Friday, September 17, 2021
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.
Thursday, September 16, 2021
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.
Wednesday, September 1, 2021
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 Arkansas, Florida, Idaho, Louisiana 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."
Thursday, August 19, 2021
Older adults in the United States are functioning better on their own and a shrinking share are living in nursing homes and assisted living settings than a decade ago, new data show.
Disability is down, as a smaller percentage of older adults receive help with daily activities and a larger share manage independently with home modifications and devices, according to 10 years of data from the National Health and Aging Trends Study (NHATS). The physical, sensory, and cognitive capacities of older adults, particularly women, are improving. And older adults are online more than ever before: They are more than twice as likely to use text or email than in 2011.
Despite these encouraging trends, NHATS data also reveal persistent racial and ethnic disparities among older adults, particularly in their ability to carry out daily tasks without help and modify their homes to meet their needs. The data also show that older adults were far less likely to participate in activities they value during the COVID pandemic than in previous years.
Conducted annually, NHATS collects information on the functional ability of older Medicare recipients, aiming to guide efforts to improve quality of life. Many NHATs findings are now available in new interactive dashboards and a companion chartbook, allowing users to dig into the data by demographic subgroup and create a custom picture of how the lives of older Americans—a rapidly growing segment of the population—are changing. (citations omitted)
Click here to access the report and all the nifty charts.
Wednesday, August 18, 2021
There was a bit of a buzz last week with the publication of a new study about metabolism. What We Think We Know About Metabolism May Be Wrong explains the recent study: "[u]sing data from nearly 6,500 people, ranging in age from 8 days to 95 years, researchers discovered that there are four distinct periods of life, as far as metabolism goes. They also found that there are no real differences between the metabolic rates of men and women after controlling for other factors."
We probably only think about our metabolisms when we are trying to lose weight. But as the article explains, the implications are far beyond weight gain and loss.
Central to [the researchers'] findings was that metabolism differs for all people across four distinct stages of life.
There’s infancy, up until age 1, when calorie burning is at its peak, accelerating until it is 50 percent above the adult rate.
Then, from age 1 to about age 20, metabolism gradually slows by about 3 percent a year.
From age 20 to 60, it holds steady.
And, after age 60, it declines by about 0.7 percent a year.
For us in elder law, here is the point: "And around age 60, no matter how young people look, they are changing in a fundamental way...'There is a myth of retaining youth, [one expert said] That’s not what the biology says. In and around age 60, things start to change. ... There is a time point when things are no longer as they used to be.'"
Thanks to Professor Naomi Cahn for sending the link to the article.
Monday, August 16, 2021
Elder Law attorney and friend Morris Klein sent me the link to this article, Some NHs Use POLST Inappropriately; Practice, Policy, Research Considerations Can Help. In discussing the importance of advance care planning, the authors note "[o]ne [step] involves the POLST (Physician Orders for Life Sustaining Treatment) paradigm. POLST is intended for persons who are at risk of a life-threatening clinical event due to a serious life-limited medical condition. However, according to the authors of an article in the August issue of JAMDA, some nursing homes (NHs) are using it in potentially inappropriate ways with patients who are ineligible because they are not at such risk. They also make recommendations for NHs to implement the appropriate use of POLST." The article, POLST Is More Than a Code Status Order Form: Suggestions for Appropriate POLST Use in Long-Term Care, can be found here. The abstract explains
POLST (Physician Orders for Life-Sustaining Treatment) is a medical order form used to document preferences about cardiopulmonary resuscitation (CPR), medical interventions such as hospitalization, care in the intensive care unit, and/or ventilation, as well as artificial nutrition. Programs based on the POLST paradigm are used in virtually every state under names that include POST (Physician Orders for Scope of Treatment), MOLST (Medical Orders for Life-Sustaining Treatment), and MOST (Medical Orders for Scope of Treatment), and these forms are used in the care of hundreds of thousands of geriatric patients every year. Although POLST is intended for persons who are at risk of a life-threatening clinical event due to a serious life-limiting medical condition, some nursing homes and residential care settings use POLST to document CPR preferences for all residents, resulting in potentially inappropriate use with patients who are ineligible because they are too healthy. This article focuses on reasons that POLST is used as a default code status order form, the risks associated with this practice, and recommendations for nursing homes to implement appropriate use of POLST.
