Tuesday, March 19, 2019
Kaiser Health News ran a story last week on how to push back vs. loneliness in older adults. Understanding Loneliness In Older Adults — And Tailoring A Solution doesn't mean telling folks to get a hobby. Instead, the idea of fighting loneliness is making connections with others, living a purpose-filled life, and having important social roles. Loneliness among elders has been found to be connected to many issues. "Four surveys (by Cigna, AARP, the Kaiser Family Foundation and the University of Michigan) have examined the extent of loneliness and social isolation in older adults in the past year. And health insurers, health care systems, senior housing operators and social service agencies are launching or expanding initiatives." Not everyone will respond well to one solution, so it's important that programs offer alternatives.
Interestingly, the story describes two categories of loneliness, what might be called short-term and long-term loneliness. "The headlines are alarming: Between 33 and 43 percent of older Americans are lonely, they proclaim. But those figures combine two groups: people who are sometimes lonely and those who are always lonely... The distinction matters because people who are sometimes lonely don’t necessarily stay that way; they can move in and out of this state. And the potential health impact of loneliness — a higher risk of heart disease, dementia, immune dysfunction, functional impairment and early death — depends on its severity."
The article not only explores the length of loneliness but the depth and types of it as well. "According to a well-established framework, “emotional loneliness” occurs when someone feels the lack of intimate relationships. “Social loneliness” is the lack of satisfying contact with family members, friends, neighbors or other community members. “Collective loneliness” is the feeling of not being valued by the broader community. .. Some experts add another category: “existential loneliness,” or the sense that life lacks meaning or purpose."
A program that might effectively combat loneliness has to look at the causes of it. Those include the sense that people don't care about you, disappointing relationships, for example. Some types of loneliness might have an easier fix. The article offers the example of "[s]omeone who’s lost a sense of being meaningfully connected to other people because of hearing loss — the most common type of disability among older adults — can be encouraged to use a hearing aid. Someone who can’t drive anymore and has stopped getting out of the house can get assistance with transportation. Or someone who’s lost a sibling or a spouse can be directed to a bereavement program."
The article is very interesting and brings depth to a very important topic.
Friday, March 8, 2019
The Baltimore Sun reported that the Maryland House of Delegates has passed a measure to legalize physician-aided dying in Maryland. Maryland House of Delegates approves legalizing medically assisted suicide notes that the bill passed by a close margin and a corresponding bill is pending in the Maryland Senate.The House version contains various protections, including "[t]he patient must be 18 years old, have a terminal illness with a prognosis of less than six months to live and be able to take the drugs by themselves. The patient must request the prescription on three separate occasions, including at least once in private and at least once in writing — provisions meant to prevent patients from being coerced into obtaining the medication." More information about the House bill is available here.
Thursday, March 7, 2019
The New York Times ran a story that notes that nursing homes are closing in rural America, leaving residents with few options. Nursing Homes are Closing Across Rural American, Scattering Residents highlights the dilemma for many in rural areas when the local nursing home closes. "More than 440 rural nursing homes have closed or merged over the last decade ... and each closure scattered patients like seeds in the wind. Instead of finding new care in their homes and communities, many end up at different nursing homes far from their families. ... In remote communities ... there are few choices for an aging population. Home health aides can be scarce and unaffordable to hire around the clock. The few senior-citizen apartments have waiting lists. Adult children have long since moved away to bigger cities." Think about the implications when the facility closes and there isn't another one near by. Not only might the resident suffer from transfer trauma, there are other implications. As the article notes, with distance comes the lack of ability for frequent visits, the time spent traveling to the new SNF, the inability to get to the new SNF quickly if a need arises and the vagaries of Mother Nature who may heap bad weather on the area, making it unsafe to travel. There are various reasons why nursing homes in rural communities are closing, including financial instability, Medicaid reimbursement rates, failure to meet the minimum health and safety standards and even the inability to hire staff.
