Friday, October 22, 2021

More Resources on COVID Scams

Following up on my October 5 post on the APS TARC brief on COVID scams, the FTC is offering consumer info on avoiding COVID Scams.   The post offers extensive resources designed to provide accurate information to consumers on a variety of topics, including avoiding various scams, vaccinations, treatment claims,  privacy/online security, up to date info on scams, government resources, and more. I thought the section on avoiding scams to be helpful:

AVOID CORONAVIRUS SCAMS

  • COVID-19 vaccines are free. If anyone charges you for help signing up or the shot itself, it’s a scam.
  • You can’t buy the COVID-19 vaccine anywhere. It’s only available at federal- and state-approved locations.
  • Always talk with your doctor or healthcare professional before you try any product claiming to treat, prevent, or cure COVID-19.
  • Don’t post your vaccination card to your social media account. Someone could use the information for identity theft.
  • Right now, there are no official plans to create a national vaccine verification app or certificate or passport.
  • If someone asks you for personal information or money to get a national vaccine certificate or passport, that’s a scam.
  • Contact your state government(link is external) about its vaccine verification plans and requirements.
  • Check with airlines, cruise lines, and event venues about their vaccine verification or negative testing requirements.
  • When you’re looking for pandemic-related help, start with sites like coronavirus.gov and usa.gov/coronavirus.

October 22, 2021 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care | Permalink | Comments (0)

Monday, October 4, 2021

Breakthrough in Alzheimer's Research?

My dear friend and colleague, Professor Feeley, sent me a link to this recent article, Likely cause of Alzheimer’s identified in new study.

Here's a brief bit of info about the study

[S]cientists in Australia have recently discovered an additional factor that may be responsible for the development of this neurodegenerative condition.

Lead study author Dr. John Mamo, Ph.D. — distinguished professor and director of the Curtin Health Innovation Research Institute at Curtin University in Perth, Australia — explained to Medical News Today the conclusion from the new research...

“This study,” he added, “shows that exaggerated abundance in blood of potentially toxic fat-protein complexes can damage microscopic brain blood vessels called capillaries and, thereafter, leak into the brain, causing inflammation and brain cell death.”

The findings were published here. This is the abstract from the article

Several lines of study suggest that peripheral metabolism of amyloid beta (Aß) is associated with risk for Alzheimer disease (AD). In blood, greater than 90% of Aß is complexed as an apolipoprotein, raising the possibility of a lipoprotein-mediated axis for AD risk. In this study, we report that genetic modification of C57BL/6J mice engineered to synthesise human Aß only in liver (hepatocyte-specific human amyloid (HSHA) strain) has marked neurodegeneration concomitant with capillary dysfunction, parenchymal extravasation of lipoprotein-Aß, and neurovascular inflammation. Moreover, the HSHA mice showed impaired performance in the passive avoidance test, suggesting impairment in hippocampal-dependent learning. Transmission electron microscopy shows marked neurovascular disruption in HSHA mice. This study provides causal evidence of a lipoprotein-Aß /capillary axis for onset and progression of a neurodegenerative process.

October 4, 2021 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, International, Other, Science | Permalink

Friday, October 1, 2021

COVID 19 Impact on Older Adults

A couple of weeks ago, the Commonwealth Fund released a report,  The Impact of COVID-19 on Older Adults: Findings from the 2021 International Health Policy Survey of Older Adults. Here are the survey highlights:

  • Compared to their counterparts in the other survey countries, older adults in the U.S. have suffered the most economically from the COVID-19 pandemic, with more losing a job or using up all or most of their savings.
  • Latino/Hispanic and Black older adults in the U.S. have been far more likely than white older adults to experience significant negative economic consequences.
  • COVID vaccination rates for older adults were highest in countries where vaccines were most widely available when the survey was fielded. In the United Kingdom, nearly all older adults (97%) had already been vaccinated. The U.S. had the largest percentage of older adults who were not planning to get vaccinated.

