ER for about 4 hours.  Many of the patients that were sitting with agonized expressions on their faces when I first arrived at 6 p.m. were still in the same location when I left for the final time just after 11 p.m.  There were no hospital rooms available.  Period.  

My friend could not take the chance of going home to wait for the tests results, and it was clear that if she did so, no one would be available to talk with her by phone who could give an informed diagnosis and discuss options.

COVID-19 and certainly the recent variants, have exposed and intensified what has long been a problem for hospitals: the process of emergency admissions.  My father, years ago, summarized the problem accurately even while he was in the early stages of dementia.  "I would rather die on the steps than spend one more night in that place" -- referring to the ER.

But it isn't just emergency rooms at hospitals.  I've had to abandon waiting rooms in doctors' office, dentist offices, even the pharmacy, because whomever I was bringing in for help was panicking when they felt trapped in chairs that they were afraid to even touch. Post-Covid-personnel shortages at all levels of care are clearly making the problem of access to health care very problematic. But I suspect the problem pre-existed the pandemic.  (Inadequate, un-separated seating in airport lounges and transport buses? I'm thinking of you too!)

Solutions?  I'm not sure.  But certainly some creative minds could tackle this.  I know some care-sites ask patients, if possible, to wait in their cars to be called in for the actual appointment.  But that doesn't work for many older persons, especially in hot or cold weather, or where it is a very long walk to get to a bathroom.  

I do know that one source of help I stumbled across in one state was using the non-emergency number for the 911 responders in the area.  In that state, I discovered calling that number resulted in a "first available" non-emergency response by a team of trained professionals who could do high level assessments, and who could help prioritize any needed transport to the ER.  But that doesn't' seem to be a uniformly available alternative in all states.

There is a saying, sometimes attributed to Winston Churchill (probably incorrectly) reminding us to "never let a good crisis go to waste."  Let's use the current crisis to rethink ways to more effectively access health care assessments.  Certainly that would be better for patients, but also for the front-line responders.  

December 4, 2021 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Health Care/Long Term Care | Permalink | Comments (1)

Friday, November 26, 2021

Surveillance When Using Tech to Age in Place?

It's not "Big Brother ... Watching You." (If you are a Baby Boomer, you will likely remember the phrase.)  So who is watching if you are using tech to age in place?  The Washington Post addressed this question in For seniors using tech to age in place, surveillance can be the price of independence.

On the surface the benefits of home and health monitoring technology seem obvious. A flow of information about the older person can put a caretaker at ease and help keep track of physical or cognitive decline. It is a way to extend the amount of time they are able live in their own homes before moving to someplace like a retirement or nursing home.

But the devices, many of which grew out of security and surveillance systems, can take privacy and control away from a population that is less likely to know how to manage the technology themselves. The idea of using tech to help people as they age is not a problem, say experts, but how it’s designed, used and communicated can be. Done wrong or without consent, it is one-way surveillance that can lead to neglect. Done right, it can help aging people be more independent.

New tech is being developed according to the article, and the article points out that the tech requires maintenance. "Aside from privacy issues, Internet connected devices are also a security worry. Many are stuffed with insecure software and require regular updates and password changes so they are not vulnerable to breaches." Even though tech can offer some advantages, there are still some caregiving tasks that require a human to perform (at least for now).

Here's an important point about the use of monitoring technology. "There is an imbalance of power that often exists between the elderly and their caretakers when it comes to technological know how. In the worst case scenario, it can also play a role in elder abuse, whether it is financial, physical or emotional, experts say." The elder needs to give consent to the use of the monitoring devices and understand that "[b]eing old does not mean you lose your rights."

Thanks to Professors Bauer and Cahn for sending me the link to the article.

November 26, 2021 in Consumer Information, Current Affairs, Ethical Issues, Health Care/Long Term Care, Other, Web/Tech | Permalink | Comments (0)

Monday, September 27, 2021

Why Monoclonal Antibodies Might Be Used in Assisted Living

Recently a friend noted with concern that she'd been advised that an elderly relative would be receiving "antibodies" in her assisted living community. The confusion was "if she has been fully vaccinated, and hasn't tested positive herself, why would she need "antibodies?"  Turns out there were new incidences of COVID-19 in her wing of older adults, many of them with multiple risks factors, and the staff was being proactive.   More than likely, what she was receiving was "monoclonal antibodies."  The question arose before the question of authorization of "booster" shots had been addressed by the FDA.

As explained in this WebMD Health News article, titled Monoclonal Antibodies vs. Vaccines vs. COVID-19, from August 2021, families with loved ones in communal settings may want to discuss monoclonal antibodies with the health care team: 

Can I help relatives in assisted living get it?

If you believe that a relative in a residential facility -- like a nursing home, assisted living facility, long-term care home, or prison -- has COVID-19 or has been exposed, the first thing you should do is have a conversation with the medical leadership at the facility.

 

[Michigan Department of Health and Human Services Division of EMS and Trauma Director, Dr. William Fales] has partnered Michigan-based paramedics with several nursing homes in the state to have monoclonal antibodies delivered to these facilities when there’s an outbreak. It’s also possible for long-term care pharmacies to get monoclonal antibodies to administer in-house. If the medical leadership doesn’t appear to be aware of the treatment, you can use the same websites to find the nearest infusion center and begin coordinating treatment with it.

 

It's a good idea, Fales says, to find out where monoclonal antibodies are offered in your area, and perhaps talk with your doctor or a high-risk loved one’s doctor about how to get them, to be prepared. The faster you can get the treatment, the more likely it will help.

September 27, 2021 in Consumer Information, Current Affairs, Ethical Issues, Health Care/Long Term Care, Science | Permalink | Comments (0)

Thursday, September 16, 2021

Friday's Public Hearing re Approval for Third Dose Covid-19 Boosters Can Be Viewed Online

The U.S. Food and Drug Administration hearing on Friday, September 17, 2021 to address the question of approval for "booster" doses of Covid-19 vaccines is scheduled to be "open" to the public through online portals.  The hearing begins at 8:30 a.m. Eastern time.

The FDA's website helpfully links to the submissions from the drug companies and other interested parties as well to the hearing portal.  In contrast to The Lancet article published earlier this week which takes the position that a booster vaccine dose is not "currently" indicated for most members of the public, Pfizer and Moderna each submitted materials to the FDA this week in support of administering third shots beginning six months after an individual's second shot. Pfizer is recommending a full-strength dose for its booster shot, while Moderna is recommending a dose that is 1/3 the level of its original doses.  It appears both companies are citing observational studies, clinical trials, and antibody tests in support of their recommendations, including studies in the U.S., Israel, and South Africa, and discuss histories of reactogenicity, adverse events, and risk/benefit assessments.  

Here's the useful FDA vaccine hearing webpage and links:  https://www.fda.gov/advisory-committees/advisory-committee-calendar/vaccines-and-related-biological-products-advisory-committee-september-17-2021-meeting-announcement#event-materials

September 16, 2021 in Consumer Information, Current Affairs, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Science, Statistics | Permalink | Comments (0)