Tuesday, March 5, 2019
Forbes is reporting on a story first appearing on CNN, where the Former Aetna Medical Director Admits To Never Reviewing Medical Records Before Denying Care.
"This admission was made during a deposition in a lawsuit brought against Aetna by [a patient]... with common variable immune deficiency (CVID) who was denied coverage for an infusion of intravenous immunoglobulin (IVIG) four years ago." The former medical director testified that the process was for nurses to review records and then make recommendations to him. Additionally, "when asked by Washington's attorney if it was his general practice to look at medical records as part of his decision making process, he replied that it was not."
Thanks to Julie Kitzmiller for alerting me to the story.
Monday, March 4, 2019
The Law Library Journal has published a comprehensive bibliography on Physician-Aided Dying. Physician-Assisted Death: A Selected Annotated Bibliography, prepared by Alyssa Thurston, who is head of Reference Services at Pepperdine University School of Law Library in Malibu, Calif., provides a comprehensive update on this important topic.
Here is the abstract of the paper. "Physician-assisted death (PAD), which encompasses physician-assisted suicide and physician-administered euthanasia, has long been controversial. However, recent years have seen a trend toward legalizing some form of PAD in the United States and abroad. The author provides an annotated bibliography of sources concerning PAD and the many issues raised by its legalization."
The introduction offers some helpful information for the reader:
¶3 This bibliography compiles selected secondary and primary materials on
PAD. Secondary sources include books, book chapters, law review and law journal
articles, bibliographies, websites, and current awareness materials, and are mostly
limited to publication dates of 2007–2018.10 Many of these materials discuss multiple
issues within the broader topic of PAD, and I have categorized them by subject
based on what I perceive to be their primary themes.
¶4 Most of the included materials focus on the United States, but a number of
sources also discuss other countries, and one section is devoted to international
experiences with PAD. In addition, PAD is often debated alongside other end-oflife
topics, such as withdrawal or refusal of medical treatment,11 palliative care,12
hospice care,13 or the use of advance directives,14 and some of the scholarship listed
in this bibliography concurrently address one or more of these subjects in depth.
Thanks to my colleague, Professor Brooke Bowman, for alerting me to this helpful resource!
Professor Richard Kaplan, elder law prof extraordinaire and a good friend, sent me a notice about a fabulous program today at the University of Illinois College of Law. The Ann F. Baum Memorial Elder Law Lecture will take place today at noon est. The speaker, Professor David M. Studdert of Stanford Law will present Medical Malpractice Litigation and the Elderly: An Empirical Perspective. If only I was within driving distance. I know it will be successful. Thanks to Professor Kaplan for letting us know.
Wednesday, February 27, 2019
McKnight's Long Term Care News reported that Nursing home employees indicted for involuntary manslaughter after patient’s death from bedsores. "The Ohio attorney general has indicted seven former Columbus nursing facility workers on dozens of charges following a patient’s 2017 death from bedsores ... against six employees and a contracted nurse practitioner at the Whetstone Gardens and Care Center. All told, the seven individuals have been hit with 34 charges, including involuntary manslaughter, with some stemming from alleged neglectful care of a second patient." One of the patients died of septic shock and the second received insufficient care. The SNF takes a different view of the incidents.
Tuesday, February 26, 2019
The Washington Post recently published an article, Changing ‘the tragedy narrative’: Why a growing camp is promoting a more joyful approach to Alzheimer’s. This article examines a different point of view about the disease, "coming at it with a sense of openness, playfulness and even wonder" although there still is a substantial number of folks who take a different approach. The article explains this different point of view promoted by various experts. "Without dismissing the difficulties of the disease, especially in the late stages, [experts] are promoting a more adaptive approach, which they say can help caregivers and patients alike. It involves a lot of flexibility and willingness to expand one’s ideas of how things are supposed to be — even, crazy though it might sound, to see Alzheimer’s as a kind of gift."