The conclusion includes several steps for going forward "to reduce this burden on older Americans and to ensure that their health care needs are met":

Reducing care barriers... affordable access to care is increasingly a priority for policymakers and care delivery systems. Timely access to primary care is particularly important for older adults with multiple chronic conditions, because effective treatment requires coordination and follow-up plans....

Role of telemedicine...  countries clearly have an opportunity to improve care delivery to older adults through the expansion of virtual care services for those unable or resistant to receiving care in a clinician’s office....

Expanding vaccination ...  "[f]or older adults who said they were not planning to get vaccinated, limited trust in government to ensure vaccine safety and concerns with side effects were the most cited reasons. To increase uptake in this population, messaging campaigns should address their apprehension by engaging a wide range of voices, from clinicians and scientists to community members and local, state, and federal government agencies, to get the word out....

The full report is available here and the charts, here.

October 1, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other, Science | Permalink | Comments (0)

Thursday, September 30, 2021

Have You Taken A "Getting Old Inventory"?

Jane Brody wrote an article a few weeks ago for the New York Times, How to Age Gracefully. The catalyst for the article is a new book, “Stupid Things I Won’t Do When I Get Old, the title of which really appealed to me!  The book inspired her to take an "inventory of my life and started at the top, with my hair. I’d been coloring it for decades, lighter and lighter as I got older. But I noticed that during the pandemic, many people (men as well as women of all ages) had stopped covering their gray. And they looked just fine, sometimes better than they did with hair dyed dark above a wrinkled facade. Today, I too am gray and loving it, although I can no longer blame my dog for the white hairs on the couch!"  She also changed her attitude about her clothing and use of makeup. She also discusses things she won't stop doing just because of her age, some of which observers might consider risky behavior. As she observes, "[s]ooner or later, we all must recognize what is no longer possible and find alternatives... [and has] vowed to stop talking to whoever will listen about my aches, pains and ailments, what [the book's author] called the “organ recital.” It doesn’t provide relief — in fact, it might even make the pain worse. Rather than instill empathy, the “organ recital” likely turns most people off, especially young ones."  She discusses two more major hurdles she will tackle, clutter and driving.  She offers this quite lovely advice for us "Live each day as if it’s your last, with an eye on the future in case it’s not...."

September 30, 2021 in Books, Consumer Information, Current Affairs, Health Care/Long Term Care, Other | Permalink | Comments (0)

Tuesday, September 28, 2021

Two Articles on Caregiving

We all know the importance of caregiving and some of the issues facing the U.S. vis a vis caregivers.  First, an article a few days ago published in the Huffington Post, Why A Transformation Of Caregiving Could Be Biden’s B.F.D. Here's one excerpt from the article

It’s got three main components. One is an initiative to provide up to three months of paid leave to take care of family members, including newborns. Another is a proposal to make child care and prekindergarten available to any family that wants it, and to improve the quality of that care for everyone. The third piece is a proposal to fund what are known as “home- and community-based services,” a clunky piece of policy-speak that refers to programs that allow disabled and elderly Americans to live on their own rather than in nursing homes and other institutions.

After discussing the politics of the plan, the article provides a history of caregiving. "Responsibility for caregiving has historically fallen disproportionately on women ― who, in turn, were expected to provide it for little or no pay. That was possible, in part, because until relatively recently in history most women didn’t have alternatives in the paid workforce. That was especially true for women of color, who were subject to discrimination (and, at one time, enslavement)."  Discussing the pay scale for caregivers, and the approach in other countries, the article discusses the "policy opportunity" at hand in Congress.

Then consider this recent article from the New York Times, Long Hours, Low Pay, Loneliness and a Booming Industry,  about the home health industry.

The industry is in the midst of enormous growth. By 2030, 21 percent of the American population will be at the retirement age, up from 15 percent in 2014, and older adults have long been moving away from institutionalized care. In a 2018 AARP survey, 76 percent of those ages 50 and older said they preferred to remain in their current residence as they age. In 2019, national spending on home health care reached a high of $113.5 billion, a 40 percent increase from 2013, according to the most recent data from the Centers for Medicare and Medicaid Services.

