Monday, December 7, 2020
JAMA Internal Medicine published the results of a recent study, Financial Presentation of Alzheimer Disease and Related Dementias.
Here are the key points from the study:
Question Are Alzheimer disease and related dementias (ADRD) associated with adverse financial outcomes in the years before and after diagnosis?
Findings In this cohort study of 81 364 Medicare beneficiaries living in single-person households, those with ADRD were more likely to miss bill payments up to 6 years prior to diagnosis and started to develop subprime credit scores 2.5 years prior to diagnosis compared with those never diagnosed. These negative financial outcomes persisted after ADRD diagnosis, accounted for 10% to 15% of missed payments in our sample, and were more prevalent in census tracts with less college education.
Meaning Alzheimer disease and related dementias were associated with adverse financial events starting years prior to clinical diagnosis.
The full article is available here.
Wednesday, November 18, 2020
Billboard published a recent feature on Dolly Parton. Dolly Parton Steers Her Empire Through the Pandemic—and Keeps It Growing! Now you may wonder why I'm blogging about Dolly Parton on the elderlawprof blog? Well, she's 74. But that's not why I thought this article was worth inclusion. The bulk of the article is about her life, her music portfolio, and her businesses. Here's why:
Though there is an air of immortality to Parton, thanks to her immutable image and lyrics like “You’re never old unless you choose to be,” she and Nozell have spent the past few years preparing for a world without her. Unlike Prince or Aretha Franklin, who died without wills, Parton has worked to get her estate in order, and Nozell says that most decisions now are made with Parton’s legacy in mind. (Parton and Carl Dean, her husband of 54 years, have no children.) “I would not want to leave that mess to somebody else,” Parton says, before offering a little advice. “A word to all the other artists out there: If you haven’t made those provisions, do that. You don’t want to leave that mess to your family for people to have to fight over. You need to take care of that yourself, even if it’s a pain in the ass — and it is.”
This is good advice for everyone-regardless of the size of their estates. Take it from Ms. Parton-planning is important!
Stetson’s Journal of Aging Law & Policy, the preeminent journal for cutting-edge issues of national and international aging law and policy, is seeking articles for its Volume 13, which will be published in May 2022. Stetson’s Journal of Aging Law & Policy is a unique journal with an elder law emphasis that also focuses on both law and policy.
If you are interested in submitting an article for publication, please email Nicholas Marler, Managing Editor, at firstname.lastname@example.org. Submission requirements: Articles must be in 12-point font and double spaced. Citations should be in accordance with either the ALWD or BlueBook citation manuals and the article must be related to a relevant elder law topic. Submission preferences: The Journal seeks articles that are between 10,000 and 20,000 words. However, consideration may be given to articles that fall outside of this word requirement.
Submissions and questions should be directed to Managing Editor, at email@example.com
Monday, November 16, 2020
My friend Morris Klein sent me this article a couple weeks ago (thanks Morris). Good urban design can make Greater Washington more dementia-friendly explains that "Greater Washington’s population of older adults is growing. So too is the number of people with dementia and other age-related memory loss. That makes designing for dementia one of the key ways we can make our urban spaces work for the people using them." The article explains that many folks with dementia live within the community rather than in a facility. As a result, city planners need to consider this when updating their urban planning and their zoning ordinances.
[M]ost people with memory loss age in their communities, cared for by family members who do not receive enough support. Those in nursing homes often face abusive, unhealthy, or unhappy environments. Thousands of people with dementia and memory loss died from the coronavirus pandemic in nursing homes. As a result of these trends, more families are now seeking to keep loved ones with dementia in the community.
But public spaces are often unusable by people with cognitive abilities affected by dementia. People with dementia often feel overwhelmed, get lost, have trouble, or face dangerous situations while trying to navigate cities. Skills that we take for granted are difficult for older adults with dementia, including the ability to find alternative routes, filter out extraneous sensory information, or remember directions. Much of this is unintentional: designers and planners are often unaware of these needs. That intent, however, does not change the impact.
The article discusses various suggestions and techniques, such as wayfinding, signage and invigoratingly-designed spaces. Of course, safety parking, and types of seating must also be considered. Most importantly is "listening to people with dementia, who should be engaged in design processes in some way, even if just in informal conversations. Planners and designers can learn from social programs for older adults with memory loss."