The article highlights several programs that use humor, among other things, to help those with the disease. It is worth reading and our students will find it informative. Check it out.
Sunday, February 24, 2019
A new article, published by Professor Naomi Cahn and Amy Zietlow, The Sandwich Generation on Wheels: Tips for Long-Distance Family Caregivers discusses the all too common issue of caregiving from afar. Based on their respective research and experiences, they note "that it is helpful for family caregivers to define the "sandwich" layers they face in order to proactively plan for what role they can and should play." The first layer is what we might analogize to client identification in law practice, that is "clarify who in your older generation depends on you in some way. List your parents, stepparents, in-laws, grandparents, aunts or uncles, etc. In conversation with them, formalize your caregiving role. This is particularly important in stepfamily situation." With this layer, not only do you identify who needs help, you identify the needed documents but articulate the limitations that arise from long-distance caregiving. The authors briefly explore the potential for caregiving to help in such situations.
The second layer, "your job, " focuses on caregivers who are employed and how to juggle your job and your caregiving responsibilities. The third layer, "spouse and child" recognizes the sandwich issue-you have responsibilities to your own immediate family as well as the elders for whom you are caregiving. "Communicating with your spouse and your children about your goals for this season of life is critical. Acknowledging how you will be dividing your time, and why, will help them feel engaged and involved. You will need their moral support in your role as caregiver."
Thanks to Professor Cahn for sending us this!
Tuesday, February 19, 2019
Kaiser Health News ran a story recently, Seniors Aging In Place Turn To Devices And Helpers, But Unmet Needs Are Common details the use of caregivers and assistive devices to help them age in place. Reporting on a new study, the article notes that there are a substantial majority of elders with insufficient help and adapt their living in order to get by. The study, published in the Commonwealth Fund, Are Older Americans Getting the Long-Term Services and Supports They Need? explains this issue "[o]lder adults’ needs have evolved and are no longer met by the Medicare program. With the recent passage of the Bipartisan Budget Act of 2018 (BBA), Medicare Advantage (MA) plans can now provide beneficiaries with nonmedical benefits, such as long-term services and supports (LTSS), which Medicare does not cover."
The key findings and the conclusion from the study abstract show:
Two-thirds of older adults living in the community use some degree of LTSS. Reliance on assistive devices and environmental modifications is high; however many adults, particularly dual-eligible beneficiaries, experience adverse consequences of not receiving care. Although the recent policy change allowing MA plans to offer LTSS benefits is an important step toward meeting the medical and nonmedical needs of Medicare beneficiaries, only the one-third of Medicare beneficiaries enrolled in MA plans stand to benefit. Accountable care organizations operating in traditional Medicare also should have the increased flexibility to provide nonmedical services. from the study.
Monday, February 18, 2019
MedicalXPress ran a story about a New tool for documenting injuries may provide better evidence for elder abuse cases. which opens noting that "[a]n estimated 10 percent of older adults experience some form of abuse each year. However, the link between injuries and possible elder abuse may take months or years to establish and is often difficult to investigate due to poor documentation during prior medical visits." To improve the process, Dr. Laura Mosqueda and her team have created "the Geriatric Injury Documentation Tool (Geri-IDT)." The tool was a result of a study done by her team, the results of which were recently published in the Journal for General Internal Medicine, Developing the Geriatric Injury Documentation Tool (Geri-IDT) to Improve Documentation of Physical Findings in Injured Older Adults.
An excerpt of the abstract offers this insight
Experts agreed that medical providers’ documentation of geriatric injuries is usually inadequate for investigating alleged elder abuse/neglect. They highlighted elements needed for forensic investigation: initial appearance before treatment is initiated, complete head-to-toe evaluation, documentation of all injuries (even minor ones), and documentation of pertinent negatives. Several noted the value of photographs to supplement written documentation. End users identified practical challenges to utilizing a tool, including the burden of additional or parallel documentation in a busy clinical setting, and how to integrate it into existing electronic medical records.
