Thursday, July 9, 2020
During an AALS-sponsored online "hang-out" session this week, the featured host, Syracuse Law Professor Nina Kohn, helped faculty think about better ways to conduct online courses, including Elder Law. We also talked about our research projects for the summer. Nina commented that she has never before had "so much to write about and so little time to do so," which I suspect has something to do with her wonderfully active children! But, I also think that most of us in the AALS Section on Law and Aging are feeling the same way. It is as if our client base -- older persons -- are at the epicenter of so much tragedy. Sadly, the COVID-19 illness has hugely impacted older persons, as documented frequently on this Blog.
And now the news that in Japan, seasonal rains that have become steadily worse over the years for reasons associated with climate change, have triggered extraordinary flooding, resulting in the drowning deaths of many elders in their nursing homes or while trying to shelter at home. From the New York Times article, Japan's Deadly Combination: Climate Change and an Aging Society:yAlthough the Japanese gird every June and July for the rainy season — known as tsuyu — this year the rainfall has set records in Kyushu, with more rain expected to blanket central Japan by the end of this week.
Older residents accustomed to year after year of summer rains may believe they know how to ride out the downpours at home. Yet they may not understand the growing severity of the rains or the increased dangers of flooding.
“Under the emerging impact of global warming, there is an increasing risk or potential that rainfall amounts could be at a level that we haven’t experienced in the past,” Professor Nakamura said. “So I think that citizens must realize that their previous experience may no longer work. We have to act even earlier or faster than what we have experienced in the past.”
Evacuation itself can pose a risk to the elderly. Conditions in evacuation centers inevitably fall short of those in nursing homes designed for old-age care. For the frailest patients, the moves can cause injury or destabilize long-term care plans....
In the case of the Senjuen nursing home, Aki Goto, its director, told The Kumamoto Nichinichi Shimbun, a local newspaper, that she had been more concerned about mudslides than flooding. When the waters came, she added, the caregivers could not move quickly enough to move all the residents upstairs.
Six of the workers were on call the night of the floods last weekend, the newspaper reported. That still left each caregiver in charge of more than 10 aging residents, some of whom were unable to walk without help. Even with the aid of local volunteers, they could not bring everyone to safety upstairs as the floodwaters rapidly rose and deluged the ground floor.
Whether it is hurricanes in the Carribean and US, wildfires in western US states, extraordinary storms or unique diseases around the world, our elderly are often seeming to take the heaviest blows. Isolated and with inadequate protective equipment or assistance, the pattern of "unexpected" deaths continue. Unexpected?
Thursday, July 2, 2020
Hard to believe we are scheduling for January 2021, isn't it! Here's the scheduled speakers and topics for the co-hosted program during the AALS Annual Meeting in San Francisco on "Intersectionality, Aging and the Law:"
Alex Boni-Saenz (Chicago-Kent), Age Diversity
Naomi Cahn (GW) & Nina Kohn (Syracuse), How Law and Sex Shape What It Means to Be Old
Veronica C. Gonzales-Zamora (UNM), The Triple Threat: Millenium Women of Color
Jessica Mantel (Houston), Allocating Scarce Medical Resources During a Pandemic: Rationing Based on Age is not the Same as Rationing Based on Disability
Katherine Pearson (PSU-Dickinson), Pandemic Protections: Where is the Line in Patient Autonomy?
Tara Sklar (U Arizona), Frailty, Vulnerability, and Big Data
Ruqaiijah Yearby (SLU), The Dark (Trinity): How Structural Discrimination, Wealth Inequalities, and Lack of Access to Health Care Cause Health Disparities for Elderly Women of Color
July 2, 2020 in Advance Directives/End-of-Life, Cognitive Impairment, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, International, Programs/CLEs, Statistics | Permalink | Comments (0)
Thursday, June 18, 2020
On Monday, June 22, 2020, I'm joining the 3rd Annual Memorial Elder Abuse Sympsium hosted by Legal Aid Services of Oklahoma and being delivered as a webinar over the course of several sessions. On Monday, the first set of speakers includes deeply experienced professionals in banking and securities, both potential avenues for elder fraud, as well as Judge Scott Roland of the Oklahoma Court of Criminal Appeals. I follow them with the topic "Extreme Home Takeovers - Dealing with Concerned Relatives" -- the clever title supplied by our hosts!
