Wednesday, September 15, 2021

Social Security & Medicare Trustees' Reports

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

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

Here's an excerpt from the conclusion:

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


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


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

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

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

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

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

 

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

Tuesday, September 14, 2021

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

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

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

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

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

Monday, September 13, 2021

Webinar on Guardianship Accountability and Autonomy

The Elder Justice Initiative has announced an upcoming webinar, Innovations in Guardianship: Maximizing Autonomy and Ensuring Accountability, scheduled for September 30, 2021 at 2 eastern. Here's a description of the webinar:

Guardianship is one approach to providing support and assistance to adults who need help with decision-making about finances and personal issues. However, as recent high-profile and less visible cases illustrate, guardianship can also infringe on personal rights and can lead to mistreatment of older adults and adults with disabilities. Join us for a webinar to discuss current trends and challenges in state guardianship systems, policies and practice. Using real-life guardianship scenarios, the webinar will explore ways to maximize autonomy and ensure accountability throughout the guardianship process. Presenters will discuss less restrictive alternatives to guardianship as well as ways to improve adjudication and post-appointment oversight of guardians.

The link to register for the free webinar is here.

September 13, 2021 in Cognitive Impairment, Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Programs/CLEs, Webinars | Permalink

Sunday, September 12, 2021

Florida's Guardianship Improvement Task Force

The next public hearing of Florida's Guardianship Improvement Task Force is scheduled for September 14, 2021 (tomorrow) at noon eastern. According to the emailed announcement, "[a] live stream of the meeting can be accessed here beginning at 12:00 p.m., EDT, on September 14The meeting agenda is being finalized and will be available on the Task Force website once completed."  More info about tomorrow's meeting should be available here.

Video of the five prior meetings, as well as supporting materials, are available on the website as well.

According to the website,

The Guardianship Improvement Task Force was formed with the mission of studying the current status of Guardianships in Florida, with the goal of making recommendations to improve the protection of wards throughout the state.

To accomplish this goal, the Task Force will hear from many stakeholders and study current vulnerabilities. After careful consideration, recommendations will be made to improve the protection and best interests of wards. Some recommendations may be directed for action by the various stakeholders, but the anticipation is that most will be offered as positive legislative recommendations.

The Task Force is being sponsored and staffed by the Florida Court Clerks & Comptrollers association.

September 12, 2021 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Programs/CLEs, State Statutes/Regulations, Web/Tech | Permalink

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

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

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

 

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

 

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

 

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

 

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

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

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

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

Friday, September 10, 2021

Bringing Voices of the Public into Classrooms: Lessons from Ireland and 9/11

Dr. Joe Duffy Honored October 2014A number of years ago, I had an especially wonderful sabbatical experience with the help of  the U.S. Fulbright Program that provided opportunities to conduct research in both Northern Ireland and the Republic of Ireland. Queen's University Belfast was my host institution, and there I met Professor Joe Duffy (on the left), who was working in social work, aging services and law.  We have become forever friends, as well as co-workers on several projects.  

One of the key educational concepts I learned from Joe's work was the importance of involving service users in the classroom, as well as in research.  I experienced this as a "student" in Northern Ireland as I listened to speakers with Loyalist (Unionist) and Republican (Nationalist) perspectives on the historic "Troubles" in Ireland.   I'd been working for years with U.S. law school clinics, which are inherently involved with "user" (client) voices, but when I returned from my time in Belfast I began to more actively include older adults in my doctrinal classes, usually as guest speakers about a particular case or experience.  I confess, however, that I've drifted away a bit from that, but today I have a fresh reminder of why it is important to bring clients into the classroom.

Joe Duffy did his own Fulbright-sabbatical in the U.S. recently, and as part of that experience he worked at NYU with social work students and survivors of 9/11.   This week, Queen's University offers Joe's detailed written account of how the NYU team planned carefully for including survivors as speakers in the classroom, and how the experiences were valuable for everyone.  We can -- and I believe should -- remember to make time for similar outreach and listening exercises with students in law school.  Here's a brief taste from Joe's experience with bringing 9/11 survivors into the classroom:

I knew from the beginning that trust building was at the heart of this process. I was indeed mindful of this throughout, where would I start in terms of asking people to share such difficult and personal experiences? The answer was to start with the people themselves and to create a safe environment where people felt valued and respected.  In planning, we met as a group over a number of weeks and decided how the programme would evolve. Every aspect was therefore co-produced and together we agreed the following questions as the basis for the Conversation:

  1. Can you share with these students a summary of your experiences from 9/11?
  2. To what extent does the aftermath of such a traumatic event still impact on your life today and others close to you?
  3. How has this experience affected your identity?
  4. What sort of help did you receive to support you after these experiences?
  5. What are the skills that these students need to focus on when helping an individual cope with trauma related issues and also what are the behaviours they should avoid?
  6. What are the students take away messages from today.

