Monday, September 9, 2019
Recently I had the enjoyable experience of being interviewed by Jon Wainwright, Project Manager for the Capital Center for Law and Policy at McGeorge School of Law, University of the Pacific. He asks great questions. His podcast project, CAP-Impact, is a well-developed resource to foster nonpartisan understanding of law and policy, offering a wide array of discussion topics, ranging from the role of lobbyists to science-based support for law reform.
The interview focused on the Guardian Education Project I'm working on currently with community stakeholders, law students (Summer 2019 Team pictured here) and faculty, with financial support from Penn State University. This project is an outgrowth of the Pennsylvania Supreme Court's Elder Law Task Force that recommended changes in procedures and policies governing adult guardianships in Pennsylvania, including better education for new guardians.
For the actual podcast -- about 25 minutes in length -- go to Episode 53: Data Driven Best Practices for Protecting the Elderly with Professor Katherine Pearson.
Don't forget to "like" it -- or whatever is appropriate as support for Jon's podcast project. As he amusingly pointed out, "elder law" isn't usually considered to be a sexy area for researchers, but as he demonstrates, what happens with older adults or others in potential risk of neglect or exploitation, is important!
Sunday, September 8, 2019
With Dorian finally moving on, I thought it would be good for all of us to post something that was happy. So Kiplinger ran an article, 10 of the Happiest Places to Retire in the U.S. According to the article, these "10 retirement destinations rank the highest in terms of the overall well-being of residents." These are Charlottesville, VA; Ann Arbor, MI: Portland, ME;Carlsbad, CA; Durham-Chapel Hill, NC; Cape Coral, FL; Richland, WA;; Provo, UT; Charleston, S.C.; and Burlington, VT. Not having lived in these, I can't comment on if they are happy places to live.
To come up with the rankings, Kiplinger relied on the "Well-Being index" which the article explains " is based specifically on residents' feelings about five elements of well-being: "purpose" (liking what you do and being motivated to achieve goals), "social" (having supportive relationships and love), "financial" (managing your budget to feel secure), "community" (liking where you live) and "physical" (being in good health). " Using this index, then Kiplinger "factored in the "community" and "physical" components of the Well-Being Index, where available, as well as living costs, safety, median incomes and poverty rates for retirement-age residents and the availability of recreational and health care facilities."
The article is available here.
Tuesday, August 27, 2019
We have all had that after lunch afternoon slump where we just want a nap. Do you find yourself napping more than usual? There is a new study on changes to sleep-wake cycles and Alzheimer's. For the non-scientist like me, here's the USA Today story: Napping more? That could be an early symptom of Alzheimer's, new study says.
So wait, don't panic if you are a normal napper. Here's a segment from the article that explains: "People who develop Alzheimer's tend to sleep more during the day, taking naps or feeling drowsy and dosing off. Sometimes, they wake up during the night; that's called fragmented sleep .... If napping is a part of your routine on a regular basis though, you don't need to worry about taking an afternoon snooze, or mid-morning for that matter." So it's all about the change in sleep patterns. Whew.
Here's the abstract for the article about the study.
Sleep-wake disturbances are a common and early feature in Alzheimer's disease (AD). The impact of early tau pathology in wake-promoting neurons (WPNs) remains unclear.
We performed stereology in postmortem brains from AD individuals and healthy controls to identify quantitative differences in morphological metrics in WPNs. Progressive supranuclear palsy (PSP) and corticobasal degeneration were included as disease-specific controls.
The three nuclei studied accumulate considerable amounts of tau inclusions and showed a decrease in neurotransmitter-synthetizing neurons in AD, PSP, and corticobasal degeneration. However, substantial neuronal loss was exclusively found in AD.
WPNs are extremely vulnerable to AD but not to 4 repeat tauopathies. Considering that WPNs are involved early in AD, such degeneration should be included in the models explaining sleep-wake disturbances in AD and considered when designing a clinical intervention. Sparing of WPNs in PSP, a condition featuring hyperinsomnia, suggest that interventions to suppress the arousal system may benefit patients with PSP.