I'll be offering comparative statutory and common law approaches for recovering a house. including my own experiences while supervising Dickinson Law's Elder Protection Clinic. The need is usually triggered by a transaction often tied to the worries of the older person, hoping or believeing that a family member, friend or new "befriender" would be more likely to save them from the dreaded nursing home if they give the hoped-for-caregiver "the house." I'll be using cases from Ireland, Pennsylvania, Oklahoma (of course) and beyond for strategies, and discussing everything from filial support laws, to improvident tranaction laws, to the common law concept of failure of consideration in "support deeds."
More Reasons for a Serious Bi-Partisan Commitment to Citizenship for DACA Health & Long-Term Care Workers
Shared by my colleague, Professor Medha Makhlouf, who heads Dickinson Law's Medical-Legal Partnership Clinic, this thoughtful article explaining the importance of DACA-recipient health care workers in the United States, especially now:
The Covid-19 pandemic is stretching our public health system to its limits and challenging our ability to meet the urgent and critical medical needs of the country as never before. As executives responsible for the legal affairs of major hospitals and lawyers working in Covid-19 hot spots, we know how crucial it is to have every available front-line medical worker fighting this pandemic. . . .
New data from the Center for American Progress reveals that the DACA-recipient health care work force includes more than 6,000 diagnosing and treating practitioners, including respiratory therapists, physicians assistants and nurses; some 8,000 health aides, including nursing assistants and orderlies; more than 7,000 other health care support workers; and some 5,500 health technologists and technicians.
The Association of American Medical Colleges told the Supreme Court that nearly 200 physicians, medical students and residents depend on DACA for their ability to practice medicine and serve their communities. Those 200 trainees and physicians alone would care for hundreds of thousands of patients per year in normal times — the association estimates as many as 4,600 patients per year, per person. Under the demands of the Covid-19 pandemic, those numbers will be much higher.
The Center for Migration Studies found that 43,500 DACA recipients work in the health care and social-assistance industries, including more than 10,000 in hospitals....
The decision on the DACA case is expected this week. "If the Supreme Court upholds the decision to terminate DACA, nearly 700,000 people — including those health care workers — will lose their ability to work and live in the United States." For more, ready the full NYT article, There's Only One Thing Stopping Trump From Deporting Health Care Workers.
For once, the members of Congress from both sides of the aisle should be ready with emergency legislation for citizenship (or at a minimum, permanent residency status) for these essential workers. It is the least we can do for people who are doing the most. And it is vital for the best interests of public health across the nation. A win-win, if we can just focus on what's important.
WOW! Moments after I posted the above, I see the news flash that Supreme Court Rules Against Trump Administration Attempt to End DACA, A Win for Undocumented Immigrants Brought to U.S. As Children.
After reading the opinion(s), it is clear that while DACA recipients have a temporary reprieve, the real need is serious consideration of true relief from fear of deportation. Must they really wait until after the election?
June 18, 2020 in Consumer Information, Current Affairs, Discrimination, Ethical Issues, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, International | Permalink | Comments (0)
Wednesday, June 17, 2020
The Supreme Court 's ruling on the fate of DACA-residents and workers in the U.S. could be issued this week. Regardless of the outcome on the case itself, everyone who cares about quality of health care, including long-term care, should also care about the United States' need to be honest about how much health care depends on the hard work and commitment to care provided by temporary-status and undocumented-status workers in health and personal care jobs. I've seen DACA workers in action in elder care, and I've seen their families ripped apart by harsh immigration rulings.
