Saturday, May 16, 2020
I've written about Pennsylvania's ongoing dispute between its Department of Health and some County Coroners regarding responsibilities for reporting Covid-19 related deaths and how to better assure accuracy of data. It seems possible to me that part of the controversy in Pennsylvania may reflect the fact that the County Coroners are elected officials, and may not identify with the political views of the Governor. Some Republicans vs. Democrat. In contrast, disputes between Florida's 25 medical examiner district offices and the state's Department of Health are emerging news.
I don't follow politics in Florida closely enough to know whether party-politics are involved, but there does appear to be concern from the regional officials that the State is inclined to discount Covid-19 related deaths in Florida, perhaps in an attempt to protect tourism into the state. Should a "tourist" that dies in Florida be counted as a death in Florida? From Florida Today, this opening account of one tourist death:
When a 66-year-old man was found dying on an Amtrak train passing through Okeechobee County on April 5, there was nothing to indicate that he had COVID-19. It was the local medical examiner's office that pieced it together.
The examiner discovered the man had recently arrived with a fever at New Jersey's Newark Liberty International Airport from the United Kingdom. The Centers for Disease Control stopped him from boarding a flight to Florida and sent him to a local hospital for a coronavirus test. Released before the results came back, he got on a southbound train, went into cardiac arrest while traversing the Sunshine State, and was pronounced dead at a Florida hospital.
But since at least April 20, the Florida Department of Health has blocked the Medical Examiners Commission from releasing their own detailed spreadsheet of the COVID-19 dead. On Wednesday, the state released the medical examiners' spreadsheet but redacted the narratives and cause of death entries.
Thursday, May 14, 2020
New research described in the Bulletin on Retirement and Disability published by the National Bureau of Economic Research provides new support for thinking about ways to help maximize use of benefits to pay for core living expenses. Researchers Lint Barrage (UC Santa Barbara), Ian Chin (Michigan), Eric Chin (Dartmouth),and Justine Hastings (Brown) examine how timing of receipt of Supplemental Nutrition Assistance Program (SNAP) benefits affects a household's ability and success in paying for utilities, such as electric bills. They observe:
Our results suggest that, for low income households, timing of income from government benefits and the timing of bills due may have long-run consequences. If bills are not received when income is received, households are more likely to miss payments, which may compound into disconnections which may further impact family financial and health outcomes.
These results add to a growing literature suggesting that government benefits programs and/or private industry innovate in ways to help low income households balance budgets throughout the month and avoid potential poverty traps. In the case of electricity bills, moving bill receipt to coincide with SNAP benefits receipt could improve repayment rates. This could help low income families avoid poverty traps, but also lower electricity rates for all rate payers in regulated markets, since collection and electricity service disruption are costly and must be covered by regulated electricity rates. Further research is needed to implement and measure the impact of changes in timing of bill receipt through, for example, a randomized controlled trial, and to expand the outcome measures of impact to include measures of financial well being such as credit scores.
For more, read How Bill Timing Affects Low-Income and Aged Households, NBER RDRC Working Paper 19-09) and the Bulletin summary.
Our thanks to George Washington Law Professor Naomi Cahn for this reference. I suspect that the timing of core household bills and public receipt of pandemic-driven federal stimulus payments would make for another interesting study.
Wednesday, May 13, 2020
Could Residents in Nursing Homes, Assisted Living Facilities and Personal Care Homes be "Canaries in the Coal Mines?"
Coronavirus infection rates at nursing homes are hot news, and getting hotter each day. Some see this as evidence of substandard care. I had been holding hope, frankly, that when I read another horrific story about a specific nursing home with xxx cases, high death rates, or a staff decimated by infections, the explanation could be as simple as negligent care.
But, what if that isn't the reason? What if facilities are employing best available practices, but the "best available practices" just are not good enough in the context of congregate care settings for this complicated disease? Frankly, state of the art models for long-term care are ones with strong behavioral programs, where quality of daily life is as important as protection against risks. Interactions, engagement, exercise, activities are what make those programs "best available."
A few days ago a friend sent me a news story about an assisted living facility where approximately 50% of the residents have recently been diagnosed with Covid-19 infections -- and where a first Covid-19 related death has occurred. I was startled, because I recognized the name of the facility.
Less than four weeks ago, the testing at that facility had shown no patients or staff members to be positive for the coronavirus. Early in March, the pro-active managers instituted "no visiting" rules for family members and other outsiders, along with other strict precautions. The facility even made arrangements for nearby housing for staff members -- at no cost to the staff -- to make it easier for them to separate themselves from cross-infections in their own homes during the quarantine. The staff continued to involve residents in daily activities, recognizing that engagement was a critical part of care, especially without family and friends visiting.
I'd been hoping that the early reports of "no virus" were testament to the fact that best practices can be employed successfully to keep fragile elders or disabled adults safe without locking them in their rooms. But, that apparently proved not to work out at this very careful facility. I've heard critics say the solution is for elders to be "at home," But "keeping your loved one at home" often won't be a practical solution, especially if the needed care is complicated, often requiring more than "just" family.