The article in pdf is available here.
Now here's a clever idea. The National Consumer Voice for Quality Long-Term Care is selling playing cards that contain the rights of a resident of a SNF. The playing cards sell for $8. It's not just the idea that's clever. The design is as well. "Each card highlights a different residents' right. The back of the cards features colorful artwork created by rolling wheelchairs through paint in order to represent how residents move through their facility, designed by residents in Lanai City, Hawaii." How's that for clever! The deck comes in a box--and wouldn't this be a thoughtful gift for an attorney to give a client who has just finished planning for long-term care?
Friday, August 13, 2021
The New York Times recently published an opinion piece, Getting Old Is a Crisis More and More Americans Can’t Afford. The article has some good statistics in it. Focusing on long-term care needs, the article compares demand and supply and costs. "[M]ost seniors will require long-term care. Almost 70 percent of Americans turning 65 today are expected to need extended services and supports at some point. About 20 percent will need care for more than five years. Despite this, the majority of those age 40 and over have done no planning for their long-term care, according to a 2021 survey by the AP-NORC Center for Public Affairs Research." The article notes the scope and limitations of Medicare, Medicaid and long-term care insurance and examines the work of "a broad cross-section of policy experts, consumer advocates and industry representatives [who] formed the Long-Term Care Financing Collaborative to explore more sustainable funding models. The central recommendation of the group’s final report, issued in 2016, was the creation of a universal public insurance program." Noting challenges of making this a reality, the author suggests that "[t]he outlook may be more promising at the state level. In 2019, Washington State passed the nation’s first state-run long-term-care insurance program. The WA Cares Fund is to be funded by a 0.58 percent payroll tax on employees. Starting in 2025, eligible residents can receive benefits of $100 per day, with a lifetime cap of $36,500."
Thursday, August 5, 2021
I wanted to follow up yesterday's post on the rise of COVID cases in SNFs with this article about West Virginia's efforts, Amid Covid Booster Debate, West Virginia to Check Immunity of Vaccinated Nursing Home Residents.
West Virginia raced ahead of the country last winter to get people in nursing homes vaccinated against covid-19, but with cases and hospitalizations on the rise again, state officials want to know whether immunity levels are falling for residents who had their shots... Starting [this month], the state plans to begin measuring the levels of disease-fighting antibodies in the blood of vaccinated nursing home residents, which could help indicate whether they need a booster shot. The process will be voluntary and the data will be shared with federal health agencies evaluating the need for boosters."
The article points out there there is no authorization yet from the federal government for the boosters.W.VA. has done better than most states and the number of cases (at the time of the article was published at the end of July) bears this out. In addition to measuring residents anti-body levels, the state will look at the number of COVID hospitalizations, deaths, and "break-through" infections.
Wednesday, August 4, 2021
Another surge, another rise in COVID in SNFS? According to a recent article in the New York Times, Nursing Homes Confront New Covid Outbreaks Amid Calls for Staff Vaccination Mandates, the cases are rising. Featuring one company, the article notes
The case count has ticked up again: It’s still below 100 among residents and staff, the company said, but includes many breakthrough cases of vaccinated residents testing positive. Then last week, two vaccinated residents died with Covid .... The company said it had pinpointed the cause of the spread there and at other of its facilities: The breakthroughs had happened in the same homes where unvaccinated staff were testing positive, seemingly carrying the virus into the home from the community.
The company recently announced it was requiring all staff to be vaccinated, the article notes. As we all know, vaccine mandates are controversial.
Growing calls for vaccine mandates among health care workers have gained urgency but also met resistance in the nursing home industry, where some homes say it will cost them staff members in an industry already plagued with high turnover. Only about 60 percent of nursing home staff members are vaccinated, and some states report an even lower rate, with less than half inoculated, according to the most recent government data.
Staff immunization has been an issue in many states, especially as the highly contagious Delta variant races through regions with low vaccination rates. Some states and cities, not waiting for the nursing home industry, are imposing their own mandates for vaccinations on long-term care employees or operators may face penalties or additional testing requirements for unvaccinated staff....