NPR's Morning Edition had a short and yet deeply important segment today on Health Care Workers Who Are Awaiting Supreme Court DACA Decision. Do listen to the podcast replay -- it is just 4 minutes -- and think about whether this is a key opportunity for a true, bipartisan solution for DACA-children (families) who so often are working in some of the most challenging (and dangerous) U.S. jobs during the COVID-19 pandemic. Let's do the right thing.
June 17, 2020 in Consumer Information, Current Affairs, Ethical Issues, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, International, Medicaid, Medicare | Permalink | Comments (0)
Sunday, June 7, 2020
The increasing use and sophistication of various new technical products and remote platforms for monitoring patients and family members is profiled in this article from the New York Times. I can remember when my very rudimentary way of checking daily on my Mom was watching her yahoo email account to see whether there was a green oval to indicate she was typing! Somewhere along the way, the ethical implications of monitoring other's online activity eliminated that option, and that makes sense.
And speaking of technology, tomorrow is my first participation in an online memorial. A Zoom send-off. A another step in the brave new world of finding new ways to be together alone.
Tuesday, May 26, 2020
George Washington Law Professor Naomi Cahn recently shared a piece by Israel-based law and policy author Barbara Pfeffer Billauer on "Al Tashlichaynu L'Et Zichna: Ageism in the Time of Corona." This thoughtful piece begins with a theme I've been discussing with others, how close to dystopian science-fiction the last 10 weeks have seemed. She makes the opening comparison of current policy-based decisions to the science-fiction movie Logan's Run, where the "acceptable" price paid for a civil society was a mandatory limit on life spans -- to just 30 years. Professor Pffeffer Billauer observes "In this world of COVID, the age of devitalization is a bit older. But us oldsters are subject to truncation just the same."
It’s time to expose the flawed basis on which morbidly dystopic and discriminatory responses toward the aged have been become public health policy– both as a warning that initial and instinctive public health responses must be constantly re-evaluated and updated – and as an alert that discriminatory responses can be couched as public health concerns, even as their main purpose is to further political goals.
At first glance, “protection of the vulnerable” seems laudatory and compassionate. Nevertheless, this approach should trigger concerns of discrimination. In the case of age-related discrimination, the dangers are, perhaps, exacerbated, as those affected are more likely to just accept it. Others accept these pronouncements without delving into the “scientific” or epidemiological underpinnings of the pronouncements. Even worse, is that rationale that might, in actuality, be political can be camouflaged as nobly “helping the needy.”
Professor Pfeffer Baillauer warns that even as governments begin to ease virus-related restrictions, in many instances "the 'vulnerable' (aka the elderly)" are still locked down, and that the "differential relaxation of lockdowns is problematic, both from legal and public health perspectives."
Based purely on early (and stagnant) reports, we bought into this protectivist age-related response: The elderly were — and are — to have their liberty disproportionately restricted –because they are considered “vulnerable”. It’s time to question this approach and unmask the rank discrimination behind it, or at the very least, reveal the dangers of blind acquiescence without serious inquiry into the scientific basis.
She questions the statistical basis for some governments' decisions to impose mandatory isolation:
The Italian debacle, notably lots of deaths, was attributed to their older population. But these pronouncements were based on gross, oversimplified statistical calculations. Germany, with a similar age distribution, suffered far fewer deaths. So did Japan, with a population even older than Italy’s . Compare the case-fatality in Italy of 14% (as of March 19) with that of Germany (at 4.5%), or the even older Japanese demographic with a similar case-fatality (4.7%). Basic tools of epidemiological assessment, such as standardized age-adjusted rates, appear not to have been performed to sustain the extrapolation of the Italian experience to other countries. Basic epidemiological constraints, such as the ecological fallacy, were never even considered.
But there is more to the misleading assertion that the elderly are at greater risk than just flawed statistics. The approach obscures the key question: greater risk of what? Of disease susceptibility, of spreading it to others – or of dying?