The ranks of home care aides are expected to grow by more than those of any other job in the next decade, according to the Bureau of Labor Statistics. It’s also among the lowest paying occupations on the list.

The article examines the wages of aides and the activities they perform. The article also covers the impact of the pandemic on them, including those who died of COVID.  The article looks at the regulations of home health agencies in NY. This particular part of the article gave me pause. "Working overnight makes an already isolating and demanding job even more so. Aides assigned to “live-in shifts” spend 24 hours a day at a patient’s home, sometimes for several days in a row. The aides are paid for only 13 hours of that time because they are expected to get eight hours of sleep and three hours of meal breaks, according to New York State guidelines and federal regulations."  And it is only recently that aide  have been protected by the Fair Labor Standards Act "Home health aides are classified as “domestic service” workers, many of whom were exempt from a set of labor protections known as the Fair Labor Standards Act until 2015, when the Department of Labor expanded its regulations."

September 28, 2021 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, State Statutes/Regulations | 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)

Wednesday, September 22, 2021

New Article on Medicare For All

Professor Richard Kaplan recently published a new article comparing Medicare for All to current Medicare.  Just a note-I make a point of reading anything Professor Kaplan publishes (just look at his download stats on SSRN, and you will see that many others share my opinion). He's a true elder law scholar and ROCK STAR. Here is the abstract for  Medicare for All vs. Medicare As Is: Eight Key Differences.

This article examines eight principal differences between the Medicare-for-All proposal championed by Senator Sanders, inter alia, and the Medicare program as it actually exists. In doing so, the article shows how the current program bears little resemblance to what the Medicare-for-All proponents are trying to enact. Those key differences include: (1) Medicare is a real program, (2) Medicare is only health care financing, (3) Medicare is an earned entitlement, (4) Medicare is not a simple program, (5)Medicare has a significant co-insurance component, (6) Medicare’s financing relies on non-Medicare enrollees, (7) Medicare’s coverage of long-term care is minimal, and (8) Medicare can accommodate expansion without major disruption. The article concludes that the differences between Medicare as it is and Medicare-for-All are too significant to elide and may make the effort to enact Medicare-for All less likely to succeed.

Professor Kaplan, thanks for publishing in Stetson Law's Journal of Aging, Law, & Policy.

September 22, 2021 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Tuesday, September 21, 2021

NM Aid In Dying Law Compared to Other Statutes

A recent opinion piece in USA Today was comparing the provisions of the New Mexico Aid-in-Dying law to those in other states, Terminal patients deserve death with dignity. New Mexico aid-in-dying law sets standard.
According to the author, there are 3 sections of the statute that are improvements over statutes in other states:

  • Offsetting the growing physician shortage statewide. The law mirrors the practice of medicine found in other fields and allows advanced practice registered nurses and physician assistants to use their training to serve as either the prescribing or consulting clinician.
  • Requiring only one written request and one 48-hour waiting period between receiving and filling the prescription for aid-in-dying medication. The prescribing provider has the ability to waive the 48-hour waiting period if the terminally ill person is likely to die during that waiting period.
  • Clarifying that if a health care provider objects to participating in medical aid in dying, they must inform the terminally ill person and refer them to either a willing provider or a party who can help the terminally ill patient find assistance.

    Furthermore, providers that oppose medical aid in dying must accurately and clearly disclose that on websites and in any appropriate materials given to patients.  

The law also takes a different approach to the waiting period used in other states, and according to the author, Oregon shortened its waiting period a couple of years ago "to allow doctors to waive the 15-day waiting period" and recently, "California passed legislation to improve access ... by reducing the mandatory 15-day waiting period between the two requests for aid-in-dying medication to 48 hours." 