Because this facility was where each of my parents lived during their last weeks, I saw first hand just how diligent and how careful that staff is about infection.
We are all gaining a stronger understanding of how complicated care is even without this particular, terrible new disease. The disease has also run rampant through many jails, prisons and commercial food plants, all additional examples of congregate settings. But if dedicated care communities with good ratios of professional staff and very good records on quality of care are struggling to prevent Covid-19 infection, what is the real message the canaries are singing?
Tuesday, May 12, 2020
Identifying the What, Where and Who for Documenting Key Information on Cause of Death during a Pandemic
As I reported last month, the Pennsylvania Department of Health and County Coroner offices are in a bit of a struggle over their roles and responsibilities to report causes of death, including COVID-19 related causes. The dispute continues and the issues include:
- How to report the "county location" of the deceased for a COVID-19 related-death? For example, if the individual became infected while living in Adams County, Pennsylvania, but the final treatment and death was at Penn State Hershey Medical Center in Dauphin County, should the "county of death" be Adams or Dauphin County?
- How to characterize the cause of death? For example, under Pennsylvania statutory law at 16 P.S. Section 1218-B (2018), County Coroners "shall investigate the facts and circumstances concerning a death that appears to have happened within [their] county, notwithstanding where the cause of the death may have occurred" to "determine the cause and manner of death." Should a "COVID-19 related death be described as "death by natural cause," a phrase often used on death certificates or more specifically as a "death known or suspected to be due to contagious disease and constituting a public hazard," a phrase referenced in the Coroner's law?
- Where a patient's attending medical professional certifies the cause of death and reports the cause directly to the State Registrar of Vital Statistics, should the state then be required to share that information with County Coroners? Attending medical professionals have legal authority to sign death certificates and to make reports directly to the State Registrar under Pennsylvania's Vital Statistics Law of 1953 at 35 P.S. Section 450.101 et seq. (amended in 2012). Without a clear path for sharing information, how will counties have timely information that can affect other county reporting obligations?
- Does the State have authority to mandate reporting by the County Coroners using criteria recommended by the federal Centers for Disease Control and Prevention (CDC)? In April 2020, the National Vital Statistics System, which operates under the CDC, issued guidance for reporting COVID-19 related deaths, offering three sample scenarios where the "immediate cause of death" would be described as some form of acute respiratory illness, while COVID-19 would be described as an "underlying cause" that initiated the events resulting in death.
- Who is responsible for resolving any inconsistencies in County and State statistics for deaths, including COVID-19 related deaths?
On a recent WITF-Radio's Smart Talk program in central Pennsylvania, coroners from York County and Cumberland County described their concerns about disparities between state and local statistics. Charley Hall reported that Cumberland County had 45 COVID-19 related deaths, while the State at the same time was reporting 37 deaths. In York County, the lower COVID-19 number was reported at the County level, while the State recorded a higher number. For more on the practical problems, listen to the Smart Talk Podcast for 5/11/2020. The coroners raised the potential for such discrepancies to trigger erosion of public trust.
In many Pennsylvania counties, as in other states, a significant majority of COVID-19 deaths are occurring in nursing homes or other long-term care residential settings. Some of the concerns about accuracy and transparency of reporting imply intentional under-reporting or misleading reports regarding deaths in nursing homes. Pennsylvania has one of the largest populations of citizens in the nation who reside in nursing homes. Long-term living is a major, multifaceted industry in Pennsylvania.
In addition, the number of diagnosed cases, the location of diagnosed cases, and the number of COVID-19 related deaths can make a difference in whether any particular county is allowed to move away from strict social-distancing related rules.
Monday, May 11, 2020
Syracuse Law Professor Nina Kohn (currently a visiting professor at Yale Law), has an important Op-Ed in the Washington Post, in which she tackles the not so subtle ageism that accompanies response to COVID-19 -- while making it clear that the issues are much deeper than a single disease. She writes:
Of course, older adults are at heightened risk, even though covid-19 strikes younger people, too. But across America — and beyond — we are losing our elders not only because they are especially susceptible. They’re also dying because of a more entrenched epidemic: the devaluation of older lives. Ageism is evident in how we talk about victims from different generations, in the shameful conditions in many nursing homes and even — explicitly — in the formulas some states and health-care systems have developed for determining which desperately ill people get care if there’s a shortage of medical resources.
For more, read The Pandemic Exposed a Painful Truth: American Doesn't Care About Hold People. The subtitle? "We speak of the elderly as expendable, then fail to protect them."
May 11, 2020 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Statistics | Permalink | Comments (0)
Thursday, April 30, 2020
The AALS Section on Law and Aging is joining forces with the Sections on Civil Rights, Disability Law, Family and Juvenile Law, Minority Groups. Poverty, Sexual Orientation, Gender-Identity Issues, Trusts & Estates and Women in Legal Education to host a program for the 2021 Annual Meeting, scheduled to take place in San Francisco in January. The theme for the program is appropriately broad -- "Intersectionality, Aging and the Law."