She is provocative. She notes that if there is legitimacy to mandating isolation of the elderly based on nursing home statistics on infection and death, perhaps the same rule should be assigned to the "financially flush," such as those who make up the majority of cruise ship passenger rosters, whether or not they are embarked on an actual cruise.
For more, read the full blog post linked above. For MUCH more, keep an eye on Barbara's SSRN account for her next piece. Thanks, Naomi, for another great share!
May 26, 2020 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Discrimination, Ethical Issues, Health Care/Long Term Care, Housing, International, Statistics | Permalink | Comments (0)
Sunday, May 17, 2020
At just about this time last year, I was in Europe and took a walking side trip to the Royal Mews, the stables for Buckingham Palace. So, I smiled today when I happened to notice this Vanity Fair headline: "The Queen is Riding Horses Every Day and Ready to Work Harder Than Ever" -- at age 94.
Monday, May 4, 2020
Tuesday May 5 (tomorrow) is the annual #GivingTuesdayNow. We all know how much others need assistance. The American Bar Association Fund for Justice and Education highlights the work that the ABA Commission on Law & Aging is doing
The link to make a donation is here.
Wondering how you can help others? This is how. Do it now. Whether for the Commission, a food bank, a senior center, the Red Cross, or another organization, do it now!
Thursday, April 30, 2020
The AALS Section on Law and Aging is joining forces with the Sections on Civil Rights, Disability Law, Family and Juvenile Law, Minority Groups. Poverty, Sexual Orientation, Gender-Identity Issues, Trusts & Estates and Women in Legal Education to host a program for the 2021 Annual Meeting, scheduled to take place in San Francisco in January. The theme for the program is appropriately broad -- "Intersectionality, Aging and the Law."
I like this definition of "intersectionality":
The interconnected nature of social categorizations such as race, class, and gender as they apply to a given individual or group, regarded as creating overlapping and interdependent systems of discrimination or disadvantage. Example: "Through an awareness of intersectionality, we can better acknowledge and ground the differences among us."
We need great presenters!
We are interested in participants who will address this subject from numerous perspectives. Potential topics include gray divorce, incarceration, elder abuse (physical or financial), disparities in wealth, health, housing, and planning based on race or gender or gender identity, age and disability discrimination, and other topics. The conception of the program is broad, and we are exploring publication options.
If you are interested in participating, please send a 400-600 word description of what you'd like to discuss. Submissions should be sent to Professor Naomi Cahn, firstname.lastname@example.org, by June 2, 2020, and the author[s] of the selected paper(s) will be notified by July 1, 2020.
AALS is planning on hosting the annual meeting from January 5-9 and I personally feel the overall theme for the conference is apt in these fraught times: The Power of Words
April 30, 2020 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Current Affairs, Discrimination, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Grant Deadlines/Awards, Health Care/Long Term Care, Housing, International, Legal Practice/Practice Management, Programs/CLEs, Property Management, Science, Statistics, Webinars, Weblogs | Permalink | Comments (0)
Wednesday, April 8, 2020
At Dickinson Law, in the last third of the Spring 2020 Semester, my Elder Law students are doing a module on End-of-Life Decisions. I had planned this module more than a year in advance; certainly the timing has proven to be uniquely relevant. Originally, my plan was for an in-depth discussion about choices related to assisted death, sometimes known as the Death with Dignity or Physician-Assisted Death. And we are considering comparative studies and positions on legislation intended to support this choice, starting with a review of Oregon's more than 20 years of experience in providing this option.
The COVID-19 pandemic, however, is triggering new focal points on end-of-life decisions. Consider for example the statement by an emergency room chief in a San Francisco hospital, as quoted recently in the Los Angeles Times, "You have an 80-year-old and a 20-year-old and both need a vent and you only have one. What do you do?" Individuals may have thoughtfully made advance decisions about whether they want mechanical assistance in breathing during life-or-death circumstances. They may have appointed an agent to speak for them or created written directions via living wills, DNR orders, or POLST documents. But it is one thing to make you own decision; it is another to have the "decision" made because of lack of what is arguably baseline equipment.