A practical tool to improve medical documentation of geriatric injuries for potential forensic use would be valuable. Practical challenges to utilization must be overcome.
Monday, February 4, 2019
Kaiser Health News published a story, Frail Seniors Find Ways To Live Independently. The focus of the story is on "a program for frail low-income seniors: Community Aging in Place — Advancing Better Living for Elders (CAPABLE). Over the course of several months last year, an occupational therapist visited Jeffery and discussed issues she wanted to address. A handyman installed a new carpet. A visiting nurse gave her the feeling of being looked after."
A study of the project, recently published in the Journal of the American Medical Society (JAMA) Internal Medicine shows promising results. "New research shows that CAPABLE provides considerable help to vulnerable seniors who have trouble with “activities of daily living” — taking a shower or a bath, getting dressed, transferring in and out of bed, using the toilet or moving around easily at home. Over the course of five months, participants in the program experienced 30 percent fewer difficulties with such activities, according to a randomized clinical trial...."
The article also explores the costs of the program-and it saves money! There are efforts to expand this program's reach, including approaching "Medicare Advantage plans, which cover about 19 million Medicare recipients and can now offer an array of nonmedical benefits to members, to adopt CAPABLE. Also, Johns Hopkins and Stanford Medicine have submitted a proposal to have traditional Medicare offer the program as a bundled package of services. Accountable care organizations, groups of hospitals and physicians that assume financial risk for the health of their patients, are also interested, given the potential benefits and cost savings."
Monday, January 28, 2019
Elder drivers is a topic I cover in my class every spring, and it's one guaranteed to generate a robust discussion. So a recent story about Prince Phillip allows me to bring in current events to this topic. The Washington Post ran this article, Britain’s Prince Philip, 97, crashed his car. Rescuers say it’s ‘amazing people weren’t seriously injured.’.
Of course, age alone is not an indicator of good or bad driving, but stories like this one allow the students to think about the various issues and how we may as a society address them. Geographic location and financial stability also play into the options available for those who shouldn't (or can't) drive. In our area, public transportation isn't as plentiful as other urban areas. The students, of course, would open up a ride-sharing app on their smart phones and order a car. Elders may not be able to afford to do so, or even know it exists. There are a number of issues that can then arise for those who lose the ability to get places. And of course, we all have an interest in getting unsafe drivers off the road.
I am guessing that Prince Phillip likely has many more transportation options that an average 97 year old in the U.S. Families frequently need to have "the chat" with their elder relative about stopping driving. The Washington Post article addressed that. "So, who might ask Philip to hand over his car keys? 'It will be the Queen, she’ll be the only one who can really tell him...'”
Sunday, January 27, 2019
CNN ran a story last week about a blood test that detects Alzheimer's. Blood test could detect Alzheimer's up to 16 years before symptoms begin, study says starts with an explanation of the "technical" aspects where the test would "measur[e] changes in the levels of a protein in the blood, called neurofilament light chain (NfL) [which] researchers believe [with] any rise in levels of the protein could be an early sign of the disease..." The study is in the most recent issue of Nature Medicine.
This is not a cure, but there are advantages to knowing this far in advance that the person has Alzheimer's. For starters, as the story notes, it would help with testing of treatments. From a legal point of view, it may encourage more clients to plan.
Monday, January 21, 2019
Hate housework? Well here's a new reason to look forward to it. According to a story on NPR, Daily Movement--Even Household Chores--May Boost Brain Health in Elderly a recent "study finds even simple housework like cooking or cleaning may make a difference in brain health in our 70s and 80s."
The study looked at 454 older adults who were 70 or older when the research began. Of those adults, 191 had behavioral signs of dementia and 263 did not. All were given thinking and memory tests every year for 20 years.
In the last years of research before death, each participant wore an activity monitor called an accelerometer, similar to a Fitbit, which measured physical activity around the clock — everything from small movements such as walking around the house to more vigorous movements like exercise routines. Researchers collected and evaluated 10 days of movement data for each participant and calculated an average daily activity score.