I like this definition of "intersectionality":
The interconnected nature of social categorizations such as race, class, and gender as they apply to a given individual or group, regarded as creating overlapping and interdependent systems of discrimination or disadvantage. Example: "Through an awareness of intersectionality, we can better acknowledge and ground the differences among us."
We need great presenters!
We are interested in participants who will address this subject from numerous perspectives. Potential topics include gray divorce, incarceration, elder abuse (physical or financial), disparities in wealth, health, housing, and planning based on race or gender or gender identity, age and disability discrimination, and other topics. The conception of the program is broad, and we are exploring publication options.
If you are interested in participating, please send a 400-600 word description of what you'd like to discuss. Submissions should be sent to Professor Naomi Cahn, email@example.com, by June 2, 2020, and the author[s] of the selected paper(s) will be notified by July 1, 2020.
AALS is planning on hosting the annual meeting from January 5-9 and I personally feel the overall theme for the conference is apt in these fraught times: The Power of Words
April 30, 2020 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Current Affairs, Discrimination, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Grant Deadlines/Awards, Health Care/Long Term Care, Housing, International, Legal Practice/Practice Management, Programs/CLEs, Property Management, Science, Statistics, Webinars, Weblogs | Permalink | Comments (0)
Sunday, April 26, 2020
Last week, I listened to an interview of a County Coroner in Pennsylvania. The focus of the radio program was whether statistical accuracy for any State's determination of cause of death is important, especially during the COVID-19 pandemic.
The coroner said "yes" to the softball, threshold question but then the interview took a surprising turn. The host next asked, "How do you characterize cause of death for possible COVID-19 related deaths?" In Pennsylvania, there has been a bit of controversy on this topic, as detailed recently by the Philadelphia Inquirer. For example, if the affected person, especially an older adult, had multiple co-morbid conditions, such as serious heart disease and diabetes, is the new infection with COVID-19 (a contagious disease and public health hazad) the "official" cause of death as recognized by Pennsylvania law at 16 P.S. Section 1218-B (as revised and effective on December 24, 2018)?
The particular County Coroner, however, took his answer down a whole different path, predicting that COVID-19 deaths may end up being characterized as "homicides," if or when the disease is proven to be manipulated or caused by a laboratory in China. Whoa!
That track of analysis clearly startled the host, who tried to refocus the speaker's attention on the potential complicating factors that determine how death is related in whole or in part to the coronavirus disease. But the coroner wasn't willing to walk back his speculation, and started talking about the need for openness to the possibility of foreign, criminal intention.
The interview was an abrupt reminder that documenting any cause of death can be complicated. This can be especially true when the official in charge of the decision is an elected official. Elected officials, whether at the state or county level, may be subject to political views or pressures. Further, Pennsylvania and a surprising number of other states permit but do not require elected or appointed coroners to have a medical or pathology degree as a qualification for the job. In Pennsylvania, coroners for Class 2 and smaller counties -- the vast majority of its 67 counties -- are "elected." In 2018, the state law was amended to require newly elected county coroners to take a 32 hour course of instruction relevant to crime-scene investigation, toxicology, forensic autopsies and the legal duties of a coroner. Officials elected prior to the December 2018 effective date of that modernized law, however, are grandfathered into the credentials and are not required to take or pass any threshold test.
It seems that even without the one coroner's flirtation with conspiracy theories about the origination of the COVID-19 virus, Pennsylvania state officials were already trying to harmonize state and local policies about reporting COVID-19 as an official cause of death. During the Spring of 2020, Pennsylvania's Department of Health issued "Guidance" for Coroners and Medical Examiners regarding reporting COVID-19 related deaths, and the policy appears to emphasize that most certifications reporting cause of death are to be made by "a medical professional who attended the deceased during the last illness." According to the Guidance, it is only when there is a "referral" to the County Coroner or Medical Examiner that the county official would have a role in making a death report under the state's Vital Statistics Law.
Friday, April 24, 2020
Transparency Issues in Long-Term Care: The Potential for Misuse of Confidentiality Policies to Hide Infection Facts from the Public
Recently I was talking with a friend in another state who is the director of an assisted living facility that largely serves older adults who have significant risks factors. I asked, "Have you had any residents or staff members that have tested positive for COVID-19?" I asked her directly, because there was no way to know the answer to that question from public websites, either in her state or on a national basis. The good news was that her facility had had no such diagnoses, either among staff or residents. I also asked what she felt was key to avoiding infections, and we talked about the rates uncovered in other facilities in her own state. She said bluntly, "We learned from our experience with influenza the last two years that we had to make real changes, and we did so before the COVID-19 was a reality and doubled down when we started hearing about the coronavirus."