I've been particularly interested in the history behind ventilator shortages as reported by The New York Times.
Thirteen years ago, a group of U.S. public health officials came up with a plan to address what they regarded as one of the medical system’s crucial vulnerabilities: a shortage of ventilators. The breathing-assistance machines tended to be bulky, expensive and limited in number. The plan was to build a large fleet of inexpensive portable devices to deploy in a flu pandemic or another crisis.
Money was budgeted. A federal contract was signed. Work got underway.
And then things suddenly veered off course. A multibillion-dollar maker of medical devices bought the small California company that had been hired to design the new machines. The project ultimately produced zero ventilators.
The rest of the story reads like a detective tale. The small California-based company was proposing a new generation of easy-to-use, more cost effective, mobile ventilators. By 2012, the partners were on schedule to file for market approval in September 2013, paving the path for production. However, in May 2012, a much large medical device manufacturer bought the California-based company for just over $100 million. Good news? That larger company might have especially strong resources for speedy production, right?
The new owner, Covidien, already made ventilators -- at a higher cost -- and in 2014, reportedly told federal officials they wanted to get out of the new ventilator contract. The federal government agreed to cancel the contract. Covidien was sold to an even larger international company in 2015.
Why? For more, read "The U.S. Tried to Build a New Fleet of Ventilators. The Mission Failed," by Nicholas Kulish, Sarah Kliff and Jessica Silver-Greenberg, published in the NY Times on March 29 2020 and updated on March 31, 2020. Or catch a NY Times podcast that looks further into shortages of hospital rooms, COVID-19 testing supplies and ventilator availability. All interesting -- especially if you are talking about "end-of- life decisions."
Sunday, March 29, 2020
I blogged a couple of times about social isolation's impact on elders as we move through this pandemic. Imagine social isolation when you live alone and how that compounds your loneliness. This report from Pew Research, released before the pandemic swept the U.S., reports that elders in the U.S. live alone in greater numbers than other countries. Older people are more likely to live alone in the U.S. than elsewhere in the world shows that:
Living with an extended circle of relatives is the most common type of household arrangement for older people around the world, according to a recent Pew Research Center study. But in the United States, older people are far less likely to live this way – and far more likely to live alone or with only a spouse or partner.
Let me share some stats from the article:
- "In the U.S., 27% of adults ages 60 and older live alone, compared with 16% of adults in the 130 countries and territories studied."
- "U.S. adults ages 60 and older also are more likely than their counterparts around the world to live as a couple without young children at home. Almost half of Americans in this age group (46%) share a home with only one spouse or partner, compared with three-in-ten globally (31%)."
- "Globally, living in extended-family households – those that include relatives such as grandchildren, nephews and adult children’s spouses – is the most common arrangement for people 60 and older. "
Thursday, February 13, 2020
Public Charge and Immigrant Seniors
In January, the U.S. Supreme Court removed the nationwide temporary injunction that had prevented the Department of Homeland Security (DHS) public charge immigration rule from taking effect. This means that the public charge rule that DHS finalized last August can go into effect nationwide, except in Illinois, where it is blocked by a statewide injunction. DHS announced that it will begin implementing the final rule on February 24th.
The Supreme Court’s decision endangers the health and well-being of older immigrants and their families and cruelly impedes the path to citizenship and family unification. However, it is not a final decision and we must continue to fight to stop this harmful policy from becoming permanent. The multiple cases challenging the underlying legality of the final public charge rule will continue in the courts. DHS has appealed all the district court decisions that issued preliminary injunctions to the Second, Fourth, Seventh, and Ninth Circuits. DHS has also asked the U.S. Supreme Court to hear the case.