Wednesday, October 28, 2020
COVID-19 has hit residents of nursing homes hard. But it’s also hit hard those with dementia. Dementia deaths rise during the summer of COVID, leading to concern was published recently in The Conversation. The article opens with this sobering observation
Deaths from dementia during the summer of 2020 are nearly 20% higher than the number of dementia-related deaths during that time in previous years, and experts don’t yet know why. An estimated 61,000 people have died from dementia, which is 11,000 more than usual within that period.
“There’s something wrong, there’s something going on and it needs to be sorted out,” Robert Anderson, chief of mortality statistics at the U.S. Centers for Disease Control and Prevention, said in a recent interview with Politico. “This is highly unusual.”
The author analyzes the four factors that may have played a role in the deaths of these individuals. Those include social isolation (“[s]ocial isolation, which essentially is little or no contact with others, is the last thing seniors with dementia need. But it’s what many have received, as caregivers are forced to limit visits during the pandemic”), caregiver burnout (“during COVID-19, caregivers have been isolated too. What help they had from the outside is now probably gone. Burnout becomes more likely”), decreased access to medical care (“[f]or dementia patients, accessing care may even be more problematic. Telemedicine, often an option for other patients, may not be manageable for those with dementia”), and staying home or using the health care offered by the facility, when they’ve decided the risk of leaving the house is greater than the medical issue (“a good example of something we doctors call goal-concordant care: when doctors understand a patient’s health goals, and then provide them with the best they can within the scope of those goals”).
The author concludes with some advice: check on the folks with dementia whom you know, check in on the caregiver…and be a good listener, and talk to your family about your wishes if this becomes your future.
Thanks to Professor Naomi Cahn for sending the link to this article.
Monday, October 26, 2020
Scientific American ran an article, Helping Alzheimer’s Patients Bring Back Memories Targeting recall processes could let people who are in the disease’s early stages access what they currently can’t remember.
People of all ages have moments when it feels like we’re on the edge of recalling something but can’t quite do it—where we parked our car or left our phone, for example, or what name goes with that familiar face. It’s extremely frustrating in the moment, but for most of us, we can usually remember if we try. For patients with Alzheimer’s, Huntington’s and many other dementia-causing diseases, however, memory loss is much more profound.
The article discusses two theories regarding memory loss: “one is that these patients can’t store new information properly in the brain; the other is that their ability to recall stored information has been weakened.” The author discusses his research and how that led him to support the “weakened memory recall idea.”
The author uses great analogies to help the reader understand the science of the disease and the work. The author notes that there is a lot yet to know, “but what’s clear is that we need to take advantage of targeting recall to help treat patients in the near future.”
Thanks to my colleague and friend, Professor Feeley, for sending me this article.
Sunday, October 25, 2020
Last week I posted a blog about the ability of folks with dementia to vote. On the subject of voting, here’s a poignant story that appeared in the Washington Post. One last vote: In Michigan, a terminally ill man’s mission to cast a ballot tells the story of a terminally ill individual whose last wish was to live long enough to vote in this election. He made it to the first day of early voting, even depositing his completed ballot himself in the official drop-off box for the ballots. Slightly over a week later, he died. After his death, it was learned that his vote didn’t count because in his state the votes, even those cast early, are not counted until election day. His son’s words can be taken to heart: “It’s not that he thought his vote was going to change the election. He believed it was important as an example to his children and grandchildren,” he added. “The way you use your energy, particularly when you don’t have much left, that is a very true reflection of what you really care about.”
Monday, October 19, 2020
The New York Times reported recently on a hot topic with the upcoming election: whether an individual with dementia can still vote. Having Dementia Doesn’t Mean You Can’t Vote "tells us that for some, voting is still possible. The key, "he ability to express a preference," citing to a new report from experts on this topic. Even though the person has the right, the exercise of that right may be challenging: "[v]oting can become challenging for many older citizens, who may struggle to reach polling places, stand in lines, use computerized voting machines or read ballots printed in small type."
Further, the article notes, many believe they cannot help the voter in casting the ballot. "A diagnosis of cognitive impairment does not bar someone from voting. Voters need pass no cognitive tests. They don’t have to be able to name the candidates or explain the issues. If they need help reading or physically marking the ballot, they can be assisted, either at the polls or with mail-in ballots. In some states, even people under court-appointed guardianship don’t lose their voting rights."
So you want to help. What do you do? "If you are considering helping someone with dementia to participate in an election, and they have registered to vote, in most cases there are only two real guidelines to keep in mind.