Some states have reinstated visitation restrictions and the CDC is monitoring the number of cases. The article goes on to discuss in depth the issues surrounding a vaccine mandate, with some states requiring frequent testing in lieu of adopting a mandate. Looks like we are going to be dealing with this through the end of 2021. I go over with my students a list of questions regarding choosing a nursing home. I'm adding "how many of your staff and residents are vaccinated again COVID" to the list.
Tuesday, August 3, 2021
Following up on yesterday's post about friendship, here's an article from Kaiser Health News, Restoring a Sense of Belonging: The Unsung Importance of Casual Relationships for Older Adults. "These relationships with people we hardly know or know only superficially are called “weak ties” — a broad and amorphous group that can include anyone from your neighbors or your pharmacist to members of your book group or fellow volunteers at a school... [and] many older adults are renewing these connections with pleasure after losing touch during the pandemic." These kinds of relationships have a positive impact on us. "These ties can cultivate a sense of belonging, provide bursts of positive energy, motivate us to engage in activities, and expose us to new information and opportunities — all without the emotional challenges that often attend close relationships with family and friends." So next time you are out for a walk, say hi to the folks you pass on the street. It's good for both of you!
Monday, August 2, 2021
Just wanted to start off August with a happy story. She’s nearly 100. He’s 2 and lives next door. Here’s how they became best friends. The title of this story in the Washington Post pretty much tells it all. But it does illustrate the importance of being connected to others. We know the negative impact of isolation can have on folks. This friendship actually sprang to life because of the pandemic. "With nowhere to go and no one to see, O’Neill started spending more time getting fresh air in her backyard. On the opposite side of the fence, the Olson family did the same... Although they’ve been neighbors for 12 years, “we started spending a lot more time together during quarantine,” said Sarah Olson, 36, Benjamin’s mother. In a matter of weeks, O’Neill became Benjamin’s very first friend." It's clear this friendship enriched both their lives, and eased the burden of isolation during the lockdown. "While she has many hobbies that keep her busy, if not for her friendship with Benjamin, the months of persistent pandemic-induced isolation “would have been a lot lonelier. I wouldn’t have had anything to do,” she said."
So a tiny bright spot as we face another surge...
Tuesday, July 20, 2021
The Washington Post recently published an article about ongoing research into the role of creativity in both longevity and healthy aging, Creativity may be key to healthy aging. Here are ways to stay inspired. "Studies show that participating in activities such as singing, theater performance and visual artistry could support the well-being of older adults, and that creativity, which is related to the personality trait of openness, can lead to greater longevity." However, creativity isn't limited to the arts. Not sure what it means? The article offers some ideas, including travel, daydreaming, being playful (and childlike, but not childish :-)), applying your knowledge, meditating, meeting your challenges, playing brain games, and exercise. So go out and have a little fun!
Monday, July 19, 2021
Washington University St. Louis Institute for Public Health has some interesting programs, including the Center for Aging. One program (actually, a course) is featured in the article, When I’m 64: What will our future be? . Here's how the course is described:
Beginning August 30, students enrolled in the “When I’m 64” course ... will work with multidisciplinary faculty and graduate students, local organizations and experts in aging to learn how they can help transform society as they age. The course features lectures, activities and small group discussion, and interaction each week in class with older adults from local organizations like STL Village, a local non-profit that “assists people 50+ to age in their own homes with 24/7 access to a full range of activities and support services for safe and socially-connected living.”
PS-is the song now stuck in your head?
Monday, July 12, 2021
Last month the New York Times ran an article on How Deceptive Campaign Fund-Raising Ensnares Older People.
The dirty little secret of online political fund-raising is that the most aggressive and pernicious practices that campaigns use to raise money are especially likely to ensnare unsuspecting older people, according to interviews with digital strategists and an examination of federal donation and refund data.
Older Americans are critical campaign contributors, both online and offline. More than half of all the online contributions processed by [one company] in the last cycle, 56 percent, came from people who listed their occupation as “retired,” federal records show.