The 90-minute classes ran for three consecutive weeks with two/three group participants joining me each week with the students. The students listened attentively and respectfully to the dialogue and there was total silence in the classroom, such was the emotional magnitude of the atmosphere. After each class we gathered for a coffee at a nearby café which helped the group support each other and reflect on what we had learned from the process.

I encourage you to read Joe's full article, Changed Lives: Voices from 9/11 in the Classroom.  The voices of both survivors and students are captured succinctly here -- and provide wonderful reminders of the importance of a simple (or, perhaps not-so-simple) skill that all lawyers need to cultivate, the ability to listen.  That seems especially relevant as a reminder during the 20th anniversary of 9/11.  

September 10, 2021 in Consumer Information, Current Affairs, International, Legal Practice/Practice Management | Permalink | Comments (0)

Thursday, September 9, 2021

Colorado City Makes Public Apology & Pays $3 Million to Settle Lawsuit Over Violent Takedown and Arrest of Older Woman

In May of 2021, we linked to emerging information about a June 2020 arrest of a 73 year-old woman with dementia in Loveland Colorado.  

The family of the older woman, Karen Garner, filed a civil suit.  On September 8, 2021, the City of Loveland issued a press release announcing a $3 million dollar settlement and expressing an apology to the family:  

“The settlement with Karen Garner will help bring some closure to an unfortunate event in our community but does not upend the work we have left to do. We extend a deep and heartfelt apology to Karen Garner and her family for what they have endured as a result of this arrest,” said Loveland City Manager Steve Adams. “We know we did not act in a manner that upholds the values, integrity, and policies of the City and police department, and we are taking the necessary steps to make sure these actions are never repeated.” 

***

“There is no excuse, under any circumstances, for what happened to Ms. Garner. We have agreed on steps we need to take to begin building back trust. While these actions won’t change what Ms. Garner experienced, they will serve to improve this police department and hopefully restore faith that the LPD exists to serve those who live in and visit Loveland,” Chief Bob Ticer stated.

Criminal charges are still pending against the officers involved in the violent takedown,  in her arrest, and for the detention of the injured woman who was then left without medical care in a holding cell while officers sat comfortably in a booking room, reviewing their own bodycam videos, appearing to laugh over the sound of her breaking arm.  For more, read here and here. 

There is a lot of work still ahead for so many police and detention units.  

September 9, 2021 in Cognitive Impairment, Consumer Information, Crimes, Current Affairs, Dementia/Alzheimer’s, Discrimination, Elder Abuse/Guardianship/Conservatorship, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Monday, September 6, 2021

Massachusetts Supreme Court Holds Conservator Entitled to Absolute Immunity for Conduct "Authorized or Approved" by Probate Court

In a case of first impression for the high court in Massachusetts and decided in August 2021, the Supreme Court concluded that where a conservator acts on behalf of an elderly woman "pursuant to judicial approval as a quasi-judicial officer," the conservator is entitled to "absolute immunity for conduct that is authorized or approved by the probate court."  

In Hornibrook v. Richard,  the plaintiff is one of two sons of a woman in her "mid-eighties and suffering from progressive dementia due to Alzheimer's Disease." He was appointed by a Massachusetts probate court to serve as guardian for his mother, but when his allegedly neglectful brother objected to his appointment as a permanent guardian for their mother, the probate court appointed a Massachusetts licensed attorney, selected from a list of qualified attorneys, to serve separately as the conservator.  The dual appointments occurred in the context of a serious, ongoing dispute between the woman's two sons.  It seems clear the court appointed the nonfamily-member conservator in an effort to diffuse the family dynamics.