September 21, 2021 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, State Statutes/Regulations | Permalink

Friday, September 17, 2021

Washington State Long-Term Care Program

Morris Klein, elder law attorney, friend and frequent contributor to this blog sent me links to two articles.  Washington's first-in-the-nation long-term care program starts in January, with opt-out deadline soon and  Payroll Tax Will Fund New Washington Long-Term Care Program.

The WA Cares fund was created by [their] Legislature in 2019 as a safety net for the seven in 10 people who will ultimately need professional or personal care at some point in their lives.

The only opportunity to opt out of the program is fast approaching, raising questions for workers who may be deciding whether getting a private policy is better or worse. Here, we lay out answers to some of the common questions.

. . . 

Part of the motivation for creating the worker-funded program is the fact that private long-term care insurance policies can be too expensive for retirees to keep paying premiums on until they need to use them.

"Beginning in 2025, the plan will pay benefits to enrollees who need help with non-hospital-based health care expenses."  "As more families applied for Medicaid, [Washington's legislators] saw a greater share of the state’s future budgets going to health care expenses.  So, in 2019, the legislature ...  opted to put the state in the long-term care business."

The articles are worth reading to learn more about how the program will work.  Considerations for employees in deciding whether to stay in or opt out can be found here.

September 17, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other, State Statutes/Regulations | 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)

Flexibility Needed for Working Caregivers

AARP Research has a new report, Working Caregivers' Worries Over Workplace Return.  With some employers bringing employees back to the physical office, will the flexibility provided by working from home completely disappear?

AARP surveyed Americans who provide unpaid care to a family member or friend and work part- or full-time to learn about their concerns coming out of the pandemic. Of the national sample of adults polled by phone, 56% say their employer offered new benefits as a result of the pandemic, such as flexible schedules and the ability to work remotely.

As of July, about half of caregivers (52%) were continuing to work from home at least some of the time and 89% would like that option going forward. Most said it's been easier to juggle the demands of work and caregiving while not having to commute (49% to a great degree and 40% to some degree), according to the AARP survey.

The full report is available here.  I have pasted the key findings here for your convenience:

  • Working caregivers have felt the strain as the COVID-19 pandemic has ensued. With nearly eight in ten saying the pandemic increased their level of stress. Two in three caregivers (66%) express concern that they will have difficulty juggling responsibilities in the next 12 months.
  • More than half of working caregivers say their employer instituted new benefits as a result of the pandemic. The most common benefits instituted were flexible schedules and the ability to work remotely.
  • Flexibility is important for working caregivers to successfully balance caregiving with work. In fact, it is so highly valued that more than four in ten caregivers say they would consider looking for a new job if their employer rolled back any of the benefits they instituted during the pandemic.
  • A slight majority of working caregivers currently have the ability to work at home at least some of the time and most want to continue with this arrangement.
  • Nearly half say working at home has helped them manage their dual roles a great deal.
    In addition to balancing responsibilities, working caregivers are most concerned about exposing the person they care for to the coronavirus or leaving them home unattended while they go to work.

September 16, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other, Statistics | Permalink | Comments (0)

Wednesday, September 15, 2021

The Challenges of Federal Oversight for Medications or Food Supplements Targeting an Aging Public

I'm finding myself spending a lot of time reading and thinking about the Food and Drug Administration (FDA) and Federal Trade Commission (FTC).  Of course, public concerns about the efficacy of Covid-10 vaccines dominate the attention of many of us working on health-related legal concerns that affect older adults.  For example, I've been researching questions about the potential for FDA approved antibody tests for Covid-19 vaccines.  

But also intriguing is a report that a slow-moving FTC suit against developers and marketers of the dietary supplement known as Prevagen may be getting closer to a possible trial date in the Southern District of New York.  A dismissal of the 2017 law suit filed jointly by the FTC and the New York Attorney General was overturned in 2019 by the Second Circuit in a summary order, concluding that the "FTC and New York have made plausible allegations that Defendants] marketing campaign for Prevagen contained deceptive representations."  For more on this and other Prevagen-related suits, see the Washington Post's recent article Does the Supplement Prevagen Improve Memory? A Court Case is Asking that Question.

