Thursday, March 11, 2021
The New York Times discussed planning and saving for your longer life in the article, If You Live to 100, You’ll Need More Than Money. As more folks reach the 100 years old marker, it's more than just having enough money to live on. The article focuses not just savings, but planning and identifying a purpose. According to one financial advisor featured in the article, "[w]hile focusing on their savings goals, [he] also helped them embrace life planning, which asks: Besides not outliving your money, how can you make your life meaningful in retirement, which could last three decades or more?"
Here's some interesting data about centenarians from the article. "The growth in the 100-plus age group is partly a result of better medical care and a combination of improved lifestyle factors. This cohort has expanded 44 percent since 2000, according to a C.D.C. study. Eighty percent of centenarians are women. And in about 40 years, the number of people 100 and older will be six times as high as it is now, according to the Census Bureau."
The article discusses factors that may lead to reaching the 100 year old mark. If you are feeling optimistic, you might check out this calculator:
In recent years, estimating longevity and planning for it have become more sophisticated. The LivingTo100 longevity calculator, developed by Dr. Perls, is a good place to start to get a rough estimate of your life span and what you can do to improve your odds of living longer, should you want to go down that path.....
Wednesday, March 10, 2021
It was only a matter of time, once the COVID vaccines became available, that we saw this question being discussed. Can Long-Term Care Employers Require Staff Members to Be Vaccinated? was the subject of a recent article in the New York Times.
It’s a question that many long-term care employers, from individual families to big national companies, are confronting as vaccines become more available, although not available enough: In a pandemic, can they require vaccination for those who care for very vulnerable older adults? Should they?
Some employers aren’t waiting. Atria Senior Living, one of the nation’s largest assisted living chains, has announced that by May 1 all staff members must be fully vaccinated.
These requirements are not without controversy. How many employers will mandate this remains to be seen. Think about this in the long term care setting, where employees are in close and frequent contact with vulnerable residents. The article offers this interesting info:
Experts say it is probably legal for employers to make vaccination a condition of employment. The federal Equal Opportunity Employment Commission has agreed, so long as mandates permit health and religious exemptions. A University of Pennsylvania analysis found last fall that nationally, about half of American adults would consider employer mandates acceptable.
One expert mentioned that these vaccines were approved under an emergency mandate, and are not yet approved by the FDA, although that is expected to be coming soon. As far as the mandate, this expert offered this view "Ethically ... it’s entirely justified. People have the right to take chances with their own health, but they absolutely do not have the right to endanger others.”
The article discusses incentives employers may offer to get more folks vaccinated and the challenges in getting direct-care workers vaccinated.
PS-for those who are members of ASA, this issue was part of a podcast offered in February for members
Tuesday, March 9, 2021
Not everyone wants to retire. Some folks continue to work because they need to while others continue to work because they want to do so. The Washington Post addressed this in a recent article, Don’t want to retire? Here’s how to maintain a fulfilling career into your 80s and beyond. "People age 75 and over, including our fresh-on-the-job president, are the fastest-growing group in the labor force, even though “age discrimination is very real,” said Susan Weinstock, vice president of financial resilience at AARP." The author of the article explores the wellness advantages of continuing to work and reviews the habits of those interviewed for the article:
- view work as pleasure
- healthy eating and exercise is a must.
- Keep stress in check.
- Mentor and nurture others, as well as yourself.
Thanks to Professor Naomi Cahn for sending me the link to this article.
Sunday, March 7, 2021
NBC News ran this story, America now knows that nursing homes are broken. Does anyone care enough to fix them? . Once COVID starting sweeping through facilities last year, more folks learned about the current model of providing long-term care, and their short-comings. Experts began calling for reform on the way we provide SNF care in the US. But did that call for reform get drowned out by the daily news about the havoc COVID was wreaking on our country?
The NBC News story ran yesterday (thanks to my colleague and dear friend Professor Bauer for sending me the link).
The pandemic turned nursing homes into a death trap for more than 170,000 long-term care residents and staff members who have lost their lives to Covid-19.
But the virus also revealed how America’s system for long-term care is fundamentally broken in ways that will continue to harm vulnerable residents and workers, long after the pandemic has faded away.
The biggest underlying problem? For all the billions of taxpayer dollars that the United States spends on a system meant to care for frail, elderly residents, not enough money is being invested in caregiving itself, according to interviews with more than a dozen nursing home researchers, advocates, industry representatives and staff members.
There are two sides to this issue, as noted in the story, as well as an opportunity for reform, complete with roadblocks to achieving it.
Nursing homes, by their nature, are ideal breeding grounds for Covid-19: Frail, elderly residents live in close quarters, often requiring support from aides to eat, get out of bed, bathe and get dressed.