Instead, attempts by the conservator to evict or negotiate with the resident-son from the mother's home appear to have dragged on for months, and the mother was never able to return to home.  The guardian-son eventually sued the conservator, alleging (1) breach of fiduciary duty, (2) malpractice, (3) conversion, and (4) fraud.   

The Supreme Court used Massachusetts' "functional analysis" for determining whether an individual performs a quasi-judicial function that entitles the officer to "absolute immunity."  The court compared the case to prior Massachusetts immunity decisions involving a court-appointed psychiatrist, court clerks, guardian ad litem in family court, and a personal representative in an estate, concluding that where individuals are appointed to perform "essential judicial functions" they are entitled to absolute immunity. 

Facts that appeared to be key to this ruling included the conservator's formal request for court authority to take specific, disputed actions, such as renovating the house and placing it on the market for sale. 

The court issued a de-facto caution, however, that immunity may not be granted for all actions taken by a conservator:

"Because the plaintiff here does not allege that the defendant was acting outside the express authorization of the probate court, we do not address the extent to which the conservator may be liable personally when acting within his or her statutory authority but without express authorization or approval of the probate court."

One can anticipate more motions and probate hearings being sought by guardians -- at least the cautious guardians -- as a result of this ruling.  But one can also expect that family members resentful of slow-moving protective-probate proceedings will not be reassured by this ruling.  

September 6, 2021 in Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Medicaid, State Cases | Permalink | Comments (0)

Friday, September 3, 2021

What Happens When You Are "Widowed," Not by the Death of Your Spouse, But By Alzheimer's?

New York Times Magazine has an Ethicist Columnist and recently the topic was "My Stepdad Has Alzheimer's. Can My Mom Date Someone Else?"

The adult child who raises the topic explains that her mother was a long-standing, full-time caregiver for her husband, who's early-onset diagnosis of Alzheimer's had deepened to the point that he was transferred to a more appropriate, assisted-living setting.  Lonely and missing companionship, the mother began dating another man.  On the one hand, the ethicist was tackling the concern about the appropriateness of the couple "dating."  The deeper concern, however, appeared to be that the man the mother was dating might not be a good choice, and potentially even an unsafe choice, and the family disapproved.

On the question of "dating" while still married to a spouse with dementia, the ethicist, Kwame Anthony Appiah (who teaches philosophy at NYU), makes the startling, but apt, observation about de facto widowhood:  

Making sure that a spouse is cared for is one commitment that marriage entails and, having served as a full-time caregiver, your mother has clearly done so, at real personal sacrifice. But we should not want our spouses to abjure the companionship of others once we are no longer available to them. Indeed, nobody in your family has the right to expect this of her. The painful truth is that her status is ethically equivalent to that of a widow.

The comments posted after the article in response to the ethicist's discussion are also interesting, including what sprang to my mind, a recommendation of  a sensitively-made movie directed by Sarah Polley, based on the author Alice Monroe's novel with the same title, Away from Her. 

 

September 3, 2021 in Books, Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Ethical Issues | Permalink | Comments (0)

Thursday, September 2, 2021

Star Trek Legend Conservatorship Battle

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

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

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

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

Examining Use and Misuse of Tax-Exempt or Deferred Financial Retirement Savings Plans As Increasing Economic Disparity

Check out "America is Spending A Fortune to Help Rich People Retire in Luxury," authored by Michael Mechanic. Published this week in Mother Jones, the article examines how "America's most affluent" use Roth IRAs and similar "federally subsidized retirement accounts meant for middle-class savers" to maximize their wealth.  

But it turns out IRAs are only the tip of the iceberg. The bigger problem, according to Steve Rosenthal, a tax attorney and senior fellow at Urban-Brookings Tax Policy Center, is that, thanks to a series of bipartisan bills Congress has passed over the past quarter-century, the government spends a fortune subsidizing a whole range of retirement plans whose benefits flow overwhelmingly to America’s most affluent. “It’s unbelievable the amounts of dollars at stake, and how tilted they are to the high end,” Rosenthal told me. “It’s just staggering.”