The full study is available here.
Monday, August 19, 2019
The Washington Post offers a feature story on Maine's current care employment crisis for all industries serving frail elders, including nursing, home-care agencies, nursing homes, hospice programs and hospitals. Pointing to one town's dramatic needs, as the demographic "oldest" city in the "oldest" state in the nation, the article makes clear that the problems are likely coming to communities all across the country -- and certainly I have witnessed it first hand in Arizona.
With private help now bid up to $50 an hour, Janet and her two sisters have been forced to do what millions of families in a rapidly aging America have done: take up second, unpaid jobs caring full time for their mother.
“We do not know what to do. We do not know where to go. We are in such dire need of help,” said Flaherty, an insurance saleswoman.
Across Maine, families like the Flahertys are being hammered by two slow-moving demographic forces — the growth of the retirement population and a simultaneous decline in young workers — that have been exacerbated by a national worker shortage pushing up the cost of labor. The unemployment rate in Maine is 3.2 percent, below the national average of 3.7 percent.
The disconnect between Maine’s aging population and its need for young workers to care for that population is expected to be mirrored in states throughout the country over the coming decade, demographic experts say. And that’s especially true in states with populations with fewer immigrants, who are disproportionately represented in many occupations serving the elderly, statistics show.
In terms of statistics, one "crucial milestone" is the percentage of a population older than 65, the "super-aged" label. In Maine, one-fifth of the state's population is in that category, and by 2026, Maine is predicted to be joined by 15 other states, with another dozen reaching the same level by 2030.
Across the country, the number of seniors will grow by more than 40 million, approximately doubling between 2015 and 2050, while the population older than 85 will come close to tripling.
There are tough statistical realities to confront, including the tension between living wages for workers and affordability for families paying for care out-of-pocket. One of the subtle issues is how to manage pay. Employment agencies often retain at least half of the dollars charged for hourly care. Families who want or need to pay privately must make a very real decision on whether to pay "on" or "off" the books. For those paying on the books, it means learning to navigate systems for withholding proper amounts for taxes, any insurance and other deductions.
Tuesday, August 6, 2019
With the New Jersey law going into effect last week (August 1, 2019), there are now 8 states that allow medical aid in dying, according to a recent New York Times story, Aid in Dying Soon Will be Available to More Americans. Few Will Choose It.
Maine's law becomes effective September 15, 2019, about 5 weeks from now. So with 9 states providing that option, "by October, 22 percent of Americans will live in places where residents with six months or less to live can, in theory, exercise some control over the time and manner of their deaths. (The others: Oregon, Washington, Vermont, Montana, California, Colorado and Hawaii, as well as the District of Columbia.)" Even with these laws in place, there are still issues facing the patients, the story explains. There is "an overly complicated process of requests and waiting periods" as well as the sections of the law that allows doctors to opt-out, so access may be limited.
The article also discusses why there seems to be a "trend" (if you call 9 states a trend) toward changing attitudes regarding medical aid-in-dying:
All these laws require states to track usage and publish statistics. Their reports show that whether a state has six months or 20 years of experience, the proportion of deaths involving aid in dying (also known, to supporters’ distaste, as physician-assisted suicide) remains tiny, a fraction of a percentage point.
California, for example, in 2017 received the mandated state documents for just 632 people who’d made the necessary two verbal requests to a physician, after which 241 doctors wrote prescriptions for 577 patients. More than 269,000 Californians in all died that year.
With such data showing no slippery slope toward widespread use or abuse, “a lot of the hypothetical claims our opponents made no longer carry so much weight with lawmakers,” said Kim Callinan, chief executive of Compassion & Choices.
There is even a change within the health care profession re: this issue, but there are still opponents to it. Even those who support it may not use it, and the process within the law may provide barriers to patients, according to the article. Safeguards in the laws may be imposing obstacles to some including the waiting period, the 6 month limit and others.
Clearly this is a topic on which we still will see developments. So....stay tuned.