Plus, there are significant questions arising in the wake of the FDA's June 7, 2021  announcement of its "accelerated" approval of aducanumab for treatment of Alzheimer's Disease.  See e.g., Recently Approved Alzheimer Drug Raises Questions that May Never Be Answered (JAMA Network, July 21, 2021).

As noted in Dr. Jason Karlawish's important new book, The Problem of Alzheimer's: How Science, Culture, and Politics Turned a Rare Disease into a Crisis and What We Can Do About It, the number of Alzheimer's patients in the U.S. will rise to an estimated 13.8 million by 2025.  The caregiver market alone is searching desperately for answers, and it can be very hard to make individual decisions about risks and benefits without trustworthy information.  This is a tough time for what we might call a pandemic crisis about "trust."   

September 15, 2021 in Cognitive Impairment, Consumer Information, Dementia/Alzheimer’s, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Science | Permalink | Comments (0)

Social Security & Medicare Trustees' Reports

We know they come out every year. This year is no exception. They are out! What do we learn from them? I'll give you the highlights here (those of you who have looked at the reports before know they are long and detailed....)

The Medicare Trustees' Report, released August 31, 2021, is available here.  The introduction explains the impact of COVID, and COVID vaccines, on Medicare, but not "Aduhelm, the Alzheimer’s disease drug that has been recently approved."  The introduction also references potential future scientific advances and how that would be factored into projections.  The one thing everyone wants to know from the Trustees Annual Report is what is the fiscal health of Medicare?  "The estimated depletion date for the HI trust fund is 2026, the same as in last year’s report. As in past years, the Trustees have determined that the fund is not adequately financed over the next 10 years. HI income is projected to be lower than last year’s estimates due to lower payroll taxes."  If you don't have time to peruse the entire report, read the introduction. It's very interesting!

Here's an excerpt from the conclusion:

The Trustees project that HI tax income and other dedicated revenues will fall short of HI expenditures in all future years. The HI trust fund does not meet either the Trustees’ test of short-range financial adequacy or their test of long-range close actuarial balance.


The Part B and Part D accounts in the SMI trust fund are expected to be adequately financed because income from premiums and general revenue are reset each year to cover expected costs. Such financing, however, would have to increase faster than the economy to cover expected expenditure growth.


The financial projections in this report indicate a need for substantial changes to address Medicare’s financial challenges. The sooner solutions are enacted, the more flexible and gradual they can be. The early introduction of reforms increases the time available for affected individuals and organizations—including health care providers, beneficiaries, and taxpayers—to adjust their expectations and behavior. The Trustees recommend that Congress and the executive branch work closely together with a sense of urgency to address these challenges.

The 2021 Social Security Trustees' Report is available through this page.

According to a summary provided by the SSA & Medicare Trustees, "Based on our best estimates, the 2021 reports show:"

• The Old-Age and Survivors Insurance (OASI) Trust Fund, which pays retirement and survivors benefits, will be able to pay scheduled benefits on a timely basis until 2033, one year earlier than reported last year. At that time, the fund's reserves will become depleted and continuing tax income will be sufficient to pay 76 percent of scheduled benefits.

• The Disability Insurance (DI) Trust Fund, which pays disability benefits, will be able to pay scheduled benefits until 2057, 8 years earlier than in last year's report. At that time, the fund's reserves will become depleted and continuing tax income will be sufficient to pay 91 percent of scheduled benefits.