Internal infections have long-been a documented problem in residential care settings, and certainly not limited to so-called "nursing homes." Contributing factors include residents who may have physical or mental conditions that make self-protection difficult and perhaps impossible. My sister and I used to struggle mightily with a family member whose dementia interfered with the simple task of hand-washing -- even though this same person was the one who taught us the importance of soap and water from the time we were small children. It is perhaps ironic to recall that as a horse-mad girl I had tried to persuade both of my parents that there should be an exception for "barn dirt," on my theory that horse-related dirt was "clean dirt." My mothers still insisted I undress on the back porch and wash thoroughly before coming in for dinner. Wise woman, one who was quick to dismiss utter nonsense.
Fast forward decades and every day I hear new arguments regarding why facilities that have experienced life-threatening infections should not be required to report this in a public venue. The most problematic argument is one that says an individual's infection is confidential medical information that prevents the facility from reporting statistical information, and thus an infection cannot be made public. I've seen arguments about federal or state record-keeping policies such as HIPPA privacy rules or Pennsylvania's confidentiality rules as the rationalization. I think I know what my mother would call this kind of argument.
Syracuse Law Professor Nina Kohn tackles the history of mishandled safeguards against infections in long-term care with an Op-Ed for The Hill. In "Addressing the Crisis in Long-Term Care Facilities," Professor Kohn points to specific actions at the federal level that have weakened, rather than strengthened, potential safeguards. She makes five specific recommendations, including prohibitions on staff working in more than one-long-term care facility, to reduce cross-contamination, and the need for family members and others to make it clear that we "are paying attention to what is happening." She reminds us: "Those who are health care agents for nursing home residents should not be afraid to request access to medical records, as federal law entitles them to do, if facilities are not forthcoming with information about the care being provided."
April 24, 2020 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Health Care/Long Term Care, Housing, Medicaid, Medicare, State Statutes/Regulations, Statistics | Permalink | Comments (0)
Monday, April 20, 2020
Our friend Professor Naomi Cahn at George Washington Law has advised us that the peer-reviewed Journal of Elder Policy is planning a special issue related to COVID-19. Certainly the implications of policy in this pandemic are constantly in the news, and how appropriate to begin the process of analysis.
Abstracts of 500 words are due by June 15, 2020. Full papers of between 8,000 and 10,000 words are due by September 30, 2020.
Topics may include but are not limited to:
- Risk assessment, Ageism, Legislation to protect older adults,
- Community initiatives, Medical and nursing perspectives,
- Mental health challenges for elders, Family support or conflict,
- Helping and volunteering, Rationing of care, Challenges for caregivers
Authors should send their Vita and a 500 word abstract related to their paper by June 15 to Managing Assistant Editor, Kaitlyn Langendoerfer. Details available here.
The ever-busy Naomi is a member of the Editorial Board for the Journal. Thank you for letting us know about this opportunity, Naomi!
April 20, 2020 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Grant Deadlines/Awards, Health Care/Long Term Care, Programs/CLEs, Science, Statistics | Permalink | Comments (0)
Wednesday, April 8, 2020
At Dickinson Law, in the last third of the Spring 2020 Semester, my Elder Law students are doing a module on End-of-Life Decisions. I had planned this module more than a year in advance; certainly the timing has proven to be uniquely relevant. Originally, my plan was for an in-depth discussion about choices related to assisted death, sometimes known as the Death with Dignity or Physician-Assisted Death. And we are considering comparative studies and positions on legislation intended to support this choice, starting with a review of Oregon's more than 20 years of experience in providing this option.
The COVID-19 pandemic, however, is triggering new focal points on end-of-life decisions. Consider for example the statement by an emergency room chief in a San Francisco hospital, as quoted recently in the Los Angeles Times, "You have an 80-year-old and a 20-year-old and both need a vent and you only have one. What do you do?" Individuals may have thoughtfully made advance decisions about whether they want mechanical assistance in breathing during life-or-death circumstances. They may have appointed an agent to speak for them or created written directions via living wills, DNR orders, or POLST documents. But it is one thing to make you own decision; it is another to have the "decision" made because of lack of what is arguably baseline equipment.
I've been particularly interested in the history behind ventilator shortages as reported by The New York Times.
Thirteen years ago, a group of U.S. public health officials came up with a plan to address what they regarded as one of the medical system’s crucial vulnerabilities: a shortage of ventilators. The breathing-assistance machines tended to be bulky, expensive and limited in number. The plan was to build a large fleet of inexpensive portable devices to deploy in a flu pandemic or another crisis.
Money was budgeted. A federal contract was signed. Work got underway.
And then things suddenly veered off course. A multibillion-dollar maker of medical devices bought the small California company that had been hired to design the new machines. The project ultimately produced zero ventilators.
The rest of the story reads like a detective tale. The small California-based company was proposing a new generation of easy-to-use, more cost effective, mobile ventilators. By 2012, the partners were on schedule to file for market approval in September 2013, paving the path for production. However, in May 2012, a much large medical device manufacturer bought the California-based company for just over $100 million. Good news? That larger company might have especially strong resources for speedy production, right?