Thursday, August 1, 2019
The Washington Post reported an updated development for Physician-Aided Dying in Oregon. Oregon removes assisted suicide wait for certain patients explains that the governor signed a bill that allows individuals who have 15 or less days to live to skip the 15 day cooling off period.
Those seeking life-ending medications had to make a verbal request for physician-assisted suicide, wait 15 days and then make a written request. They then had to wait an additional 48 hours before obtaining the prescription.
Under the new amendment, doctors can make exceptions to the waiting periods if the patient is likely to die before completing them.
The article discusses the position of those who opposed the amendment and notes that the number of folks availing themselves of PAD remains low.
The number of people who have taken advantage of Oregon’s law has been relatively small. Since it enacted the nation’s first physician-assisted suicide law in 1997, nearly 1,500 people died from taking life-ending medications prescribed to them by a physician. In 2018, about 46 per every 10,000 deaths could be attributed to the state’s death with dignity law, according to state data.
Thursday, July 25, 2019
The Global Brain Health Institute is taking applications for those who are interested in becoming an Atlantic Fellow for Equity in Brain Health at the GBHI.
The Atlantic Fellows for Equity in Brain Health program at GBHI is an opportunity to elevate ...r dedication and contributions to brain health. Applicants should demonstrate a commitment to brain health and health care policy, as well as an ability to implement effective interventions in their home community and to become a regional leader in brain health.
GBHI welcomes applications from people living anywhere in the world and working in a variety of professions. Fellows are typically early and mid-career. At least one-half of fellows will come from outside the US and Ireland, with an initial emphasis on Latin America and the Mediterranean.
Thanks to Sarah Hooper, Executive Director & Adjunct Professor of Law, UCSF/UC Hastings Consortium on Law, Science & Health Policy, Policy Director | Medical-Legal Partnership for Seniors, Senior Atlantic Fellow for Health Equity | Atlantic Institute for sending me the announcement.
Wednesday, July 24, 2019
The Washington Post ran a story with this eye-catching headline, He was deemed too old to be dangerous. Now, at 77, he’s been convicted of another murder.
When we teach elder law, oftentimes the focus is on the elder as a victim, but we do know that an elder can also be a perpetrator. In this case, the perpetrator, who
When he came before a judge in Portland, Maine, in 2010, he was in his late 60s, and had spent roughly a third of his life in prison. After doing time for killing his wife, he had assaulted another woman and gone back to jail, only to get out and attack a third woman. Flick’s violent tendencies didn’t seem likely to go away with age, both the prosecutor and his probation officer warned. But the judge chose to sentence him to just shy of four years in prison, noting that by the time he was released in 2014, he would be 72 or 73.
Here's the crux of the matter--the quote from the judge who sentenced him: "[a]t some point Mr. Flick is going to age out of his capacity to engage in this conduct... , and incarcerating him beyond the time that he ages out doesn’t seem to me to make good sense.” The article notes that statistics support the judge's perspective on this, but those statistics didn't predict the outcome here:
Eight years after that hearing, [he] struck again, fatally stabbing a woman outside a laundromat ... as her 11-year-old twin sons watched. Now 77, he was convicted of murder ... and, this time, it looks likely that he’ll spend the rest of his life in prison. The charges carry a minimum 25-year sentence, and prosecutors plan to request that he be placed behind bars for life.
So to answer the question posed in the title of this post, No, he wasn't too old to commit another murder.
Thursday, July 18, 2019
The Employee Benefits Research Institute (EBRI) has announced a webinar on July 24, 2019 at 2:00 p.m. edt. on Spending Patterns of Older Households and Their Financial Planning Implications.
Here's a description of the webinar:
Please join EBRI for a webinar reviewing findings from its latest research on spending behavior of older Americans. EBRI researcher Zahra Ebrahimi will examine how spending varies by retirement status, wealth, and demographic characteristics. We will then hear from Sharon Carson, Retirement Strategist, Executive Director at J.P. Morgan Asset Management, to understand the implications of these findings in assessing retirement income adequacy for financial planning purposes.