Digital operatives in both parties deploy an array of manipulative tactics that can deceive donors of all age groups: faux bill notices and official-looking correspondence; bogus offers to match donations and hidden links to unsubscribe; and prechecked boxes that automatically repeat donations, which are widely seen as the most egregious scheme.
But some groups appear to specifically target older internet users, blasting out messages with subject lines like “Social Security” that have particular resonance for older people, and spending disproportionately on ads for an older audience. In many cases, the most unscrupulous tactics of direct mail have simply been rebooted for the digital age — with ruthless new precision.
The article notes that age is not reported on federal filings, so the depth of this occurring is unclear. However, the NYT looked at refund data correlating with voter rolls for California and reports "that the average age of donors who received refunds was almost 66 on [a republican company] and nearly 65 on ... the equivalent Democratic processing site... Even more revealing: More than four times as much money was refunded to donors who are 70 and older than to adults under the age of 50 — for both Republicans and Democrats." The issue is not limited to political campaigns the article notes. "There is an entire initiative at the Justice Department devoted to elder abuse, and the F.B.I.’s Internet Crime Complaint Center reported nearly $1 billion in losses for those 60 and older in 2020." One expert quoted in the article noted "older people face a double whammy online when combining their generational lack of familiarity with technology and age-related cognitive declines."
The article delves into some reasons for such an impact and examines some of the email messages. It's an interesting read.
Tuesday, July 6, 2021
- Choose a trusted financial advocate
- Organize your financial information
- Start a conversation with your financial advocate
- Explain your future money management needs and what you expect from your advocate
- Officially appoint your advocate as your agent under a financial power of attorney
- Shift money management to your advocate when the time is right
Monday, July 5, 2021
Florida adopted eldercaring coordination legislation that went into effect last week on July 1. Here's a brief description: "Elder-focused Dispute Resolution Process; Authorizes courts to appoint eldercaring coordinators & refer parties to eldercaring coordination; specifies duration of appointments; requires courts to conduct review hearings; provides for qualifications, disqualifications, removal, & suspension of coordinators; authorizes courts to award certain fees & costs of eldercaring coordination; provides immunity from liability for certain parties; requires Florida Supreme Court to establish minimum standards & procedures."
The summary of the bill expands:
The bill creates an alternative dispute resolution process for persons 60 years of age and older who are involved in certain legal proceedings. Specifically, the bill allows a court to appoint an eldercaring coordinator to assist in disputes that can impact an elder’s safety and autonomy. The court must specifically define the scope of an eldercaring coordinator’s authority in its order of appointment.
An eldercaring coordinator may be appointed for up to 2 years, although a court has discretion to extend or suspend the appointment as needed. In order to be appointed as an eldercaring coordinator, an applicant must:
- Meet a specified professional licensing requirement, such as membership in The Florida Bar or being a licensed nurse;
- Complete 3 years of post-licensing or post-certification practice;
- Receive training in family and elder mediation;
- Receive 44 hours in eldercare coordinator training, which must offer training on topics including, among other things:
- Elder, guardianship, and incapacity law;
- Family dynamics;
- Multicultural competency; and
- Elder abuse, neglect, and exploitation.
- Successfully pass a background check; and
- Have not been a respondent in a final order granting an injunction for protection against domestic, dating, sexual, or repeat violence or stalking or exploitation of an elder or a disabled person.
The bill provides that an eldercaring coordinator may be removed or disqualified if the coordinator no longer meets the minimum qualifications or upon court order.
The bill requires an equal amount of fees and costs for eldercaring coordination to be paid by each party, subject to an exception. If a court finds that a party is indigent, the bill prohibits the court from ordering the party to eldercaring coordination unless funds are available to pay the indigent party’s allocated portion. Likewise, cases involving exploitation of an elder or domestic violence are ineligible for a referral without the consent of the parties involved. The court must offer each party the opportunity to consult with either an attorney or a domestic violence advocate prior to accepting consent of the referral and the court is required to determine whether each party has given their consent freely and voluntarily.