The findings show that higher levels of daily movement were linked to better thinking and memory skills, as measured by the yearly cognitive tests.
The article discusses limitations on the study and the need for more research. In the interim, get out a dust cloth and the broom and start cleaning!
Thursday, January 17, 2019
My dear friend and executive director of the ABA Commission on Law and Aging sent me a notice about a part-time employment opportunity for two students. The Coalition to Transform Advanced Care (C-TAC) ("an alliance of 140 organizations whose sole purpose is to ensure that all Americans with advanced illness, especially the sickest and most vulnerable, receive comprehensive, high-quality, person- and family-centered care that is consistent with their goals and values and honors their dignity") has announced two student fellowship opportunities for a project, "two part-time, temporary positions as C-TAC Changemaker Fellows. Fellows will primarily undertake research for programs that align with their interests (policy, family caregiving, health disparities, data/metrics) and will be assigned a C-TAC mentor. Supporting program staff will also be an important opportunity for the Fellows to learn and support projects." Students need to be at least seeking a bachelor's or master's degree and have relevant interests in advocacy, public policy and the political realm. More information-contact Allan Malievsky (AMalievsky@thectac.org) with “C-TAC Changemaker” in the subject line.
Tuesday, January 15, 2019
Health & Human Services has posted information on their blog about how they are implementing the new hiring process for ALJs. Establishing a New Merit-Based Process for Appointing Administrative Law Judges at HHS explains the new process, the reasons for it, and when it became effective.
HHS is announcing how the department will implement a new ALJ selection and appointment process. The department’s ALJs work for the Office of Medicare Hearings and Appeals (101) and the Departmental Appeals Board (13). The DAB also has seven administrative appeals judges and five Departmental Appeals Board members, and the new ALJ selection and appointment process will apply to these “comparable officials” as well.
The new HHS ALJ selection and appointment process - PDF is effective immediately and is described on the websites of the OMHA and the DAB.
This process is described in the post as merit-based and does not require consultation with anyone outside of the process. The process is described in detail in a 4 page document from November, 2018, available here.
To understand the significance of this change, read my blog post from October 26, 2018 here.
Monday, January 14, 2019
Last week, I wrote about the possible use of medical marijuana for treatment of anxiety in patients with dementia, pointing to the importance of peer-reviewed studies. This week, I learned of a new study on the use of medical marijuana at a nursing home, and when I read the study I was not surprised to learn the study had occurred at Hebrew Home at Riverdale in New York, a location I have come to associate with both research and thoughtful innovation. Studies of medical marijuana are complicated by the disjunction in federal and state laws governing purchase and use.
In “Medical Cannabis in the Skilled Nursing Facility: A Novel Approach to Improving Symptom Management and Quality of Life,” the authors described a medical policy and procedure (P&P) they implemented at their New York-based SNF for the safe use and administration of cannabis for residents with a qualifying diagnosis. To be compliant with state and federal statutes, policy requires that residents must purchase their own cannabis product directly from a state-certified dispensary.
After the program started in 2016, the facility provided educational sessions for residents and distributed a medical cannabis fact sheet that was also made available to family members. To date, 10 residents have participated in the program and seven have been receiving medical cannabis for over a year. Participants range in age from 62 to 100. Of the 10 participants, six qualified for the program due to a chronic pain diagnosis, two due to Parkinson’s disease, and one due to both diagnoses. One resident is participating in the program for a seizure disorder.
Most residents who use cannabis for pain management said that it has lessened the severity of their chronic pain. This, in turn, has resulted in opioid dosage reductions and an improved sense of well-being. Those individuals receiving cannabis for Parkinson’s reported mild improvement with rigidity complaints. The patient with seizure disorder has experienced a marked reduction in seizure activity with the cannabis therapy.