To register for the webinar, click here.
Monday, July 15, 2019
According to a recent story published in Modern Healthcare, Nursing home staffing levels often fall below CMS expectationsfocuses on a new study that "[n]ursing home staffing levels are often lower than what facilities report, which could compromise care quality, new research shows....Self-reported direct staffing time per resident was higher than the CMS' payroll-based metrics 70% of the time, according to a new study published in Health Affairs. Staffing levels were significantly lower during the weekends, particularly for registered nurses."
We know the importance of staffing as a quality measure and ensuring quality of care, so this study is very important. "Researchers compared facility-reported staffing and resident census data and annual inspection survey dates from the Certification and Survey Provider Enhanced Reports to the CMS' long-term care facility Staffing Payroll-Based Journal from 2017 to 2018. The payroll-based data offered a more granular look, showing how staffing evolves over time rather than relying on static point-in-time estimates that were subject to reporting bias and rarely audited...."
When comparing for-profit SNFs with NFP SNFS, the researchers found the for-profits "more likely to report higher staffing numbers ... and [s]taffing levels increased before and during the times of the annual surveys and dropped off after."
The use of payroll data to determine staffing levels has only been in effect a little over a year. The story focuses specifically just on staffing levels. A log-in is required to access the study.
Friday, July 12, 2019
Pew Research has a new Fact Tank, "On average, older adults spend over half their waking hours alone" which explains that "Americans ages 60 and older are alone for more than half of their daily measured time – which includes all waking hours except those spent engaged in personal activities such as grooming. All told, this amounts to about seven hours a day; and among those who live by themselves, alone time rises to over 10 hours a day, according to a new Pew Research Center analysis of Bureau of Labor Statistics data."
That seems like a lot, especially when you compare the "alone-time" for other generations to this one: "people in their 40s and 50s spend about 4 hours and 45 minutes alone, and those younger than 40 spend about three and a half hours a day alone, on average. Moreover, 14% of older Americans report spending all their daily measured time alone, compared with 8% of people younger than 60."
Alone time isn't a bad thing-just ask any introvert-but even too much of a good thing can be ... too much. Alone time "can be a measure [used for] social isolation" which can have a correlation to "negative health outcomes among older adults. Medical experts suspect that lifestyle factors may explain some of this association – for instance, someone who is socially isolated may have less cognitive stimulation and more difficulty staying active or taking their medications. In some cases, social isolation may mean there is no one on hand to help in case of a medical emergency."Living arrangements also play a role in how much time a person is alone. "More than a third (37%) of older adults who live alone report spending all their measured time alone. Among those who live with someone other than a spouse, the average amount of alone time a day is seven and a half hours."
Tuesday, July 9, 2019
Do you plan to retire? If you answer is no, you aren't alone. According to a recent poll in the Associated Press, almost 25% of folks plan to keep work. Poll: 1 in 4 don’t plan to retire despite realities of aging found a possible "disconnection between individuals’ retirement plans and the realities of aging in the workforce." The realities of life ... and aging... "often force older workers to leave their jobs sooner than they’d like." The article notes things like caregiving and health as reasons that cause folks to leave employment. In addition to this nearly 25% who plan to keep working, which "[includes] nearly 2 in 10 of those over 50.... [r]oughly another quarter of Americans say they will continue working beyond their 65th birthday."
The article contains data regarding the impetus to keep working (including financial needs) and the perceptions among those in the workforce regarding the continued employment of older workers:
39% think people staying in the workforce longer is mostly a good thing for American workers, while 29% think it’s more a bad thing and 30% say it makes no difference.
A somewhat higher share, 45%, thinks it has a positive effect on the U.S. economy.
Working Americans who are 50 and older think the trend is more positive than negative for their own careers — 42% to 15%. Those younger than 50 are about as likely to say it’s good for their careers as to say it’s bad.
However, desire and reality aren't always a match. The article also discusses reasons why folks who want to keep working have to leave the workforce.
Thanks to Professor Naomi Cahn for sending me the link to the story.