The new owner, Covidien, already made ventilators -- at a higher cost -- and in 2014, reportedly told federal officials they wanted to get out of the new ventilator contract. The federal government agreed to cancel the contract. Covidien was sold to an even larger international company in 2015.
Why? For more, read "The U.S. Tried to Build a New Fleet of Ventilators. The Mission Failed," by Nicholas Kulish, Sarah Kliff and Jessica Silver-Greenberg, published in the NY Times on March 29 2020 and updated on March 31, 2020. Or catch a NY Times podcast that looks further into shortages of hospital rooms, COVID-19 testing supplies and ventilator availability. All interesting -- especially if you are talking about "end-of- life decisions."
Sunday, March 29, 2020
I blogged a couple of times about social isolation's impact on elders as we move through this pandemic. Imagine social isolation when you live alone and how that compounds your loneliness. This report from Pew Research, released before the pandemic swept the U.S., reports that elders in the U.S. live alone in greater numbers than other countries. Older people are more likely to live alone in the U.S. than elsewhere in the world shows that:
Living with an extended circle of relatives is the most common type of household arrangement for older people around the world, according to a recent Pew Research Center study. But in the United States, older people are far less likely to live this way – and far more likely to live alone or with only a spouse or partner.
Let me share some stats from the article:
- "In the U.S., 27% of adults ages 60 and older live alone, compared with 16% of adults in the 130 countries and territories studied."
- "U.S. adults ages 60 and older also are more likely than their counterparts around the world to live as a couple without young children at home. Almost half of Americans in this age group (46%) share a home with only one spouse or partner, compared with three-in-ten globally (31%)."
- "Globally, living in extended-family households – those that include relatives such as grandchildren, nephews and adult children’s spouses – is the most common arrangement for people 60 and older. "
Thursday, March 12, 2020
Kaiser Health News ran this story, The Startling Inequality Gap That Emerges After Age 65. "[T]hose who reach age 65 are living longer than ever... But there’s a catch: Seniors in urban areas and on the coasts are surviving longer than their counterparts in rural areas and the nation’s interior, according to an analysis from Samuel Preston of the University of Pennsylvania, one of the nation’s leading demographers. ...This troubling geographic gap in life expectancy for older Americans has been widening since 2000, according to his research, which highlights growing inequality in later life."
The article discusses the life expectancy disparity not only between urban and rural areas, but also between various parts of the U.S. For example, "
Notably, 65-year-olds in “rural areas have had much smaller improvements than those in large metro areas,” Preston remarked. “And people living in ‘interior’ regions ― particularly Appalachia and the East South Central region [Alabama, Kentucky, Mississippi and Tennessee] — have done worse than those on the coasts.”
These geographic differences emerged around 1999-2000 and widened from 2000 to 2016, the study found. By the end of this period, life expectancy at age 65 for women in large metropolitan areas was 1.63 years longer than for those in rural areas. For men, the gap was 1.42 years.
Differences were even starker when 65-year-olds who live in metro areas in the Pacific region (the group with the best results) were compared with their rural counterparts in the East South Central region (the group with the worst results). By 2016, seniors in the first group lived almost four years longer. (The Pacific region includes Alaska, California, Hawaii, Oregon and Washington.
The article discusses the explanations of the disparities, including access to health care, smoking history and cardiovascular disease. It also discusses the differences from "death from despair" in younger generations to the older generation "Deaths from opioids, alcohol or suicide aren’t significant in the older population; instead, deaths from chronic illnesses, which take years to develop and which are influenced by social conditions as well as personal behaviors, are far more important .... "
The study is available here.
Sunday, March 8, 2020
Last month the Atlanta Journal Constitution published a story, Audit: State failing elderly victims of abuse, neglect. "A state audit identified damning new evidence that Georgia’s system to protect seniors and vulnerable adults from abuse, neglect and exploitation is failing and the breakdowns are causing additional harm." How bad is it? The story goes on, "Among the significant gaps cited in Friday’s report by State Auditor Greg S. Griffin on Georgia’s Adult Protective Services system was that investigators are taking too long to respond to urgent cases, such as when the elderly were going hungry or were sexually abused. One year, some 500 vulnerable adults facing serious situations waited three days or more before an investigator arrived. APS employees also were rejecting reports that should have been investigated, the audit found."
There are many concerns that arise from the story (and report). Consider this one: "Multiple law enforcement personnel the auditors interviewed indicated they don’t report all cases of abuse, neglect or exploitation to APS, despite statutory requirements to do so. ... The audit noted that law enforcement officers “are hesitant to report cases that involve certain types of victims or abuse.” Officers said they prefer to handle cases themselves because of negative experience with APS or a belief that APS is overworked and can’t handle all the cases reported."