When a court is determining whether to refer parties that may have an above-mentioned history that would otherwise preclude the referral, the court must consider whether a party has:
- Committed an act of exploitation or domestic violence against another party or any member of another party’s family;
- Engaged in a behavioral pattern where power and control are used against another party and that could jeopardize another party’s ability to negotiate fairly; or
- Behaved in a way that leads another party to reasonably believe he or she is in imminent danger of becoming a victim of domestic violence.
If the court refers a case to eldercaring coordination that involves a party who has any history of domestic violence or exploitation of an elder, the court must order necessary precautions to ensure safety of specified persons and property.
The bill provides that all communications that meet specified requirements and are made during eldercaring coordination must be kept confidential. The bill provides that parties to the eldercaring coordination, including the coordinator, may not testify unless one of the enumerated exceptions applies. The bill also provides remedies for breaches of confidentiality.
The bill provides legislative findings and requires the Florida Supreme Court to establish minimum standards and procedures for training, qualifications, discipline, and education of eldercaring coordinators....
The full text of the new law can be accessed here.
Friday, July 2, 2021
Politico ran an interesting story, ‘You don’t have to die in your seat’: Democrats stress over aging members.
Using a Florida Congressman as an illustration, the article notes that "[t]he entire episode has brought into sharp focus an awkward conversation that Democrats have been having for a while: at a time of deep polarization and narrow congressional majorities, do older or infirm members have a responsibility to step down to ensure the party has enough votes to advance its agenda?" The issue is one for both Democrats and Republicans. "Both parties have their share of elderly members ... But Democrats have been grappling with a noticeable generational divide within their ranks for some time — President Joe Biden and top Democratic congressional leaders are all well over 70. Ten of the 12 House members over the age of 80 are Democrats." The article discusses various other issues, including the slim majority held by the Democrats, the desires of younger folks to serve, and perhaps a lessening value of seniority.
Thanks to Professor Naomi Cahn for sending us the article.
Tuesday, June 29, 2021
We all have heard the stories about the number of SNF residents dying during the pandemic. The Inspector General for HHS recently issued a report looking at the number of Medicare beneficiaries who died in SNFs during the pandemic, COVID-19 Had a Devastating Impact on Medicare Beneficiaries in Nursing Homes During 2020.
The executive summary explains:
Nursing home residents have been particularly affected by COVID-19, as they are predominately elderly, tend to have underlying conditions, and live in close quarters. However, data on the number of nursing home residents who were diagnosed with COVID-19 or likely COVID-19 have not been readily available, particularly for early in the pandemic. Nursing homes are not required to report cases and deaths that occurred before May 8, 2020.
This data snapshot provides objective, standardized data based on Medicare claims for all Medicare beneficiaries in nursing homes throughout the country. This data snapshot is the first in a three-part series. Subsequent work will address the characteristics of the hardest hit nursing homes and strategies used by nursing homes to confront the challenges of the COVID-19 pandemic.
WHAT WE FOUND
- Two in five Medicare beneficiaries in nursing homes were diagnosed with either COVID-19 or likely COVID-19 in 2020.
- Almost 1,000 more beneficiaries died per day in April 2020 than in April 2019.
- Overall mortality in nursing homes increased to 22 percent in 2020 from 17 percent in 2019.
- About half of Black, Hispanic, and Asian beneficiaries in nursing homes had or likely had COVID-19, and 41 percent of White beneficiaries did.
- Understanding the pandemic's effects on nursing home residents is necessary if tragedies like this are to be averted.
Note that this is the first of 3 reports on the topic. The full report is available here.
Monday, June 21, 2021
This GAO report is a couple of months old, but I think it's important enough to bring it to your attention, Retirement Security: Debt Increased for Older Americans over Time, but the Implications Vary by Debt Type.
Here are the fast facts from the report:
Older Americans held nearly half of the total debt in 2020—debt that may affect their retirement security. We found that older Americans had significantly more debt in 2016 than in 1989.
We also found that low-income, older Americans had greater "debt stress"—the ratio of debts to assets. In 2016, debt stress was about two times higher for minority households than White households.
Experts said that different debt types (credit cards, housing debt, etc.) have varying effects on retirement security. For example, carrying credit card debt with high variable interest rates may make it difficult for the elderly to save for retirement.