Wednesday, July 3, 2019
In May, AARP ran a story about research identifying a new dementia that is not Alzheimer's. Is It Alzheimer's ... or LATE? explains about recent results into research of cases that although thought to be Alzheimer's are not. "[A] report published in the medical journal Brain reveals that in cases involving people older than 80, up to 50 percent may, in fact, be caused by a newly identified form of dementia. It's called LATE, which is short for limbic-predominant age-related TDP-43 encephalopathy....The news, published last month, is being heralded as a potential breakthrough, as identifying a new type of dementia could be critical for targeting research — for both LATE and Alzheimer's. In fact, the report included recommended research guidelines as well as diagnostic criteria for LATE." The disease can mimic some aspects of Alzheimer's, the story explains, and it can only be identified in an autopsy.
Here is the abstract from the study:
We describe a recently recognized disease entity, limbic-predominant age-related TDP-43 encephalopathy (LATE). LATE neuropathological change (LATE-NC) is defined by a stereotypical TDP-43 proteinopathy in older adults, with or without coexisting hippocampal sclerosis pathology. LATE-NC is a common TDP-43 proteinopathy, associated with an amnestic dementia syndrome that mimicked Alzheimer’s-type dementia in retrospective autopsy studies. LATE is distinguished from frontotemporal lobar degeneration with TDP-43 pathology based on its epidemiology (LATE generally affects older subjects), and relatively restricted neuroanatomical distribution of TDP-43 proteinopathy. In community-based autopsy cohorts, ∼25% of brains had sufficient burden of LATE-NC to be associated with discernible cognitive impairment. Many subjects with LATE-NC have comorbid brain pathologies, often including amyloid-β plaques and tauopathy. Given that the ‘oldest-old’ are at greatest risk for LATE-NC, and subjects of advanced age constitute a rapidly growing demographic group in many countries, LATE has an expanding but under-recognized impact on public health. For these reasons, a working group was convened to develop diagnostic criteria for LATE, aiming both to stimulate research and to promote awareness of this pathway to dementia. We report consensus-based recommendations including guidelines for diagnosis and staging of LATE-NC. For routine autopsy workup of LATE-NC, an anatomically-based preliminary staging scheme is proposed with TDP-43 immunohistochemistry on tissue from three brain areas, reflecting a hierarchical pattern of brain involvement: amygdala, hippocampus, and middle frontal gyrus. LATE-NC appears to affect the medial temporal lobe structures preferentially, but other areas also are impacted. Neuroimaging studies demonstrated that subjects with LATE-NC also had atrophy in the medial temporal lobes, frontal cortex, and other brain regions. Genetic studies have thus far indicated five genes with risk alleles for LATE-NC: GRN, TMEM106B, ABCC9, KCNMB2, and APOE. The discovery of these genetic risk variants indicate that LATE shares pathogenetic mechanisms with both frontotemporal lobar degeneration and Alzheimer’s disease, but also suggests disease-specific underlying mechanisms. Large gaps remain in our understanding of LATE. For advances in prevention, diagnosis, and treatment, there is an urgent need for research focused on LATE, including in vitro and animal models. An obstacle to clinical progress is lack of diagnostic tools, such as biofluid or neuroimaging biomarkers, for ante-mortem detection of LATE. Development of a disease biomarker would augment observational studies seeking to further define the risk factors, natural history, and clinical features of LATE, as well as eventual subject recruitment for targeted therapies in clinical trials.
The full article is available here as a pdf.
Wednesday, June 26, 2019
A colleague and dear friend of mine is doing amazing work to combat climate change. I have on several occasions told him he should look at the impact of climate change on elders but never have I thought about the role of elders in contributing to climate change.... until now. Last month the New York Times ran an article, Older People Are Contributing to Climate Change, and Suffering From It.