- "After reminding the person that Election Day is nearing, ask whether he or she would like to vote." If the answer is no, you are done.
- If the answer is yes, then "you may read the voter the ballot choices, if he or she cannot read them, but cannot provide additional information or interpretation, although discussions before voting begins are permitted. “Ask them their choices and see if they answer,” ... “If they do, they vote.”
Even in normal times, there are challenges for those who need help with voting, for examples residents of SNFs. In the time of COVID, the challenges are even greater. The article is really interesting and I encourage you to read it. The study findings can be accessed here.
Sunday, October 18, 2020
The New York Times ran a recent story about elders who retired after a long career and then went into business for themselves with elders as their target clients. As They Aged, They Started Businesses for People Like Them, describes these "older entrepreneurs ... [as] turning their lifelong skills into encore careers selling services and products in the booming senior consumer market. In some cases ... their own experiences become catalysts for career moves at a time when others are retiring." The article notes the confluence of two factors driving this trend: the "longevity market and the increasing amount of these "later-in-life entrepreneurs." The article offers some insights regarding the shift to becoming a late-in-life business person and the types of businesses that lend themselves to this model. Check it out!
Wednesday, October 7, 2020
Advancing Action, 2020: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers ranks individual states on the available services, etc. Here's the introduction on this latest scorecard:
This report is a compilation of state data and analysis that is based on a vision of a high-performing system of long-term services and supports (LTSS). By using reliable, consistent, available data, it is designed to spark conversations that can result in actionable solutions at the local, state, and national levels—solutions that help older adults, people with physical disabilities, and their family caregivers live their best lives possible. Making that happen is the responsibility of both the public and private sectors, with advocates playing crucial roles. And consumers’ choices and actions ultimately affect a state’s LTSS system as well.
Of course, COVID changes everything and the introduction addresses that impact on the Scorecard. The purpose of the scorecard
The 2020 Long-Term Services and Supports (LTSS) State Scorecard aims to empower state and federal policy makers, the private sector, and consumers with information they need to do the following:
- Effectively assess their state’s performance across multiple dimensions and indicators.
- Learn from other states.
- Improve the lives of older adults, people with disabilities, and their families.
The Scorecard is guided by the belief that, in order to meaningfully manage and improve performance, one must measure it. Unlike many other rankings that focus on a particular aspect of LTSS system performance, the Scorecard compares state LTSS systems across multiple dimensions of performance, reflecting the importance and interconnectedness each has on the overall LTSS system. The goal is to spark conversations, galvanize broad-based coalitions, and focus stakeholders’ attention on the factors that most directly impact consumers and their families.
Tuesday, October 6, 2020
According to AARP, The United States is an Aging Nation.
Here are the population projections they offer
1. The National Median Age is 38.2 Years Old
2. The Number of Older Adults Will Soon Outnumber Children
3. The 65+ Population Increased During the Past Decade
4. The Population of Older Adults is Getting Larger — and Older
Each of this incudes an interactive graphic that links to a separate page that provides more info about the statistic. The landing page for the projections is here.
Wednesday, September 30, 2020
There have been lots of discussions about the impact of isolation necessitated by COVID, especially on elders. We have previously written about robot pets, and now the New York Times has examined the role of these robots in lessening the impact of isolation during the pandemic: In Isolating Times, Can Robo-Pets Provide Comfort?
Such devices first appeared in American nursing homes and residences for seniors several years ago. A Japanese company began distributing an animatronic baby seal called PARO in 2009, and Hasbro started marketing robotic cats in 2015.
But the isolation caused by the coronavirus, not only in facilities but also among seniors living alone in their homes, has intensified interest in these products and increased sales, company executives said. It has also led to more public money being used to purchase them.
The article discusses the adoption of the robots by various facilities, and then the interest individuals have shown in having the robots as their companions.
Of particular interest is the Joy for All brand sold by Ageless Innovation, a spinoff of Hasbro, and available from retailers like Walmart and Best Buy for about $120.
One of the largest studies, underwritten by United HealthCare and AARP, distributed free Joy for All robots to 271 seniors living independently.
All the seniors suffered from loneliness, according to a screening questionnaire. At 30 and 60 days, “there was improvement in their mental well-being, in sense of purpose and optimism,” said [the] chief medical officer of AARP’s business subsidiary and a study co-author. The study also found “a reduction in loneliness,” ... although the questionnaires showed that participants remained lonely.