Justice in Aging and our partners have filed amicus briefs in the Second and Ninth Circuits to ask the court to affirm the district courts’ nationwide injunctions and to highlight the ways in which this rule unfairly targets older immigrants, their families, and caregivers. This webinar, Updates on Public Charge & Older Immigrants, will begin with an overview of the public charge test and how it applies to older adults, discuss the current state of litigation, and provide information on what advocates need to know about the rule’s implementation.
Who should participate:
Aging and legal advocates, advocates serving immigrant communities, community-based providers, and others wanting to learn more about how changes to the public charge test and implementation of the new regulations impact older immigrants.
Wednesday, January 15, 2020
International Federation on Aeging Webinar on 1th Session of the UN Open-Ended Working Group on Ageing
The UN Open-Ended Working Group on Ageing has its 11th Session coming up. Prior to that meeting, the International Federation on Aeging, along with the Global Alliance For the Rights of Older People (GAROP) are offering an upcoming webinar on National Advocacy ahead of the 11th Session of the United Nations Open-Ended Working Group on Ageing.is holding a webinar on National Advocacy Ahead of the 11th Session of the UN Open-Ended Working Group on Ageing on January 22, 2020 at 7 a.m. est. This webinar will
Provide information for all NGOs engaging in the UN Open-ended Working Group on Ageing (OEWG) process at the national level.
Focus particularly on what national advocacy NGOs can do to influence their governments ahead of the 11thOEWG session in April.
Include updates and insights from a UN perspective and concrete examples of national advocacy from GAROP members.
Click here to register for this program.
Summaries of the prior meetings of the U.N. Working Group can be accessed here.
Wednesday, January 8, 2020
For the last few years, I've found myself with conflicts during semester breaks that interfered with attending the AALS Annual Meeting. So I was especially happy this year to attend and catch up with long-time and new friends, especially those who work in fields relevant to elder law.
The annual meeting kicked off for me with a Joint Session hosted by the Sections on Aging and the the Law, Civil Rights, Family & Juvenile Law, Employee Benefits & Executive Compensation, and Immigration Law. The collaborative event offered lots of interesting "Emerging Issues in Elder Law," with speakers including:
Mark Bauer, Stetson Law, who spoke about recent enforcement efforts to combat elder exploitation, and pointed to a lingering weakness associated with banks that make SARS reports that never go beyond the regulatory body, and therefore never reach first responders, such as local police. He talked about support for a state-wide effort in Florida to improve police reports to make it easier to identify abusers who target older persons. He also called for better record-keeping for sales of gift cards, as these have become the number 1 method that telephone scammers get older adults to send them money.
Wendy Parmet, Northeastern University School of Law, who focused on the impact of immigration laws and policies on the health of older adults, including attempts by the current administration to change the definition of "public charge" to include anyone who could receive any public benefits whatsoever, thereby expanding the the pool of inadmissible immigrants and further restricting eligibility for legal permanent residency. She traced the impacts of such policies on older adults once eligible for family reunification, on older citizens overall, and on a nation that once took pride in providing help to immigrants who were "tired and poor."
Jalila Jefferson-Bullock, Duquesne Law, who talked about how some states are not applying sentencing reforms to elderly offenders, even though such inmates statistically are at the least risk of reoffending and, at 19% of the total prison population, are often generating care costs that are unsustainable. I learned, sadly, that my own state of Pennsylvania is one of the states that is not yet making significant progress on sentencing reforms for older adults.
Rachel Lopez, Drexel University Law, who is director of Drexel's Stern Community Lawyering Clinic, carried forward the theme of needed prison reforms for older inmates, reporting the latest events that follow the Graterford Think Tank Prison Project in Pennsylvania, and making the sobering observation that the most effective argument may not be one that sounds in human rights or human dignity, but the demonstration that return to the community for aging and ill residents saves the state money.