Not only have elders seen climate change happening, according to the article, "Older Americans ... are significant contributors to climate change. A just-published study has found that residential energy consumption rises as a resident’s age increases." The article examines the why of this and although "[t]he study could not provide explanations, but“there might be more need for air-conditioning,” ... [o]r older people may not be able to maintain their homes as well to conserve energy....." Living in one of those southern states where air conditioning is a must and on extremely hot days we get warnings about certain folks needing to stay in air conditioning, I can say the researcher was right on that reason.
The article notes that there is a vicious cycle occurring-"There will be more warm days in most areas because of climate change... [and] more energy use by the older group... [with] the population aging, there will be more people in that age group.'"
The article goes on to discuss how older people are disproportionately affected by climate extremes and disasters. Fighting climate change should be one of our top priorities because we are all affected by it-but clearly our older folks are affected more than most.
Thank you Roy for all of your work.
Tuesday, June 25, 2019
That's the age-old (pun intended) question, isn't it? I know my students perceive me as old, but I know in my mind I'm not as old as my chronological age would denote. So the Washington Post tackled the "how old is old?" question in a recent story, An ageless question: When is someone ‘old’?
Typically, people decide who is “old” based on how many years someone has already lived, not how many more years they can expect to live, or even how physically or cognitively healthy they are. I will soon turn 62. What does that actually tell you? Not very much, which is why, like many of my sexagenarian friends, I’m apt to claim, “Yes, age is just a number.”
So what does “old” really mean these days?
All of us who teach elder law know that asking how old is old is valid and important. It impacts eligibility for programs and benefits, for example. It's also important for the purpose of policymakers who have to make plans for aging populations, the article explains. In the U.S. we still see the use of 60 or 65 as a threshold to "old."
The United Nations historically has defined older persons as people 60 years or over (sometimes 65). It didn’t matter whether you lived in the United States, China or Senegal, even though life expectancy is drastically different in each of those countries. Nor did it depend on an individual’s functional or cognitive abilities, which can also be widely divergent. Everyone became old at 60. It was as though you walked through a door at midnight on the last day of 59, emerging a completely different person the next morning: an old person.
Two experts quoted in the article, demographers, discuss the different between chronological age and prospective age, that is "'chronological age 'tells us how long we’ve lived so far. In contrast, prospective age is concerned about the future. Everyone with the same prospective age has the same expected remaining years of life.'” One of them is quoted as saying you are old when you have a "specific life expectancy is 15 years or less. That .. is when most people will start to exhibit the signs of aging, which is to say when quality of life takes a turn for the worse." By this measure I'm not old yet but by golly I'm close.
The expert when on to elaborate
[For] ... folks in the United States... When are we considered old? For women, the old age threshold is about 73; for men, 70.... [The expert] layers his concept of prospective age with another quality, which he calls “characteristic aging.”... “It depends upon the characteristics of people, in which sense they are old,” he says. “Are they cognitively old? Are they physically old? Are they old in terms of their disabilities? It depends.”
Old is not a one-size fits all and not only are there variations within the U.S. there are by country. The article is really fascinating-read it and figure out how long before you are "old."
Thanks to Professor Naomi Cahn for sending the article.
Thursday, June 20, 2019
USA Today, ran this story, Seniors were sold a risk-free retirement with reverse mortgages. Now they face foreclosure. This is not a happy story.
Alarming reports from federal investigators five years ago led the Department of Housing and Urban Development to initiate a series of changes to protect seniors. USA TODAY’s review of government foreclosure data found a generation of families fell through the cracks and continue to suffer from reverse mortgage loans written a decade ago.
These elderly homeowners were wooed into borrowing money through the special program by attractive sales pitches or a dire need for cash – or both. When they missed a paperwork deadline or fell behind on taxes or insurance, lenders moved swiftly to foreclose on the home. Those foreclosures wiped out hard-earned generational wealth built in the decades since the Fair Housing Act of 1968 1
. . .
Borrowers living near the poverty line in pockets of Chicago, Baltimore, Miami, Detroit, Philadelphia and Jacksonville, Florida, are among the hardest hit, according to a first-of-its-kind analysis of more than 1.3 million loan records. USA TODAY worked in partnership with with Grand Valley State University, with support from the McGraw Center for Business Journalism.