Armed with such findings, Ageless Innovation has been offering discounted robots to state agencies working with seniors. (Both Joy for All and PARO robots can be sanitized to prevent viral transmission, the companies said.)
One Medicare Advantage plan covers them and Ageless Innovation is working to get other MA plans to also cover them. The article also discusses the views of fans and critics of the use of these robot pets. Of course, nothing beats human interaction! What do you think?
Tuesday, September 29, 2020
Mark your calendars now for a free webinar on ABLE accounts on Tuesday October 13 at 2 eastern.
The ABLE Act offers the opportunity for 8 million individuals with disabilities to save without affecting means tested benefits. The ABLE Act builds on the Americans with Disabilities Act (ADA), recognizing the extra, significant costs that come with living with a disability. This training will cover how ABLE accounts empower people to save and invest their funds in a tax-advantaged savings vehicle to cover a wide range of qualified disability expenses, providing for a better future and enhanced quality of life.
Presenters will share:
- How an ABLE account can increase financial independence
- ABLE account basics and the interaction with SSI and Medicaid
- Resources and tools
- Miranda Kennedy, Director, ABLE National Resource Center
- Marlene Ulisky, Disability Benefits Expert, ABLE National Resource Center
- Pshon Barrett, Esquire, ADA Group, LLC, Attorneys for Disabled Americans and ABLE account owner and 2020 ABLE NRC Ambassador
Closed captioning will be available on this webcast. A link with access to the captions will be shared through GoToWebinar’s chat box shortly before the webcast start time.
This training will be presented in a WEBCAST format to accommodate more participants. Due to the high volume of participants, computer audio will be the only option to listen to the presentation. No telephone call-in number will be provided. Please plan accordingly. Thank you.
This webcast will be recorded and available on our website shortly after the presentation. The recording and training materials will also be emailed to all registrants within a few days after the training.
To register, click here
Wednesday, September 23, 2020
The ABA Commission on Law & Aging, along with the Penn Memory Center, has announced the release of a new voting guide, Assisting Cognitively Impaired Individuals with Voting: A QUICK GUIDE.
Here's the intro to the guide
Difficulties in communication can occur when interacting with a person who has cognitive impairment. The techniques and tips described in this guide will help make sure that your communication is as effective as possible and within the limits of assistance permitted by election laws.
These techniques and tips are especially important when interacting with persons who are diagnosed with Alzheimer’s disease or another brain illness or disorder such as stroke or head injury.
The guide discusses capacity to vote, communication challenges, and listening skills. The guide offers 10 case studies with suggestions for those who may be assisting such voters.
An underlying principle here is that people should not be treated any diferently in voting rights based on any perceived impairment or other personal characteristic. People whose mental capacities are clearly intact may vote for candidates based on any whim or reason, rational or irrational. Similarly, for persons with some level of cognitive impairment, if they can indicate a desire to participate in the voting process and they can indicate a choice among available ballot selections, their reasons for such choice are not relevant.
The full guide is available here.
Friday, September 18, 2020
Here's a cool idea from the National Long-Term Care Ombudsman Resource Center: Ombudsman Safety Bags! As states begin to allow visits for residents of LTC facilities, ombudsmen, among others, need to keep themselves, and others, safe. The safety bags include "an Ombudsman imprinted face mask, hand sanitizer, sanitizer wipes, and resources specifically for Ombudsman programs. The resources include tips for Ombudsman program communication, a tip sheet about self-care, NORS FAQs related to COVID-19, 25 Ombudsman program promotion postcards, and COVID-19 Recovery and Reentry Resources." It seems that these bags would be helpful for any professional who interacts with others, especially in cases where attorneys make home visits to their clients.
I just wanted to share something positive with you, so there you have it!
Tuesday, September 15, 2020
The Tampa Bay Times recently reported that the Florida Governor was authorizing visitation of residents in SNFs and ALFs in certain circumstances, DeSantis says yes, but will Florida nursing homes reopen to visitors? The order, which was effective on September 1, still requires that visitors maintain social distance. "The governor’s executive order... end[ed] the five-month ban on visitors at long-term care facilities that he imposed in an effort to protect the state’s most vulnerable residents from the coronavirus. The order will continue to allow visits from those deemed essential or compassionate caregivers, including in facilities that have had recent positive tests." The order is optional and the SNFs and ALFs can choose to not allow visitors.
The final report of the task force appointed by the Florida governor is available here.