 

Indeed, such subsidies are the federal government’s single biggest tax-related expense, costing hundreds of billions of dollars per year. From 2020 through 2024, the JCT estimates, tax breaks and deferrals for retirement contributions will cost the Treasury $1.9 trillion—far more than the cost of the child/dependent or earned income tax credits, tax deductions for charitable donations, tax exclusions on long-term capital gains, or corporate tax breaks for employer-provided health and life insurance benefits. “These retirement reform packages are exceptionally confusing and technical and long and really hard for anyone to sort out,” says Rosenthal, a former JCT staff lawyer himself. “But embedded in every one are easter eggs: big giveaways to the retirement industry and to high-net-worth individuals.”

There is a lot to unpack here, and I could certainly see a seminar course built around this topic, including the complexity of finding solutions that don't harm the more-modest investor who will need every dime in retirement.  

My thanks to University of Virginia Law Professor Naomi Cahn for sharing the article, and to her colleague at UVA, Professor Michael Doran, who is prominently cited in the article  for his critiques of so-called savings reforms that "delivered expensive and unnecessary tax subsidies," that benefited higher income families and the financial services industry.

September 2, 2021 in Consumer Information, Current Affairs, Discrimination, Federal Statutes/Regulations, Retirement, Statistics | Permalink | Comments (1)

Wednesday, September 1, 2021

Elders Still Not Vaccinated

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

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

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

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

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

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

Tuesday, August 31, 2021

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

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

Here's a  description of the program:

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

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

 

 

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

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

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

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

 

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

 

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

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

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

 

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

Monday, August 30, 2021

Medicare Dental Coverage a Possibility?

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

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

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

Hidden Costs of Caregiving

Vox recently published The staggering, exhausting, invisible costs of caring for America’s elderly. "As someone ages, their health appears to gradually deteriorate in a way that doesn’t seem alarming. Most of the time, though, they’re inching toward a cliff — and when they fall off, they find themselves on another health cliff, and another, and another. With each cliff, it gets more difficult for a family member to catch them."  Lack of long term care insurance and a lack of understanding of what Medicare covers leaves many unprepared when the need for caregiving arises.  Nursing homes remain expensive and concerns arising as a result of COVID remain relevant today, the article notes. The impact on caregivers is highlighted in the article. Here are some excerpts:

[M]ost of this care work — both paid and unpaid — remains invisible. According to the most recent data from the AARP, an estimated 41.8 million people, or 16.8 percent of the population, currently provides care for an adult over 50. That’s up from 34.2 million (14.3 percent) in 2015.

Of those caregivers, 28 percent have stopped saving, 23 percent have taken on more debt, 22 percent have used up their personal short-term savings, and 11 percent reported being unable to cover basic needs, including food. The average age of someone providing care for an adult is 49, but 23 percent are millennials and 6 percent are Gen Z. Sixty-one percent are women, and 40 percent provide that care within their own homes, up from 34 percent in 2015.

A lot of these caregivers are really, really struggling. What’s required of them is more complex and time-consuming than just 10 years ago, as caregivers deal with overlapping diagnoses related to physical health, mental health, and memory loss as the elderly live longer. The work is much more than just clearing out the guest room or setting another place at the dinner table.

I find the article thoughtful and thought-provoking. It's worth reading and I'll use it in my class.  Consider this excerpt:

t’s only recently that we’ve settled on the understanding that care for elders is natural, moral, and ideal, even when the people providing this care are suffering or lacking the skills to provide the quality of care the recipient requires, or both. Crucially, by locating responsibility for care squarely on the family unit, it also continues to limit or excuse greater society — which is to say, the government — from the responsibility of providing care to the most vulnerable members of society. Our belief that the family is always the best and preferred care provider makes it much harder to advocate for the sort of larger, taxpayer-funded systems that would make all care, regardless of whether it’s provided by a family member, far easier.

There are other consequences to this naturalization of family responsibility. When labor is continually framed as something done out of love or instinct, it loses its connotation as labor and, by extension, its value. When women (and white middle-class women in particular) began moving into the workforce en masse in the second half of the 20th century, they didn’t quit their domestic work. They just did two jobs, one layered on top of the other; they would put in a full day in a traditional workplace for pay, then went home and kept working, unpaid.