 

September 15, 2021 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare, Retirement, Social Security, Statistics | Permalink

Tuesday, September 14, 2021

Highlights from Touro Conference on Aging, Health, Equity, and the Law (9.13.21)

Touro College's Jacob Fuschberg Law Center hosted a fabulous half-day, interdisciplinary program on Aging, Health, Equity and the Law.  Among the highlights:

  • A perfect kickoff with opening remarks on the theme of the conference from Syracuse Law Professor Nina Kohn, who outlined the civil rights of older persons, reminding us of existing laws and the potential for legal reforms;
  •  A unique "property law" perspective on the importance of careful planning about ownership or rights of use, in order to maximize the safety and goals of the older person, provided by Professor Lior Strahilevitz from University of Chicago Law School;  
  • Several sessions formed the heart of the conference by taking on enormously difficult topics arising in the context of Covid-19 about access to health care, including what I found to be a fascinating perspective from Professor Barbara Pfeffer Billauer  from her recent work in Israel. She started with an interesting introduction of three specific pandemic responses she's identified in her research. She then focused on how "Policy Pariah-itizing" has had a negative effect on health care for older adults, with examples from Israel, Italy, and China.  I was also deeply impressed by the candid presentations of several direct care providers, including nursing care professionals Esperanza Sanchez and Nelda Godfrey, about the ethical issues and practical pressures they are experiencing; 
  • Illinois Law Professor Dick Kaplan offered  timely perspectives on incorporating cultural sensitivity in Elder Law Courses.  His slides had great context, drawing in part from an article he published about ten years ago at 40 Stetson Law Review 15;
  • Real world examples about tough end-of-life decisions involving family members and/or formally appointed surrogates, with Deirdre Lock and Tristan Sullivan-Wilson from the Weinberg Center for Elder Justice leading breakout groups for discussions.

I know I'm failing to mention other great sessions (there were simultaneous tracks and I was playing a bit of leap-frog).  But the good news is we can keep our eyes out for the Touro Law Review compilation of the articles from this conference, scheduled for Spring 2022 publication.  I know it was a big lift to pull off the conference in the middle of the fall semester.  Thank you!

September 14, 2021 in Advance Directives/End-of-Life, Books, Cognitive Impairment, Consumer Information, Crimes, Current Affairs, Dementia/Alzheimer’s, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Housing, International, Property Management, Science | Permalink

Sunday, September 12, 2021

Front Page on the Sunday NY Times: "Phony Diagnoses" Used in Drugging at Nursing Homes

In a front-page Sunday article, Phony Diagnoses Hide High Rates of Drugging at Nursing Homes, The New York Times adds a subtle but important focus in providing its latest reports of a well known issue, the use of chemical restraints, including antipsychotic medications, to control behavior for people in long-term care settings.  The patients have been getting "new" diagnoses of schizophrenia, thus attempting to justify the sedation associated with major antipsychotic medications, such as Haldol, despite the fact that such medications are contraindicated for dementia patients. From the article:

In 2005, the Food and Drug Administration required manufacturers to put a label on the drugs warning that they increased the risk of death for patients with dementia.

 

Seven years later, with antipsychotics still widely used, nursing homes were required to report to Medicare how many residents were getting the drugs. That data is posted online and becomes part of a facility’s “quality of resident care” score, one of three major categories that contribute to a home’s star rating.

 

The only catch: Antipsychotic prescriptions for residents with any of three uncommon conditions — schizophrenia, Tourette’s syndrome and Huntington’s disease — would not be included in a facility’s public tally. The theory was that since the drugs were approved to treat patients with those conditions, nursing homes shouldn’t be penalized.

 

The loophole was opened. Since 2012, the share of residents classified as having schizophrenia has gone up to 11 percent from less than 7 percent, records show.

 

The diagnoses rose even as nursing homes reported a decline in behaviors associated with the disorder. The number of residents experiencing delusions, for example, fell to 4 percent from 6 percent.

As the news article reports, the challenges of caring for individuals with dementia are enormous, and lack of adequate staffing is certainly a reason why families and facilities use and misuse drugs to control -- restrain -- them.  But, at the same time, as I have written about on this Blog several times (see here, for example), the problem is not "just" about staffing ratios.    