The article notes that the slapdash reporting creates problems beyond failure to report, including the inability of the elders to get services.
Here's another big concern from the article: " It notes that after the General Assembly approved funding in fiscal year 2016 to hire eight agents to focus on elder abuse, GBI didn’t use the funds to hire the allotted additional agents. Instead, it trained an agent in each of its 15 regions to be a resource on elder abuse. The audit questioned how effective the agency has been in addressing elder abuse, although the agency in its response said it had increased its caseload."
To read the full article, click here.
Monday, March 2, 2020
One of my colleagues sent me this interesting article about teaching elders how to verify a story. With An Election On The Horizon, Older Adults Get Help Spotting Fake News ran last week on NPR. It's a very cool idea. "At the Schweinhaut Senior Center in suburban Maryland, about a dozen seniors gather around iPads and laptops, investigating a suspicious meme ... The seniors are participating in a workshop sponsored by the nonprofit Senior Planet called "How to Spot Fake News." As instructed, they pull up a reputable fact-checking site like Snopes or FactCheck.org and, within a few minutes, identify the meme is peddling fake news."
Consider this from the article, which underscores why workshops such as these are so important: "[a] recent study suggests these classes could be increasingly important. Researchers at Princeton and New York universities found that Facebook users 65 and over posted seven times as many articles from fake news websites, compared with adults under 29."
It's important for everyone to remember that this is not just about political stories. Think of all those scam emails you get (won a lottery recently?). So, the project at this senior center "coaches participants about the difference between propaganda, deep fakes and sponsored content. [The instructor] runs through a checklist for evaluating information online: Who wrote the information? What's the source of a claim? Does the author have an agenda?"
I can see this having application to various scams that are perpetrated online. This could be a good community service project for our students, too.
Clark says her program, Senior Planet, which sponsors all kinds of tech classes for older adults at several locations across the country, has been trying to get digital literacy in front of more seniors. But in many ways, it's more challenging than it might be for school districts.
Monday, February 17, 2020
The Wall Street Journal (subscription required) this week ran 2 stories that caught my eye for this blog. First, my friend and colleague Professor Bauer sent me this article: Growing Risk to America’s Seniors: Themselves focuses on the issue of self-neglect. Here's a brief excerpt
Self-neglect cases involved 144,296 people across the country, accounting for more than half the reports of alleged elder abuse or neglect investigated by adult protective services programs in 2018, according to a new report released by the Department of Health and Human Services. That was more than the next five most numerous categories—neglect, financial exploitation, emotional abuse, physical abuse and sexual abuse—combined.
The federal government doesn’t have comparable data for previous years, but several state and local service providers say they are seeing the self-neglect problem swell, stretching their resources. Virginia’s county and city programs, for example, investigated 18% more self-neglect cases in 2019 than in 2015. In the District of Columbia, such cases rose by 60% between fiscal years 2016 and 2019, according to the D.C. Department of Human Services. Iowa saw a 55% increase between fiscal years 2017 and 2019, while Ohio counted 19% more between fiscal years 2014 and 2019, according to state officials.
Next, a story focusing on the sandwich generation, offers poignant views of adult children's plight, ‘I Feel Very Torn Between My Child and My Dad’—Demands Intensify for the ‘Sandwich Generation’.
"New demographic forces are redefining what it means to be a “sandwich-generation” caregiver. Women are having children later in life. Longevity—and, with that, the incidence of dementia—is increasing. Families are smaller, and two-career couples are more common. All these trends are converging and intensifying the demands on those caring for generations on either side of them."
Now, most of the people in this type of caregiving role are in their 30s, 40s, and early 50s, according to a 2019 study by the National Alliance for Caregiving and Caring Across Generations. Two-thirds of them have jobs, and on average work 36 hours a week and devote 22 hours a week to caring for an adult, in addition to raising children, according to the study.
Often, responsibility for care is falling on them because their boomer parents are more likely to be single than those in previous generations, without a spouse to pitch in. The proportion of those caring for their parents as well as children under the age of 18 doubled to 26% in 2015 from 12.6% in 1999, a 2017 study showed. But even as more of these caregivers step up, it may not be enough.
Sunday, February 2, 2020
One of the many articles on this news is from the New York Times, American Life Expectancy Rises for First Time in Four Years explains that "[l]ife expectancy increased for the first time in four years in 2018, the federal government said Thursday, raising hopes that a benchmark of the nation’s health may finally be stabilizing after a rare and troubling decline that was driven by a surge in drug overdoses.” The increase is very small (one month the article notes) but it may represent an upswing although "demographers cautioned that it was too early to tell if the country had turned the corner with opioid overdoses, which have claimed nearly 500,000 lives since the late 1990s." Crossing our collective fingers it's an actual upswing and not a blip.