This hands-on caregiving is the backbone of what a nursing home provides, and the reason that most residents are in long-term care to begin with. But a chronic failure to value this work, and compensate it accordingly, helped accelerate the pandemic’s catastrophic spread, experts said.
Staffing shortages are discussed in the article, along with explaining how those shortages contribute to a greater risk of a COVID outbreak. The work these folks provide is undervalued both in terms of salary as well as the role they play in providing care.
The section of the article on funding is quite illuminating
America’s long-term care system was created as an afterthought, when nursing home coverage for poor, frail Americans was included, without much fanfare, as part of the 1965 law .... A half-century later, the elderly population has ballooned, and life expectancy has shot up, while personal savings have not, leaving millions of aging Americans unable to pay for the care they need. But unlike most major industrialized nations, the U.S. has no universal public system that covers elder care, which means that many patients, as well as nursing homes, are ultimately left to rely on Medicaid.
The trouble with Medicaid — the only federal program that pays for long-term care — is a reimbursement rate that the industry has long complained is too low, about $200 for each day of care, on average. Medicare pays at least twice as much, but it only covers up to 90 days of post-acute care and rehabilitation, typically following a hospital stay.
The article discusses accountability, the use of third-party contractors, quality of care transparency (or a lack thereof) and lobbying efforts. The article looks at proposals to change the industry. I'm assigning it to my students and we will discuss it in class. I recommend it to you.
Friday, March 5, 2021
Let's end the week with a happy story, shall we? The New York Times featured the return to "normal" for one nursing home. After Vaccines, Joy, Relief and Game Night
The first day back was full of ordinary moments: small talk over coffee, bidding wars at an afternoon auction, a game of dice. But after a year of loss, loneliness and disruption, the very ordinariness of it all brought joy and relief.
There's losses, sadness and joy. It's a happy way to end the week.
Thursday, March 4, 2021
Two articles that bear reading, both from the New York Times.
First, an op-ed We Are Going to Keep You Safe, Even if It Kills Your Spirit’ in the New York Times, examining the impact of COVID and isolation on folks with dementia. This is an important read. The article highlights the challenges for those individuals and mask-waring and social distancing, as well as how the disruption of their routines impacts them.
People with dementia “may not adequately comprehend, execute, or recall any of the suggested public health measures,” as the Alzheimer’s Association puts it. Also, it’s not possible to social-distance when you live in a nursing home, as about 15 percent of people with dementia do, and when you need help eating and going to the bathroom.
Even those who stay free of the virus have suffered disproportionately from the disruptions of pandemic life. Dementia responds well to routine: rigid, time-blocked schedules and familiar faces. But the pandemic has shown us, and warned us, how quickly the fragile channels of dementia care — the muddled blend of formal and informal networks that sustain those routines — can collapse under strain.
Second, another New York Times article, People With Dementia Are Twice as Likely to Get Covid, Huge Study Finds
People with dementia had significantly greater risk of contracting the coronavirus, and they were much more likely to be hospitalized and die from it, than people without dementia, a new study of millions of medical records in the United States has found.
Their risk could not be entirely explained by characteristics common to people with dementia that are known risk factors for Covid-19: old age, living in a nursing home and having conditions like obesity, asthma, diabetes and cardiovascular disease. After researchers adjusted for those factors, Americans with dementia were still twice as likely to have gotten Covid-19 as of late last summer.
Wednesday, March 3, 2021
Will the administration provide support for family caregivers? This was the subject of an opinion published in the New York Times. 50 Million Americans Are Unpaid Caregivers. We Need Help. focuses on the author's personal experiences as a family caregiver. Consider this: "It’s often noted that the United States is alone among rich nations in not providing maternity leave; support for child care is likewise abysmal. Similarly — but often more invisibly — we leave millions of caregivers with little or no support in managing the financial, logistical and emotional difficulties of helping ailing parents, spouses and children." Referencing the pledge made during the campaign, the author notices the benefits:
The changes would help not just caregivers like me; what’s good for caregivers also benefits those who need assistance. Expanding home care can keep frail elderly people out of nursing homes, the drawbacks of which have been painfully exposed by the pandemic. Easing financial strains and burnout for caregivers can mean better, more compassionate treatment, which in turn can improve quality of life and outcomes for our most vulnerable citizens.
Monday, March 1, 2021
The End of Life Options Act has been reintroduced in Massachusetts. This article notes an overwhelming support by U.S. adults for aid-in-dying. The article also includes a short podcast of the story. If this bill passes, Massachusetts will join a handful of other states where aid-in-dying is legal Stay tuned.