Special thanks to Laurel Terry, Dickinson Law Professor Emerita, for ensuring I saw this latest article.  

September 12, 2021 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Health Care/Long Term Care, Science | Permalink | Comments (0)

Thursday, September 2, 2021

Star Trek Legend Conservatorship Battle

I'm a fan of Star Trek. I'm not a hard core Trekkie, but I enjoy all the variations of Star Trek, whether movie or TV.  I was saddened to read about a conservatorship battle surrounding the trailblazing actor Nichelle Nichols, our beloved Lieutenant Uhura. Inside the heartbreaking conservatorship battle of a 'Star Trek' legend explains that "[a] three-way fight over Nichols’ fate involves her only child, Kyle Johnson, who is also her conservator; her former manager Gilbert Bell; and a concerned friend, Angelique Fawcette."  Here's a brief summary. "In 2018, Johnson filed a petition for conservatorship, arguing that his mother’s dementia made her susceptible to exploitation. In 2019, Bell filed a lawsuit against Johnson, alleging attempts to remove him from Nichols’ guest home, where he has lived since 2010, and 'aggressive and combative behavior.'"  Here's how the neighbor came into the suit. "Fawcette, a producer and actress who met Nichols in 2012, entered the legal fight opposing Johnson’s conservatorship petition. Fawcette pushed for visitation rights to spend time with her friend, and she argued for Nichols to stay in Woodland Hills — a scenario that has looked increasingly improbable."

The article goes in depth into her life and career and how the current litigation came to be, including declining health, a power of attorney, transfers of assets, a conversation about marriage and more.  Ms. Nichols is not the first famous person to be in the center of a conservatorship fight, nor will she be the last. 

Thanks to Julie Kitzmiller for sending me the link to the story.

September 2, 2021 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Film, Health Care/Long Term Care, State Cases | Permalink | Comments (1)

Wednesday, September 1, 2021

Elders Still Not Vaccinated

This New York Times article from last week took me a bit by surprise. Many Older Americans Still Aren’t Vaccinated, Making the Delta Wave Deadlier explains

The United States has a far higher share of seniors without full vaccine protection than many other wealthy countries, a key risk factor driving serious Covid-19 illness and death, a Times analysis shows.

As the Delta variant has torn across the country, America’s pace of vaccinations has sped up after months of relative stagnation, and full federal approval of the Pfizer vaccine on Monday could extend that momentum. Just over half of Americans are now fully vaccinated.

But national averages mask the high rate of older Americans who remain deeply vulnerable. Older people still account for most Covid-19 deaths, and in many counties, especially in the South and Mountain West, seniors without full vaccination make up more than 10 percent of the total population.

We know from the experiences of last year how deadly COVID can be to elders. And recent data proves this still to be true. "The Delta variant has hit many areas with clusters of vulnerable seniors particularly hard. Low elderly vaccination rates in ArkansasFloridaIdahoLouisiana and Nevada have coincided with surging rates of hospitalization and death."  There are still areas of high risk, without a current outbreak, according to the article.   There are many reasons for vaccine hesitancy and whether the full FDA approval of Pfizer will move the needle (pun intended) remains to be seen. "Signing up older Americans for their first shot remains a struggle, public health experts say, as people who really wanted a vaccine have already gotten it. While getting to a vaccine provider may still be an issue for some, especially in more rural areas, many more people are resistant to immunization because of their politics and personal beliefs, and those of their friends and family."

September 1, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other, State Statutes/Regulations, Statistics | Permalink

Tuesday, August 31, 2021

This CLE Is Worth Watching: #FreeBritney: Transforming & Reforming Conservatorship & Guardianship.

I had blogged a while back about this CLE, - #FreeBritney: Transforming and Reforming Conservatorship and Guardianship .  It was just excellent, and the recording is now available.  The program was sponsored by the ABA Section of Civil Rights and Social Justice, Commission on Disability Rights, and Commission on Law and Aging.   The recording is available here.