Wednesday, January 22, 2020
Kaiser Health News published an interesting piece a few days ago, What The 2020s Have In Store For Aging Boomers opens with some interesting data. "Within 10 years, all of the nation’s 74 million baby boomers will be 65 or older. The most senior among them will be on the cusp of 85. ... Even sooner, by 2025, the number of seniors (65 million) is expected to surpass that of children age 13 and under (58 million) for the first time, according to Census Bureau projections." The author interviewed a number of experts to get a sense of what this decade will look like for the boomers and the trends they will face.
- Care Crisis: "Never have so many people lived so long, entering the furthest reaches of old age and becoming at risk of illness, frailty, disability, cognitive decline and the need for personal assistance."
- Living longer and "better, " with a focus on quality of life.
- "Altering social infrastructure" such as more easily accessible transportation, increased affordable housing, making existing housing more appropriate for aging in place, and inter-generational programs.
- Flipping the perceptions of aging from negative to positive.
- "Advancing science", that is “advances in genetic research and big data analytics will enable more personalized — and effective — prescriptions” for both prevention and medical treatments ...."
- Responding to inequalities in aging.
- Longer careers in the work force
A new decade with ongoing challenges and a chance for progress!
Wednesday, January 8, 2020
For the last few years, I've found myself with conflicts during semester breaks that interfered with attending the AALS Annual Meeting. So I was especially happy this year to attend and catch up with long-time and new friends, especially those who work in fields relevant to elder law.
The annual meeting kicked off for me with a Joint Session hosted by the Sections on Aging and the the Law, Civil Rights, Family & Juvenile Law, Employee Benefits & Executive Compensation, and Immigration Law. The collaborative event offered lots of interesting "Emerging Issues in Elder Law," with speakers including:
Mark Bauer, Stetson Law, who spoke about recent enforcement efforts to combat elder exploitation, and pointed to a lingering weakness associated with banks that make SARS reports that never go beyond the regulatory body, and therefore never reach first responders, such as local police. He talked about support for a state-wide effort in Florida to improve police reports to make it easier to identify abusers who target older persons. He also called for better record-keeping for sales of gift cards, as these have become the number 1 method that telephone scammers get older adults to send them money.
Wendy Parmet, Northeastern University School of Law, who focused on the impact of immigration laws and policies on the health of older adults, including attempts by the current administration to change the definition of "public charge" to include anyone who could receive any public benefits whatsoever, thereby expanding the the pool of inadmissible immigrants and further restricting eligibility for legal permanent residency. She traced the impacts of such policies on older adults once eligible for family reunification, on older citizens overall, and on a nation that once took pride in providing help to immigrants who were "tired and poor."
Jalila Jefferson-Bullock, Duquesne Law, who talked about how some states are not applying sentencing reforms to elderly offenders, even though such inmates statistically are at the least risk of reoffending and, at 19% of the total prison population, are often generating care costs that are unsustainable. I learned, sadly, that my own state of Pennsylvania is one of the states that is not yet making significant progress on sentencing reforms for older adults.
Rachel Lopez, Drexel University Law, who is director of Drexel's Stern Community Lawyering Clinic, carried forward the theme of needed prison reforms for older inmates, reporting the latest events that follow the Graterford Think Tank Prison Project in Pennsylvania, and making the sobering observation that the most effective argument may not be one that sounds in human rights or human dignity, but the demonstration that return to the community for aging and ill residents saves the state money.
Naomi Cahn, George Washington Law, who is also the incoming chair for the AALS Section on Law and Aging, presented facts and figures on "gray divorce," especially with respect to financial impacts on women. She urged a de-coupling of Social Security benefits from marriage (or perhaps marriage longevity requirements), arguing that Social Security credits should be available for time spent as caregivers.
Browne Lewis, Cleveland-Marshall College of Law, pointed to the emerging issue of "reproductive rights" for older individuals, identifying jurisdictions that restrict women's access to assisted reproductive technologies (ART) including placing age or time restrictions on use of banked or stored eggs.
For faculty members who would like to be part of next year's Law and Aging program at the 2021 AALS Annual meeting in San Francisco, contact Naomi Cahn with your topics and interest.
January 8, 2020 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, International, Retirement, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (0)
Tuesday, January 7, 2020
Two articles, updating us on two topics important to all of us.
First, statistics. We know women statistically live longer than men,and a recent data report from Pew updates us that this still is true and in many instances women are younger than their husbands. That it means that late in life, many women will be alone. Globally, women are younger than their male partners, more likely to age alone tells us that "[t]he pattern of spousal age gaps – and the fact that women tend to live at least a few years longer than men – helps explain another universal theme: Across the world, women are about twice as likely as men to age alone. One-in-five women ages 60 and older live in a solo household (20%), compared with one-in-ten men (11%)." The report looks at religion and geography to measure the extent of this trend. "Rates of living alone over the age of 60 are tied to many factors, including cultural norms, economic development, levels of education and life expectancy. In countries where governments offer fewer retirement benefits or other support systems for older adults, families may face a greater responsibility to provide care."