Naomi Cahn, George Washington Law, who is also the incoming chair for the AALS Section on Law and Aging, presented facts and figures on "gray divorce," especially with respect to financial impacts on women. She urged a de-coupling of Social Security benefits from marriage (or perhaps marriage longevity requirements), arguing that Social Security credits should be available for time spent as caregivers.
Browne Lewis, Cleveland-Marshall College of Law, pointed to the emerging issue of "reproductive rights" for older individuals, identifying jurisdictions that restrict women's access to assisted reproductive technologies (ART) including placing age or time restrictions on use of banked or stored eggs.
For faculty members who would like to be part of next year's Law and Aging program at the 2021 AALS Annual meeting in San Francisco, contact Naomi Cahn with your topics and interest.
January 8, 2020 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, International, Retirement, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (0)
Tuesday, January 7, 2020
Two articles, updating us on two topics important to all of us.
First, statistics. We know women statistically live longer than men,and a recent data report from Pew updates us that this still is true and in many instances women are younger than their husbands. That it means that late in life, many women will be alone. Globally, women are younger than their male partners, more likely to age alone tells us that "[t]he pattern of spousal age gaps – and the fact that women tend to live at least a few years longer than men – helps explain another universal theme: Across the world, women are about twice as likely as men to age alone. One-in-five women ages 60 and older live in a solo household (20%), compared with one-in-ten men (11%)." The report looks at religion and geography to measure the extent of this trend. "Rates of living alone over the age of 60 are tied to many factors, including cultural norms, economic development, levels of education and life expectancy. In countries where governments offer fewer retirement benefits or other support systems for older adults, families may face a greater responsibility to provide care."
The next article is from Sunday's New York Times, on the continuing shortage of geriatricians.Older People Need Geriatricians. Where Will They Come From? notes the long-term shortage of geriatricians and explains their importance, using one real-life example to "spotlight the rising need for geriatricians. These doctors not only monitor and coordinate treatment for the many ailments, disabilities and medications their patients contend with, but also help them determine what’s most important for their well-being and quality of life." There's very little progress on closing this gap, according to the article. "An analysis published in 2018 showed that over 16 years, through academic year 2017-18, the number of graduate fellowship programs that train geriatricians, underwritten by Medicare, increased to 210 from 182. That represents virtually no growth when adjusted for the rising United States population."
The article explains why there aren't more doctors going into the field, including the economics realities. One measure to address the shortage is cross-training.
Medical associations representing cardiologists and oncologists have begun focusing on older patients...
Health systems are adopting age-friendly approaches, like specialized emergency rooms. The American College of Surgeons’ new verification program sets standards hospitals should meet to improve results for older patients.
Last month the Senate Committee on Health, Education, Labor and Pensions voted to reauthorize a $41 million program that educates health professionals in geriatrics; it awaits a floor vote. A companion bill has already passed the House of Representatives.
Health professionals increasingly recognize that if they’re not in pediatrics, they will be seeing lots of seniors, whatever their specialty. A 2016 American Medical Association survey, for example, found that close to 40 percent of patients treated by internists and general surgeons were Medicare beneficiaries.
Pay attention to these issues. They will affect all of us either directly or through a family member.
Wednesday, August 21, 2019
Kaiser Health News ran an article about the issues Medicare presents for beneficiaries who want to retiree to other countries. Dream Of Retiring Abroad? The Reality: Medicare Doesn’t Travel Well explains the issues:
As the number of American retirees living overseas grows, more of them are confronting choices ... about medical care. If they were living in the United States, Medicare would generally be their coverage option. But Medicare doesn’t pay for care outside the U.S., except in limited circumstances.
Expatriate retirees might find private insurance policies and national health plans in other countries. But these may not provide the high-quality, comprehensive care at an affordable price that retirees expect through Medicare. Faced with imperfect choices, some retirees cobble together different types of insurance, a mix that includes Medicare.