Here's a  description of the program:

Britney Spears’ conservatorship battle has shed light on the widespread problems and overuse of conservatorships/guardianships nationwide. Guardianships can be abusive and unnecessarily strip individuals of their civil rights to make their own decisions and use supports to live and direct their lives. Disability, aging, and civil rights advocates are calling for changes to reduce the overuse of guardianship and conservatorship, to strengthen recognition and use of less restrictive alternatives to guardianship like supported decision-making, and increase due process protections in guardianship proceedings and in the monitoring of guardianships. Our panel of experts discusses the risks and harms of guardianship, its systemic flaws, and the promise of alternatives like supported decision-making. They discuss reforms and changes that can address the problems that Britney Spears’ case has brought to light.

Put some time on your calendars to watch this very important CLE.  Don't forget to scroll down the page to check out the resources that are provided.

 

 

August 31, 2021 in Cognitive Impairment, Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care, Programs/CLEs, State Statutes/Regulations, Webinars | Permalink | Comments (0)

NPR Morning Edition: "Antibody Tests Should Not Be Your Go-To for Checking COVID Immunity

Apparently I'm not the only person asking about the proper role of antibody tests in determining safety protocols during this current phase of COVID-19 infections.  This morning on NPR's Morning Edition program, a strongly expressed piece discounted the value of current antibody tests.  At the heart of the story was the following:  

[Washington University School of Medicine Immunologist] Ali Ellebedy says that having detectable antibodies from a blood test six months after vaccination "only means that your immune system mounted a successful response then and that you have immune memory."

 

While scientists have generated a "ton of data" on which antibodies are best at neutralizing the virus, Ellebedy says, the available antibody tests are not designed to specifically pick up whether you have enough of these protective antibodies, especially in the face of evolving variants.

 

And don't forget the immune system is more than just antibodies, so even with low detectable levels in your blood, you're not defenseless. "Antibody tests — it's really probing just one part of your immune system," says Elitza Theel, who directs the Infectious Diseases Serology Laboratory at the Mayo Clinic.

The NPR piece poses the question of whether a person can "learn anything" from antibody testing.  The piece says "Yes, as long as you don't expect it to give you a straightforward answer for how well-protected you are from catching the virus."  

For more, I recommend reading or listening (3 minutes) to the NPR segment entitled "Antibody Tests Should Not Be Your Go-To For Checking COVID Immunity."  The segment suggests that "the identity of a blood test that can eventually give consumers a reliable indication of their immunity is not far-fetched."  Okay.  But as I suggest in my previous post on this topic, are there communities available for antibody testing to further the identification of "correlates of protection" that aren't being tapped currently?  Could college and university communities and long-term care communities become part of the development of a reliable tool?  

 

August 31, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, Science, Statistics | Permalink | Comments (0)

Monday, August 30, 2021

Medicare Dental Coverage a Possibility?

Here's an interesting (I don't want to say hopeful) idea.  According to the New York Times article,  Five Decades Later, Medicare Might Cover Dental Care it's a possibility that could become a reality if the odds can be overcome. "Tens of millions of older Americans who cannot afford dental care — with severe consequences for their overall health, what they eat and even when they smile — may soon get help as Democrats maneuver to add dental benefits to Medicare for the first time in its history....The proposal, part of the large budget bill moving through Congress, would be among the largest changes to Medicare since its creation in 1965 but would require overcoming resistance from dentists themselves, who are worried that it would pay them too little."

We know the implications on overall health that come from dental issues.  The article cites the statistic that 20% of older Americans have lost their teeth and dental issues can exacerbate health issues that are covered by Medicare.  Given that Medicare covers many preventive services, is it such a stretch to see the value of adding dental coverage?  But with all things political, passage is an uphill battle.  "On Capitol Hill, the proposal to add a Medicare dental benefit has near-universal support among Democrats, and many health industry and consumer groups back it, too... With the Democrats’ large policy ambitions but narrow majority, its passage is not assured."  

August 30, 2021 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)