Friday, September 11, 2020
Computer Weekly recently addressed the legal issues that may occur when using technology for caregiving AI may be a solution to the social care crisis, but what are the legal concerns?, looks at the caregiving situation in the U.K. Building on the story from yesterday about the robot "Pepper" who can carry on conversations, the article highlights some legal issues, such as an individual's privacy.
Consider this-the robot could report concerns about abuse, for example, "the technology might provide a report, supported by video evidence, to family members or those with the legal responsibility of care, such as attorneys or deputies, who can then review such material. It can easily become part of a care home contract to consent to such filming, although it is vital that this is handled in a sensitive manner and regularly deleted to ensure that a resident’s privacy is protected." The article notes concerns about "sensitive personal data." Would residents provide consent? Who would consent if a resident lacks capacity. As the article concludes, "[W]e must never forget who is at the heart of these considerations, and the legal framework needs to catch up with the technology to protect them and for it to have a viable chance of success."
Thanks to Professor Feeley for sending me this article.
Thursday, September 10, 2020
The Guardian recently published an article about the use of robots in long term care facilities to combat loneliness of residents. Robots to be used in UK care homes to help reduce loneliness describes the roll these robots can play in interacting with residents. These are not your "normal" robots, but then I don't know what one would consider a "normal" robot. These robots, on wheels, "called “Pepper”, move independently and gesture with robotic arms and hands and are designed to be “culturally competent”, which means that after some initial programming they learn about the interests and backgrounds of care home residents. This allows them to initiate rudimentary conversations, play residents’ favourite music, teach them languages, and offer practical help including medicine reminders." The researchers not that these robots do not replace human caregivers but instead supplement them. The robots were tested in the U.K. and Japan and researchers found that those residents who spent time with the robots for "18 hours across two weeks had a significant improvement in their mental health. There was a small but positive impact on loneliness severity among users and the system did not increase feelings of loneliness...."
Robots, whether "Pepper" or others, do have limitations--for example, they aren't human. The article reports some of the limitations mentioned, such as their chats with residents were lacking some depth, were impersonal and lacked cultural awareness. Their movements were, shall we say, robotic. But imagine, a robot that can hold a conversation with you. This can be a great tool, to supplement human caregivers!
Thanks to Professor Feeley for sending me the article.
Monday, August 24, 2020
There are now four digital publications available from the landing page, including the Journal, Generations Journal (quarterly), Generations Today (news publication, six times/year), Generations Now (blog and commentary) and finally, Generations Bylines, a new podcast that interviews authors and researchers in the field of aging. It's a great resource for our students, especially if you want them to stay updated on the trends in the field. (Full disclosure, I"m on the ASA board).
Friday, August 14, 2020
Earlier this week, the GAO issued a new report, CHILD WELFARE AND AGING PROGRAMS: HHS Could Enhance Support for Grandparents and Other Relative Caregivers.
Here are the highlights
In 2018, an estimated 2.7 million children lived with kin caregivers— grandparents, other relatives, or close family friends—because their parents were unable to care for them. Most of these children were cared for outside the foster care system, which can affect the types of services and supports available. While children did not live with parents for a variety of reasons, parental substance abuse and incarceration were often cited in data and in interviews with program officials.
Challenges faced by kin caregivers include having limited financial resources and needing legal assistance, particularly when caring for children outside foster care, according to survey data and studies GAO reviewed. This is, in part, because licensed foster parents generally receive foster care maintenance payments and other services. Officials in selected communities said they have addressed some challenges by, for example, providing temporary payments or legal representation to eligible kin caregivers. However, officials also said that program eligibility criteria or insufficient funds can limit availability or result in waiting lists.
The Department of Health and Human Services (HHS) provides technical assistance and other support to help states use federal programs and initiatives established to serve kin caregivers. HHS officials said that these programs are optional, so they mainly provide assistance in response to states' requests. However, this approach has not led to widespread use. For example, 23 states used the option under the National Family Caregiver Support Program to serve older relative caregivers with 1 percent or more of their fiscal year 2016 funds (spent through 2018). State officials said they would like more guides or tools for using these programs. By not proactively sharing information and best practices, HHS may be missing opportunitiesto help states better support kin caregivers.
GAO is making two recommendations to HHS on sharing information and best practices with states about federal programs that serve kin caregivers. HHS did not concur, stating that the agency already provides ongoing support. GAO maintains that implementing these recommendations would be helpful.
The full report is available here.