This study did not address cannabis as a treatment for symptoms of dementia-related anxiety. For more, see Medical Cannabis in the Skilled Nursing Facility: A Novel Approach to Improving Symptom Management and Quality of Life, published January 2019. Interestingly, the authors are a medical doctor, Zachary J. Palace, and Daniel Reingold, who lists both a Masters of Social Work and a J.D. for his background.
January 14, 2019 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, State Statutes/Regulations, Statistics | Permalink | Comments (0)
Sunday, January 13, 2019
Know anyone who has hearing loss? Maybe you yourself suffer from hearing loss-and if not now, you may in the future. Hearing loss has ramifications beyond the loss of hearing. As the article in the New York Times explains in Hearing Loss Threatens Mind, Life and Limb "[n]ot only is poor hearing annoying and inconvenient for millions of people, especially the elderly. It is also an unmistakable health hazard, threatening mind, life and limb, that could cost Medicare much more than it would to provide hearing aids and services for every older American with hearing loss." Oh and the news doesn't get any better: "[t]wo huge new studies have demonstrated a clear association between untreated hearing loss and an increased risk of dementia, depression, falls and even cardiovascular diseases. In a significant number of people, the studies indicate, uncorrected hearing loss itself appears to be the cause of the associated health problem."
Those with age-related hearing loss can tell you it doesn't happen overnight. In fact, because it "comes on really slowly, [it makes] it harder for people to know when to take it seriously...." The article explains the correlation between hearing loss and the impact on the brain (fascinating yet scary). And in case you didn't know "hearing aids and accompanying services are typically not covered by medical insurance, Medicare included. Such coverage was specifically excluded when the Medicare law was passed in 1965, a time when hearing loss was not generally recognized as a medical issue and hearing aids were not very effective...."
So, do a few things now: 1. write your Congressperson about Medicare's coverage of hearing aids, 2. schedule an appointment to have your hearing testing and 3. turn down the volume on your devices.
Thursday, January 10, 2019
This article is a couple of months old, but I don't think the subject is at all dated. Stat ran an opinion piece, U.S. hospitals ignore improving elder care. That’s a mistake explaining that hospitals aren't designed to be elder-friendly
In the 21st century, health care is to elderhood as education is to childhood. But we don’t see bond measures for the “construction, expansion, renovation, and equipping” of hospitals to optimize care of old people, an investment that would surely benefit Americans of all ages.
People age 65 and older make up just 16 percent of the U.S. population but nearly 40 percent of hospitalized adults. In 2014, Americans over age 74 had the highest rate of hospital stays, followed by those in their late 60s and early 70s.
Remarkably, hospitals aren’t designed with elders in mind. Walk through one and you’ll almost invariably find cheerful decor for children, services and facilities aimed at adults, and a gauntlet of obstacles and insults to elders.
Thinking about the design of the hospitals, consider these notes from the article' "[o]ld people end up in old buildings. That usually means long walks down halls without railings or chairs with arms for rest stops. It means signs that are hard to read until you are right under them. It means a one-size-fits-all approach to both facilities and care that doesn’t acknowledge that the needs, preferences, and realities of a 75- or 95-year-old with a medical condition might differ from those of a 35- or 55-year-old with the same thing."
Noticing the volume of business from this demographic, the article highlights some efforts
A collaboration of industry leaders, including the American Hospital Association, the John A. Hartford Foundation, and the Institute for Healthcare Improvement, has launched an age-friendly health system initiative. While its purview is limited to a few geriatric conditions, it’s a step in the right direction. (And the field of geriatrics is finally beginning to model itself after pediatrics, taking a more whole health, life stage approach to elderhood.)
Some of the best ideas for hospital design come from outside health care. Innovations developed for aging-in-place homes or continuing care communities offer prototypes of “silver architecture.” Businesses like Microsoft are investing in structural and people-flow design that meets needs across the lifespan. They are adopting the position that if you design for the mythical “average human” you create barriers, whereas if you design for those with disabilities you create systems that benefit everyone.