The article looks at some examples of individuals who are in trouble and examines the situation that led us to this point.
Federal regulators and industry leaders cautioned that numbers alone tell only part of the story, since many foreclosures result from the natural end of reverse mortgages: the homeowner’s death. The average term of a reverse mortgage is about seven years, and if a family member is not willing or able to repay the loan, lenders push the property through foreclosure.
Regulators said actual evictions of seniors are rare. There’s no way to verify that, though, since HUD, the top government regulator of Home Equity Conversion Mortgage 4 loans, does not sign off on evictions – or even count them.
The article is lengthy but full of important information. Read it yourself, and then assign it to your students.
Thanks to my colleague and dear friend, Professor Bauer, for sending me the article.
Tuesday, June 18, 2019
Kaiser Health News recently ran a story, Payroll Tax Is One State’s Bold Solution To Help Seniors Age At Home. According to the article,
[T]wo states — Washington and Hawaii — are experimenting with taxpayer-funded plans to help older residents remain in their homes.
Washington state’s ambitious plan, signed into law in May, will employ a new 0.58% payroll tax (or “premium,” as policymakers prefer to call it) to fund a $36,500 benefit for individuals to pay for home health care, as well as other services — from installing grab bars in the shower to respite care for family caregivers.
Hawaii’s Kupuna Caregivers Program, which was initiated in 2017, is also publicly funded, but state budget allocations limit enrollment and benefits. It provides up to $210 a week for services when family caregivers work outside the home at least 30 hours a week.
As the article notes, there is a growing need for caregivers.
The number of Americans 65 and older will double to 98 million by 2050, and studies show few have the financial resources to pay for care in old age. More than half of adults 65 and up will require long-term assistance at some point with everyday activities, for an average duration of about two years, according to a 2015 study by the Department of Health and Human Services. Finding a way to help people stay in their homes — and not move to nursing homes — can keep them happier and save them and the state money. Medicaid programs help cover the costs of 62% of nursing home residents.
The article notes that other states are watching the results of these two innovative programs, but it will take some time to see the results. In Washington state, "[t]he state will begin collecting the payroll tax in 2022, and starting in 2025 residents can collect benefits if they have paid into the system for at least three of the previous six years or five consecutive years within a decade. The details will be set over the next few years, but to qualify for a benefit of up to $100 a day, which will be adjusted for inflation, a person must show they need help with at least three activities of daily living." The program is projected to be a money-saver, to the tune of "$3.9 billion in state Medicaid costs by 2052."
Other states are exploring other solutions:
Minnesota is considering allowing people to convert life insurance plans to long-term care insurance.
Maine voters rejected a ballot proposal to provide free long-term care to residents, funded by a 3.8% income tax on residents making more than $128,400 a year. Instead, the state government is educating people about the need to buy long-term care insurance, including an awareness campaign in high schools.
The California Aging and Disability Alliance, an advocacy group, is considering a ballot initiative for a state program to provide long-term services and support.... Michigan and Illinois are also studying proposals.
New York lawmakers have debated a graduated income tax to pay for comprehensive long-term care for its citizens. The Assembly has passed such a bill repeatedly, but the state’s Senate has refused to approve it.
Monday, June 10, 2019
The Hastings Center has announced a new and very important research project. Dementia and the Ethics of Choosing When to Die will focus on basic issues surrounding an individual's ability to exercise end of life choices when suffering from dementia. As the announcement explains
As the American population ages and dementia is on the rise, The Hastings Center is embarking on pathbreaking research to explore foundational questions associated with the dementia trajectory and the concerns of persons facing this terminal condition. This new research is made possible by a major grant to The Hastings Center from The Robert W. Wilson Charitable Trust as part of its visionary support for the Center’s research and public engagement on ethical challenges facing aging societies.