The annual Ann F. Baum Memorial Elder Law Lecture at the University of Illinois College of Law is scheduled for March 10, 2021 at noon (central) virtually. This year's lecture, "Ways of Thinking About Medical Care: Alternative Models and Structures and Their Policy Significance" will be presented by James F. Blumstein, Vanderbilt University of the University Professor of Constitutional Law and Health Law & Policy and Professor of Management, Owen Graduate School of Management, Director, Vanderbilt Health Policy Center.
Here's a description of the presentation:
Traditionally, medical care has been understood to function under a professional paradigm; medical decisions are considered purely scientific under a standard of “medical necessity.” Medicare and Medicaid were based on this model, where economics has little sway. Over time, an alternative model, an economic paradigm, has gained traction. Under the alternative model, economics plays an important role in medical decisionmaking. The professional model had a strong influence on the design and structure of Medicare and Medicaid, with significant consequences in terms of cost escalation. Medicaid, in particular, has been an uncapped entitlement program of federal/state spending. About 20 years ago, Medicaid introduced managed care, which allowed for consideration of economic factors in medical decisionmaking. And, at the same time, the Children’s Health Insurance Program (CHIP) developed a competing model for federal/state healthcare spending. The Affordable Care Act (ACA) relied on cost savings from projected Medicare spending to fund increased access to care, a clear recognition of the salient role of economics in supporting expanded access to care. Most recently, the federal government has approved a Tennessee Medicaid waiver, essentially transferring the CHIP funding model to the context of Medicaid. The interplay of economics and program design/structure in healthcare programs, culminating in the recent Medicaid waiver for Tennessee, will form the centerpiece of this year’s Baum Memorial Lecture.
Here is the info to attend
Join by Zoom Meeting
Meeting ID: 860 8008 4604
Join by Skype for Business
Thanks to Professor Kaplan for letting me know about this wonderful program!
Sunday, February 28, 2021
Still? Yes still. Seniors Seeking Vaccines Have a Problem: They Can’t Use the Internet tells us something we already know (and I have already blogged about).
The chaotic vaccine rollout has come with a maze of confusing registration pages and clunky health care websites. And the technological savvy required to navigate the text alerts, push notifications and email reminders that are second nature to the digital generation has put older adults like Ms. Carlin, who need the vaccine the most, at a disadvantage. As a result, seniors who lack tech skills are missing out on potentially lifesaving shots.
The article explains various agencies and efforts to help those without internet access but more needs to be done.
There's got to be a better way. Is it really this hard?
Monday, February 22, 2021
Despite projects to vaccinate those elders who are homebound or lack internet access, we are still lagging behind on reaching them, according to a story today in Kaiser Health News. Countless Homebound Patients Still Wait for Covid Vaccine Despite Seniors’ Priority starts with the good news-recognizing the unique outreach efforts by hospitals, health systems, and paramedics, for example. These folks are home are highly vulnerable. Described by one expert in the article as a "hidden group", they are at great risk, "[b]y virtue of their age and medical status, these seniors are at extremely high risk of becoming seriously ill and dying if they get covid-19. Yet, unlike similarly frail nursing home patients, they haven’t been recognized as a priority group for vaccines, and the Centers for Disease Control and Prevention only recently offered guidance on serving them." The article notes that those professionals whoa are regularly in contact with them are not those with access to vaccines. Medicare's reimbursement rates for time-consuming house calls doesn't allow the health care professionals to recoup their costs, notes the article. Not only that, knowing the storage requirements for the vaccines doesn't mean a health care professional can just hop into their car and drive around with the vials in a cooler.
So this brings us to this story, a new hero for all of us! Last week in the New York Times, Woman, 90, Walked Six Miles in the Snow for a Vaccine
explained how after that recent snow storm, driving was out for her, but given all her previous failed efforts to get the vaccine, she wasn't going to miss this opportunity.
Where's Rosie the Riveter when we need her?? Surely "we can do it" or at least do better?
Friday, February 19, 2021
A week or so ago, stories started to emerge that SNF employees were passing on the opportunity to get the COVID vaccine. Kaiser Health News ran this article, explaining some views Vaccine Hesitancy vs. Vaccine Refusal: Nursing Home Staffers Say There’s a Difference.
The reluctance of one staffer interviewed for the article was noted to be shared by others: "[this] hesitancy has been echoed by nursing home staff members across the state and country. But [the staffer's] reasoning — as well as that of her colleagues who also opted against the vaccine that day — goes far beyond a simple yes or no. The decision is complicated and multifaceted, they said, which means persuading them to say yes will be, too."