The article notes that the quality of the health care may be dependent on the country, and as the number of U.S. retirees move to other countries, they need to think hard about how they will pay for health care. The article discusses issues with private health insurance policies, the costs and rates, which may be different depending on the country. Even with private health insurance, expats need to look at Medicare as the article explains:
Even when retirees buy a private policy, Medicare is another piece of the puzzle that they have to consider. Once people become eligible for Medicare coverage, usually at age 65, they face a 10% premium penalty for every 12 months they are not enrolled in Part B, which covers outpatient services. (People who are 65 but still covered by an employer plan generally do not face that penalty.)
After paying into the Medicare system for decades, it’s no wonder some expats are frustrated that they can’t generally use the program outside the United States.
That’s just the way the law is written, an official at the federal Centers for Medicare & Medicaid Services said.
And retirees should honestly consider whether they will spend the rest of their lives overseas.
Tuesday, August 20, 2019
The Global Alliance for the Rights of Older Persons has announced an upcoming webinar on August 22, 2019 from 7-8 a.m. edt (yes that's correct 7-8 AM). Here's info about the webinar:
Access to Justice is one of the new areas of older people’s human rights that will be discussed at the 11th session of the Open-Ended Working Group on Ageing in New York from 6-9th April 2020. The UN will soon call for written submissions on this topic, which will play an important role in shaping the debates that will happen at the 11th session. A strong civil society response to this consultation is vital. This webinar will explore some of the key issues and barriers around access to justice in older age. It will also offer tips and support on how you can prepare high quality substantive inputs to the upcoming UN consultation.
- Moderator: Susan Somers (INPEA and GAROP Steering Group member)
- Panelist: Bill Mitchell (Townsville Community Legal Service, Australia)
To register for this important webinar, click here.
Thursday, July 25, 2019
I've written about this combination of topics before. I can't quite believe I'm doing so again.
My sister and I lost our last parent on Friday. As with our father, who died in 2017, our mother's final months were complicated by dementia. Thankfully her death was gentle -- she just sort of wound down at age 93 (and 9 months -- isn't it amusing how we start counting the months again, as people tend to do when someone is nearing 5 and a half years of age).
Both of our parents had full and fulfilling lives, or as one of our friends commented, "your mother used the full runway." The care team at an assisted living community that specializes in dementia care came to know both of our parents well, and our bereavement was matched by the tears of many of the individual caregivers, each of whom had their own memory or story to share. As several of them noted, in her last days Mom seemed determined to "find" Dad. And, of course, we like to think she did find him.
But one additional complication was that as our mother reached her last hours, one caregiver who has worked for our family for several years, and that caregiver's mother, who has worked her way from CNA to head of a care team, were both coping with their own worries and grief. Both of them are U.S. citizens, but as is often true in the Southwest, a family member, a husband, is not documented. Recently he was picked up by ICE. No one knows quite where he is yet, but the family members know they are likely to face hard choices once he is deported. The family members must decide how and where they will live. My parents' care team -- and by extension the community of residents at the assisted living center -- could lose two more skilled and devoted caregivers. The fabric of aging care grows ever more fragile.
Wednesday, July 17, 2019
Previously I had blogged about the legal battle over removing life support from Frenchman, Vincent Lambert. The New York Times reported recently on his death, Vincent Lambert, Frenchman at Center of Right-to-Die Case, Dies at 42.
His family and his spouse disagreed on his wishes. "His wife, Rachel Lambert, said that he had clearly stated that he would not wish to live in a vegetative state. His parents argued that ending his life support amounted to the murder of a disabled person. Siblings and other family members took different sides in the dispute." As the article notes, "[e]uthanasia and assisted suicide are illegal in France. But the law allows patients who are terminally ill or injured with no chances of recovery to decide to stop treatments if the measures “appear useless, disproportionate” or if they seem to have no other effect than 'artificially maintaining life.'" An article about the final court decision is available here.
In a related matter, the Judge for the Florida Schiavo case has written a chapter for a book, as explained in this article:
Inside the Terri Schiavo case: Pinellas judge who decided her fate opens up. You should read it.