During the dementia trajectory, a person experiences progressive impairment of cognitive abilities – including memory, problem-solving, and language – as well as changes in behavior and physiological functions. As cognition deteriorates, a person with dementia will need daily assistance and eventually total care, often in an institutional setting, for several years before physical deterioration progresses to death from pneumonia or another condition associated with severe dementia. There are no effective treatments to cure or halt the progression of dementia. Alzheimer’s disease, the most common form, is the sixth leading cause of death in the U.S. Vascular dementia, the second most common form, may develop following stroke.
In 2018, 5.7 million Americans were living with dementia. An estimated 12 million others will be at high risk for developing dementia over the next 30 years as the baby boom generation lives into their 80s and 90s.
In the U.S., the basic legal right to be free of unwanted treatment is long established. People with decision-making capacity have the right to forgo life-sustaining treatment they do not want. People who lack decision-making capacity have the same right through the use of an advance directive or a surrogate decision-maker. However, this longstanding legal framework and ethical consensus does not fully reflect the situation of a person facing dementia if this person has no medical treatments to refuse. Also, the timeframe in which a terminally ill person with decision-making capacity can request and use medical aid-in-dying (MAID), now legal in nine U.S. jurisdictions, does not correspond to the dementia trajectory.
Through literature review and workshops, a Hastings Center work group will conduct an ethical analysis of end-of-life choices in the context of dementia, identifying areas where further research or policymaking is needed. In exploring these emerging issues, the work group will also consider how the field of bioethics should contribute to research, policy solutions, and public understanding to improve the experiences of living with dementia and caring for people with the condition. Products will include a special report, to be published in 2021.
“Population aging raises profound questions about how a society values the experiences of aging and caregiving,” says Berlinger. A separate Wilson Trust grant will build on a recent Hastings Center special report to support events and publications on how policymakers, practitioners, and the public can promote inclusion and equity for older adults and caregivers. Learn more about the dementia project and the aging societies project.
Monday, June 3, 2019
The GAO recently released a study examining the financial implications to caregivers. Retirement Security: Some Parental and Spousal Caregivers Face Financial Risks explains
[a]bout 10% of Americans per year cared for an elderly parent or spouse from 2011 through 2017. These family caregivers may risk their long-term financial security if they have to work less or pay for caregiving expenses such as travel or medicine.
More than half of people who cared for parents or spouses said they went to work late, left early, or took time off for care
Spousal caregivers at or near retirement age had less in retirement assets or Social Security income than non-caregivers
Experts and studies identified ways to potentially improve caregivers' retirement security, such as increasing their Social Security benefits
Some caregivers experienced adverse effects on their jobs and had less in retirement assets and income.
- According to data from a 2015 caregiving-specific study, an estimated 68 percent of working parental and spousal caregivers experienced job impacts, such as going to work late, leaving early, or taking time off during the day to provide care. Spousal caregivers were more likely to experience job impacts than parental caregivers (81 percent compared to 65 percent, respectively).
- According to 2002 to 2014 data from the Health and Retirement Study, spousal caregivers ages 59 to 66 had lower levels of retirement assets and less income than married non-caregivers of the same ages. Specifically, spousal caregivers had an estimated 50 percent less in individual retirement account (IRA) assets, 39 percent less in non-IRA assets, and 11 percent less in Social Security income. However, caregiving may not be the cause of these results as there are challenges to isolating the effect of caregiving from other factors that could affect retirement assets and income.
Friday, May 31, 2019
Yes, yes, we are almost half-way through 2019, but here is the 2018 Profile of Older Americans! The Administration for Community Living (ACL) explains that "[t]he Profile of Older Americans is an annual summary of critical statistics related to the older population in the United States. Relying primarily on data offered by the U.S. Census Bureau, the Profile illustrates the shifting demographics of Americans age 65 and older. It includes key topic areas such as income, living arrangements, education, health, and caregiving. The 2018 Profile also incorporates a new special section on emergency and disaster preparedness." You can access the 20 page profile as a pdf here or access the data in a spreadsheet here. You can also access the data for prior years from the landing page.
The highlights reveal some interesting stats, including
•Older women outnumber older men at 28.3 million older women to 22.6 million older men.