Many women could only juggle these two separate jobs with the help of other women, both paid and unpaid. Poor working women had been doing this for some time, relying on “kith and kin” for child care in particular. Some middle-class women increasingly began to do the same, relying on friends but mostly family, while some began paying other women to do the work. This domestic labor, whether in the form of child-rearing, laundering, cleaning, or cooking, was essential, but because it had been so thoroughly normalized as unpaid work, it was also easy to normalize incredibly low wages for those who do it, even if that person had no relation to the family.

The article discusses the stresses of, and costs from caregiving and concludes with a sense of urgency regarding a looming crisis, if action isn't taken

Right now, several experts told me, the public alarm around the state of elder care is about where it was with child care 10, 15 years ago. We didn’t act on the alarm bells when it came to child care, and now the system is in a pandemic-accelerated crisis, with rippling effects across the economy. The question, then, is whether we want to wait the 10, 15 years for that implosion, right as even more Gen X-ers, millennials, and older Gen Z-ers age into caregiving roles and, shortly thereafter, need their own care. Or do we want to address the problem now, before it risks collapsing us, and our families, entirely.

Thanks to Morris Klein for sending me the link to this article.

August 30, 2021 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Medicaid, Medicare | Permalink | Comments (1)

Saturday, August 28, 2021

United Kingdom to Begin Offering Home-Finger-Prick Tests for Covid-19 Antibodies

Yesterday, I wrote here about what I'm hearing about use of antibody testing in some long-term care facilities in Pennsylvania.  The more I read about antibody testing for COVID-19, the more I'm surprised by the state of the science and the level of apparent uncertainty about appropriate uses for such tests. 

I've read published articles suggesting multiple explanations for why such tests have not been widely used as part of the response to COVID-19 and variant infections including:

  • Lack of availability of commercially-based testing products 
  • Lack of reliable testing products
  • Lack of FDA protocols to establish reliable tests
  • Disagreements (or lack of clarity) over what level of antibodies should be considered "protective"
  • Concern that any test results could be misused 
  • Lack of easily administered tests, especially tests that would not require medically-trained persons for blood draws

See, for example, these two articles by John Hopkins Center researchers:  Rachel M. West et al, Antibody (Serology) Tests for COVID-19: A Case Study (May 2021); Rachel West, et al, COVID-19 Antibody Tests: A Valuable Public Health Tool with Limited Relevance to Individuals (November 2020). 

As a non-scientist I can understand some of these concerns for the first half of this pandemic, where the issue was whether and to what extent actual infection would provide protection against reinfection. But, with almost 9 months of publicly administered vaccines, it is troubling to think that there could still be concerns about reliability of antibody testing following those vaccinations. Can an illness be called a "breakthrough" infection if the level of immunity wasn't being tested?  Or rather, if the immunity status couldn't be reliably detected?  

In any event, as I dig deeper, it seems that the U.K. is moving forward this month (August 2021) to "begin offering COVID-19 antibody testing to the general public...for the first time" via a home-administered finger-prick test.  From a Reuters report that leans on other media sources:

The government's new programme is intended to produce data on antibody protections for people following infection by different coronavirus variants, according to details of the programme published by multiple media outlets, including Sky News and BBC.

 

From Tuesday, anyone aged 18 or over in England, Wales, Northern Ireland and Scotland, will be able to opt in to the programme when receiving a PCR test, Sky News reported.

 

Participants, on testing positive for COVID-19, will be sent two finger-prick tests to complete at home to inform the UK Health Security Agency of the antibody response to different coronavirus variants, BBC reported.

Again, I find it odd that the U.K. goal -- at least so far as this report -- is to determine level of antibody protections following "infections" rather than "immunizations." Why not both? Why not especially the latter?   I'd still like to think that the U.S. can better prioritize the need for any and all protective actions, including booster shots, through intelligent use of antibody testing. 
 
One of my new (and exciting) colleagues, Penn State Dickinson Law Assistant Professor Sara Gerke, is the lead author on an article discussing appropriate safeguards for implementation of employment-based antibody testing.  See Covid-19 Antibody Testing as a Precondition for Employment: Ethical and Legal Considerations, published Summer 2021 in The Journal of Law, Medicine & Ethics. The analysis begins with a series of important research-assumptions.  The authors "assume that there is an antibody test for COVID-19 on the market that is accurate and reliable with high specificity and sensitivity." They acknowledge "FDA authorized tests meeting a reasonable threshold of accuracy and reliability" are essential to establish an ethical basis for their use.  
 