The next article is from Sunday's New York Times, on the continuing shortage of geriatricians.Older People Need Geriatricians. Where Will They Come From? notes the long-term shortage of geriatricians and explains their importance, using one real-life example to "spotlight the rising need for geriatricians. These doctors not only monitor and coordinate treatment for the many ailments, disabilities and medications their patients contend with, but also help them determine what’s most important for their well-being and quality of life." There's very little progress on closing this gap, according to the article. "An analysis published in 2018 showed that over 16 years, through academic year 2017-18, the number of graduate fellowship programs that train geriatricians, underwritten by Medicare, increased to 210 from 182. That represents virtually no growth when adjusted for the rising United States population."
The article explains why there aren't more doctors going into the field, including the economics realities. One measure to address the shortage is cross-training.
Medical associations representing cardiologists and oncologists have begun focusing on older patients...
Health systems are adopting age-friendly approaches, like specialized emergency rooms. The American College of Surgeons’ new verification program sets standards hospitals should meet to improve results for older patients.
Last month the Senate Committee on Health, Education, Labor and Pensions voted to reauthorize a $41 million program that educates health professionals in geriatrics; it awaits a floor vote. A companion bill has already passed the House of Representatives.
Health professionals increasingly recognize that if they’re not in pediatrics, they will be seeing lots of seniors, whatever their specialty. A 2016 American Medical Association survey, for example, found that close to 40 percent of patients treated by internists and general surgeons were Medicare beneficiaries.
Pay attention to these issues. They will affect all of us either directly or through a family member.
Monday, January 6, 2020
I had blogged previously about meeting with two professors from the School of Social Work at the U. of Missouri. One, Dr. Erin Robinson, was kind enough to write the following blog on this important topic.
The Greying of HIV in America
By: Dr. Erin L. Robinson, MSW, MPH
Assistant Professor, University of Missouri School of Social Work
My name is Dr. Erin Robinson and much of my research focused on older adults, sexual health, and the prevention of HIV. I get a lot of questions about my research, including the need for such research, therefore I am going to share some information with you about the ‘greying of HIV’ in the United States. Over the past decade, older adults have been one of the fastest growing population groups affected by HIV/AIDS in the United States. Currently, 17% of all new HIV infections in the U.S. occur among people ages 50 years and older. This age group also accounts for nearly half of all people currently living with HIV. While the routes of HIV transmission in older adults is similar to that of their younger counterparts, there are some unique factors that contribute to the ‘greying of HIV’ in the U.S. Below are some interesting facts:
Facts about HIV and Aging:
- Older men are disproportionately impacted by HIV, however rates of older heterosexual women becoming newly infected are rapidly growing. This has led to specialized prevention interventions for older, heterosexual women.
- Older African American and Hispanic men and women are disproportionately impacted by HIV.
- 60% of all older adults living with HIV are virally suppressed, which means they have no risk of sexually transmitting the disease to others.
- Older adults are more likely to be diagnosed when HIV is further along in the disease progression (i.e. late-stage HIV). This means treatment options may not be as effective and mortality rates increase. Many of the symptoms for HIV can be similar for other illnesses, therefore if an older person does not test for HIV then they (and their healthcare provider) may attribute the symptoms to other causes.
- HIV can cause dementia-like symptoms, this is called HIV-associated neurocognitive disorders (HAND), AIDS dementia complex, or HIV-associated dementia. However, those symptoms can be reversed with proper HIV medications.
- Over the past few years, new HIV infections have decreased among the aging population. This is due, in part, to tailored prevention interventions among public health officials. However, we still have progress to make in order to curb the disparities.
Why are we seeing this ‘greying of HIV’ in the U.S.?
- Historically, older adults today have higher divorce rates than previous generations. This means older adults are engaging in new romantic relationships at higher rates as well.
- Our older generation today has lived through major historic events that have helped shape their outlook on themselves, their relationships, and their sexuality. This includes the industrial revolution, the 2nd wave of the women’s rights era, the Civil rights movement, the sexual revolution, the gay rights movement, and others.
- Older adults are healthier now than ever before, allowing them to experience sexually satisfying relationships later in life. Over the past 20 years, erectile dysfunction medications have also enabled men to engage in sexual relationships well into their later years.
- After women have reached menopause and can no longer get pregnant, we see lower levels of condom use. This is true for both committed relationships and new sexual encounters with a casual partner.
- Older adults do not perceive themselves to be at risk for STIs and HIV, therefore are less cautious in avoiding transmission.
- A lot of stigma exists around older adults and their sexuality. Many people like to believe that older adults do not engage in sex. Therefore, this creates an environment where older adults feel like they have to hide or deny their sexuality, which exacerbates STI and HIV infection and diagnosis rates.
- Healthcare providers have a difficult time talking to their older patients about their sexual health and HIV. In fact, when there is an age differential and a gender differential between the provider and the older patient, providers report being uncomfortable prompting such conversations. Providers also report that time is a big barrier in initiating such conversations, especially when their older patient has other health concerns.