In reaction to the stories that SNF employees were refusing the vaccine, the article goes on to explain: "[S]ome nursing home staffers say their reluctance is being misconstrued. Most are not saying they’ll never take the vaccine, but simply that they have concerns about such a new product. They understand it went through months of clinical trials, but what about possible long-term side effects, for instance? Or how did politics play into the development process? For communities of color, their historical mistreatment by the medical system can also factor into the decision."
The article also reports on various approaches taken by SNFs to get their employees to get vaccinated.
Thursday, February 18, 2021
Register now for two upcoming webinars.
1. Webinar: Financial Protection for Older Adults During the COVID-19 Pandemic set for Feb 23, 2021 at 1 eastern.
Join experts from the Consumer Financial Protection Bureau (CFPB), the Federal Communications Commission (FCC), and ACL on Tuesday, February 23 at 1 pm ET for a free webinar on financial protection of older adults during the COVID pandemic. The FCC will begin the program with an overview of coronavirus-related phone scams targeting older adults. The CFPB will share resources to help older adults address the financial impact of the pandemic. HHS will conclude the webinar with a discussion of the role of the aging services network.
Click on FCC live link to join the webinar on Feb 23 at 1 eastern.
2. A series of 3 webinars from the DOJ Elder Justice Initiative;
- March 4th 2pm EST | Programs for Older Adults Who Have Experienced Financial Exploitation. Learn about three distinct programs designed specifically for older adults who have experienced financial exploitation. Register here.
March 23rd 2pm EST | The Path Forward: One MDT’s Journey to Address the Impact of Racial Injustice on Their Work. The Hennepin County Minnesota Adult Protection/Law Enforcement Multi-Disciplinary Team “MDT” provides a model case study of the impact of racial injustice on their work as an elder abuse MDT in Minneapolis. Register here.
April 13th 2pm EST | Tackling Transnational Robocall Scams: The Importance of State and Federal Partnerships Features a Federal and State partnership that successfully fought against computerized autodialing “robocall” scammers. Register here
February 18, 2021 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Programs/CLEs, State Cases, State Statutes/Regulations, Webinars | Permalink | Comments (0)
Wednesday, February 17, 2021
The Vatican is calling for a new paradigm of care for older people after what it calls the "massacre" wrought by the coronavirus pandemic, which has disproportionately killed people living in nursing homes.
The Vatican's Pontifical Council of Life issued a position paper Tuesday that made the case for a global rethink of how to care for people in their final years, including resisting any rush to institutional care in favor of adapting home environments to the needs of people as they age.
First, good news from California. Recognizing the issue with elders who may not be able to get to vaccine sites (or sign up online....), Kaiser Health News reports on one solution in California. Vaccines Go Mobile to Keep Seniors From Slipping Through the Cracks
The team of county nurses and nonprofit workers is targeting Contra Costa County residents who are eligible for covid vaccines but have been left out: residents of small assisted-living facilities that haven’t yet been visited by CVS or Walgreens, and occasionally people who live in low-income senior housing. The retail pharmacy giants have a federal government contract to administer vaccines in most long-term care facilities.
Launched a few weeks ago, the strike team moves through each vaccination clinic with practiced choreography. At a small group home in Antioch recently, a nurse filled syringes while another person readied vaccine cards and laid them on a table. An administrative assistant — hired specifically for these clinics — checked everyone’s paperwork and screened them for symptoms and allergies before their shots, logging them into the state’s database afterward. After the shots, a strike team member told each person when their 15 minutes of observation was up.
The endeavor is going to take time because there are so many of these facilities, many of which have just a handful of residents. It may be slow-going, but it's going!!!!
So that was the good news. Now for the not-so-good, but not surprising news from this article also published in Kaiser Health News: Family Caregivers, Routinely Left Off Vaccine Lists, Worry What Would Happen ‘If I Get Sick’.
Tens of thousands of middle-aged sons and daughters caring for older relatives with serious ailments but too young to qualify for a vaccine themselves are ... terrified of becoming ill and wondering when they can get protected against the coronavirus.
Like aides and other workers in nursing homes, these family caregivers routinely administer medications, monitor blood pressure, cook, clean and help relatives wash, get dressed and use the toilet, among many other responsibilities. But they do so in apartments and houses, not in long-term care institutions — and they’re not paid.
““In all but name, they’re essential health care workers, taking care of patients who are very sick, many of whom are completely reliant upon them, some of whom are dying... Yet, we don’t recognize or support them as such, and that’s a tragedy.”
If the caregiver is older and meets the age-threshold for the caregiver's particular state, then the caregiver is eligible for vaccination that way. But the younger caregivers are out of luck right now. This is an important article. Read it!