So much of COVID-19 testing is happening in an unusually public context, with new information generated every day. The intensity of a pandemic response certainly affects research and treatment priorities.  Nonetheless, the fact that some facilities are using antibody tests to facilitate care decisions seems significant.  Could certain residential institutions offer -- encourage? -- voluntary testing for COVID-19 antibodies, especially after the administration of the first doses, and  both before and after any booster doses?  Could colleges and universities, assisted living centers and nursing homes, all places where people are likely to live, work, and play together in close quarters around the clock, be uniquely good platforms for important data generation?   Could these locations be making better priority-based decisions about protective measures that both help their customers stay safe and provide better information for the public at large? 

August 28, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, Science, Statistics | Permalink | Comments (0)

Friday, August 27, 2021

Are LTC Residents "Telling" Us that Antibody Testing is Important for Covid-19 Prioritization for Boosters?

In recent weeks, I've spoken to or read about residents of long-term care facilities being tested for Covid-19 antibodies.  Some residents, without being ill, are showing low (or even "no") levels of antibodies, despite having been fully inoculated in the spring of 2021.  This doesn't mean there was anything wrong with the original vaccinations, but it does suggest that at least for older persons, the immunity reduces over time.   As a result of these test results, the facilities are recommending that families support getting booster shots for their loved ones. That strikes me as using scientific data appropriately, to help prioritize next steps in fighting the troublesome developments with Covid-19. 

Why aren't other institutions, including universities, seeking similar information about antibodies or lack thereof?   Does it "matter" that a faculty member -- or a student -- or an administrator -- or a staff member -- was "fully vaccinated" in, for example, February 2021, if they aren't still "protected" in September 2021?  

Here's what I know so far:

  • My own health insurance company requires a "doctor's order" to permit an antibody test to be covered for reimbursement.
  • My local pharmacy advertised last spring that its onsite clinic would be offering antibody tests.  I learned recently, however, that it never actually set up that program.  The pharmacist I talked with didn't know why that decision was reversed.
  • My regular physician said I could sign up for a booster shot approximately 9 months from my last of the two-shot original vaccination, and said that therefore I didn't need an antibody test.
  • My insurance company asked whether I had a known exposure to Covid-19, implying that if the answer was yes, they would cover testing for a breakthrough-Covid infection, but not for antibody testing unless I had a doctor's order.

I realize one personal anecdote isn't evidence of much of anything.  But, is nursing home data already being generated that suggests antibody testing can supply relevant facts, perhaps facts that are "more" relevant than simply a history of immunization?     

 

August 27, 2021 in Consumer Information, Health Care/Long Term Care, Science, Statistics | Permalink | Comments (0)

Monday, August 23, 2021

Nurse Robots?

There have been stories of late about shortages of nurses, for various reasons. For example, NPR reported, Hospitals Face A Shortage Of Nurses As COVID Cases Soar. So, then a dear friend and colleague of mine today sent me a link to this story: Meet Grace, the ultra-lifelike nurse robot.  Grace, developed by a robotic company in Hong Kong, is "a humanoid robot it hopes will revolutionize healthcare.... Designed as an assistant for doctors, Grace is equipped with sensors, including a thermal camera to detect a patient's temperature and pulse, to help doctors diagnose illness and deliver treatments....The android is a companion for patients, too. Specializing in senior care, Grace speaks three languages -- English, Mandarin, and Cantonese -- and can socialize and conduct talk therapy."  The company expects to start large scale production of this robot and another robot by year's end. The article notes that this robot is attended to assist, not supplant, health care providers.  There's an accompanying video, which includes a brief clip of the robot showing Tai Chi moves to the reporter.  The robot at one point responds that her specialization is in "senior care." I don't know what the cost will be of such a robot and what patient load it can handle. Plus, I'm not sure about the lack of human connections in caregiving.  We'll have to wait to see whether the robot is at least a partial solution to the caregiving and nursing shortages.

 

August 23, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, International, Science | Permalink | Comments (0)

Thursday, August 19, 2021

The "State" of Aging in the U.S.

Let's close out the week with some data.  The Population Reference Bureau has released new data about An Improved State of Aging in America. 

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.

August 19, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other, Statistics | Permalink | Comments (0)