Tuesday, February 16, 2021
Pursuant to the request from the Editor of the ACTEC Law Journal.
Call For Papers: ACTEC Law Journal
Modernizing Trusts and Estates
The American College of Trust and Estate Counsel announces a Call For Papers on the following topic:
As trusts and estates academics and practitioners look forward into the remainder of the 21st century, we acknowledge the aspects of law and practice that are changing, that should change, and that should resist change.
A special issue of the ACTEC Law Journal will be devoted to a discussion of the topic of Modernizing Trusts and Estates and will be comprised of shorter articles (2,500-5,000 words). The issue will focus on what matters are of most importance to the forward-looking trusts and estates professional. Topics may include developments in tax law, adaptations in legal technology, racial justice and diversity, new or impending statutory reform, remote or electronic estate planning documents, the funeral and death industry, and other topics that demonstrate the way in which the trusts and estates landscape is shifting.
Procedure for proposals: Authors wishing to contribute to this special volume should send a brief proposal with estimated word count to Professor Alyssa A. DiRusso, Editor, ACTEC Law Journal, at email@example.com. Please include “ACTEC Theme Volume” in the subject line of your e-mail.
Proposals are due by March 15, 2021 and authors will be notified whether their article has been selected for publication by April 1, 2021. Given the brevity of each article, articles that delve into one or two topics in detail will normally be preferred over more general articles. We encourage submissions by authors from a variety of backgrounds, including those actively involved in fiduciary administration or the practice of law.
Final articles will be due no later than August 1, 2021, and earlier submissions are welcome. Selected articles will be published in the ACTEC Law Journal, Volume 47 Issue 1, with an anticipated publication date of December 2021.
Monday, February 15, 2021
Read these three articles, to get a full picture of what happened. First, the AP story: AP: Over 9,000 virus patients sent into NY nursing homes. Next, the CNN story: New York governor's top aide apologizes and says administration 'froze' after inquiries on Covid-19 deaths at long-term care facilities. Finally, Politico's story: Top Republicans call for Cuomo's ouster following nursing home revelation.
Thursday, February 11, 2021
Sen. Warren calls Genesis Healthcare executive bonus act of ‘unfathomable greed’ according to the recent article published in the Washington Post.
A nursing home chain that gave its former CEO a $5.2 million “retention payment” at the height of the pandemic has received a sharp rebuke from Sen. Elizabeth Warren (D-Mass.), who sits on the Senate’s Special Committee on Aging.
Warren called the payout by Genesis Healthcare to George Hager Jr. — at a time when the death toll among residents was approaching 2,800 and the company was relying on federal emergency aid to survive financially — “inexplicable and unseemly” in a letter dated Jan. 27. She asked the company board to explain its decision and to provide the minutes of all meetings in 2020 where compensation was discussed. And she warned the company not to seek additional emergency relief from Washington.
Wednesday, February 10, 2021
Nike has announced their hands-free shoes, Go Flyease. The article, Nike made a hands-free shoe and you have to see it to believe it describes this new shoe. "[I]t's Nike's first pair of lace-less sneakers that can easily be put on and taken off without using your hands. The casual shoe arrives at a time when people are touching fewer things during the pandemic and a revival of comfier counterparts that take minimal effort to take on and off ...." The description and the video demo make it look easy-peasey: "[t]he Go Flyease has unique features, including a tension band that secures the shoe in place of laces. Putting them on involves just stepping into the shoe so that it will snap into place. Taking them off is done by stepping on the heel." Think about the advantages this will for certain folks, beyond those who are trying to limit their touching.
Thanks to Professor Feeley for sending me the article.
Periodically I will see items about businesses seeking protection against liability for injuries to others that occurred during the pandemic. It's not just SNFs seeking protection. Here are a couple of updates on the topic.
First, a Florida-specific article, Brandes bill shielding business from coronavirus suits gets backing in Senate.
The Senate Judiciary Committee on Monday approved a proposal that would give Florida businesses that “substantially” comply with public-health guidelines broad protection from coronavirus-related lawsuits filed by customers and employees.
The bill (SB 72) would not apply to health-care providers such as hospitals, nursing homes and physicians, who have been clamoring for protections since spring. Instead, the bill would help shield other types of businesses and educational and religious institutions from claims for damages, injuries or deaths.
Then, an article from NPR, Why Nursing Homes' COVID-19 Legal Shields May Interfere With Other Cases. Here is a summary: "[o]ver the course of the pandemic, 27 states have granted legal immunity to nursing homes. Some advocates worry this temporary reprieve is being used to hide misconduct not related to the coronavirus." The link includes the podcast as well as a transcript.