Monday, July 5, 2021

Urban Institute Study Predicts "Senior Households" Will Lead Household Growth from 2020 to 2040

I'm currently working on an article that looks at senior living trends, and came across several interesting,  significant data points in a January 2021 article entitled The Future of Headship and Homeownership, by Laurie Goodman and Jun Zhu for the Urban Institute.  

The central prediction is that household growth will be "weak" over the next two decades, a decline associated with slowing of U.S. population growth and lower "headship rates" among most age groups.  The terms are defined at the beginning of the article.

Further, key takeaways from the article include these findings:

  • Almost all net household growth will be from senior households. Of the 16.1 million net new households formed between 2020 and 2040, 13.8 million will be headed by someone over 65.
  • All net household growth will be from households of color. Between 2020 and 2040, there will be 16.1 million net new households. Hispanic households will grow by 8.6 million, households of other races (mostly Asian households) will grow by 4.8 million, and Black households will grow by 3.4 million. White households will decline by 0.6 million. 

However, despite what at first seems like "better" (if not good news) for households of color, the authors also predict:

  • The decline in the homeownership rate will be particularly pronounced for Black households headed by 45-to 74-year-olds. If current policies stay the same, the Black homeownership rate will fall well below the rate of previous generations at the same age and result in an unprecedented number of Black renters over 65; we project elderly Black renters will more than double from 1.3 million in 2020 to 2.6 million in 2040.

July 5, 2021 in Consumer Information, Current Affairs, Ethical Issues, Housing, Statistics | Permalink | Comments (0)

Friday, July 2, 2021

Elected Officials and Advanced Age

Politico ran an interesting story, ‘You don’t have to die in your seat’: Democrats stress over aging members.

Using a Florida Congressman as an illustration, the article notes that "[t]he entire episode has brought into sharp focus an awkward conversation that Democrats have been having for a while: at a time of deep polarization and narrow congressional majorities, do older or infirm members have a responsibility to step down to ensure the party has enough votes to advance its agenda?"  The issue is one for both Democrats and Republicans. "Both parties have their share of elderly members ... But Democrats have been grappling with a noticeable generational divide within their ranks for some time — President Joe Biden and top Democratic congressional leaders are all well over 70. Ten of the 12 House members over the age of 80 are Democrats."  The article discusses various other issues, including the slim majority held by the Democrats, the desires of younger folks to serve, and perhaps a lessening value of seniority.

Thanks to Professor Naomi Cahn for sending us the article.

July 2, 2021 in Consumer Information, Current Affairs, Discrimination, Other, Statistics | Permalink

Thursday, July 1, 2021

As Covid-19 Eases, Is Germany Again Seeking "Filial Support" (Elternunterhalt) Payments from Children?

It has been a while since I've written a "Filial Friday" post.  After more than a year of no calls or requests for information about "Elternunterhalt" payments in Germany, in the last 45 days I've heard from three sets of American citizens who recently received requests for financial contributions to the care of an aging parent in Germany.  In each of the instances, the adult children had never heard of Germany's parental maintenance laws before receiving the demand.   

Since last writing about elternunterhalt on this Elder Law Prof Blog (see here and here), I've learned about some changes to the German laws.  

First,  Germany adopted a threshold annual income for a potentially obligated child of at least 100,000 Euros, effective for claims after January 1, 2020.

Second, it appears that Germany has also clarified that only the adult child's income is considered in determining the amount of the potential support obligation.  In the past, the German authorities would routinely ask for "all" income and asset information for the child and any spouse or partner.  

For more on this, see this article and another article, from Germany, describing these changes as "reforms."  Germany's renewed use of filial support laws began with a ruling by the Federal Court on June 23, 2002.  "The legal basis is mainly Section 1601 and 1602 Paragraph 1 BGB," according to a third article.  

While I've often seen "claim letters" submitted to adult children living in the U.S., I've never seen a formal administrative proceeding or court proceeding to enforce such a claim if not paid voluntarily. In some instances, I've seen German authorities agree to drop the claim, usually because there is strong evidence that the now needy-parent neglected or mistreated the child while the child was a minor.  I have also sometimes seen a voluntary settlement between the U.S. child and the German authorities.  But, have  any of our readers seen a litigated outcome in a cross-border claim?  Do we have any attorneys reading this blog with experience with cross-border claims between the U.S. and Germany?   

July 1, 2021 in Consumer Information, Current Affairs, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, International, Statistics | Permalink | Comments (0)

Wednesday, June 30, 2021

Early Recommendation: Read "The Problem of Alzheimer's" by Dr. Jason Karlawish


The Problem of Alzheimer's A number of years ago, I had an email correspondence going with Dr. Jason Karlawish, Professor of Medicine, Medical Ethics and Health Policy, and Neurology at the University of Pennsylvania.  He was writing and speaking in intelligent, understandable ways about complex issues in degenerative neurocognitive disorders.  

My sister brought him back to my attention, as she had just heard Brené Brown's podcast interview with Dr. Karlawish.  Dr. Karlawish recently published an important book on The Problem of Alzheimer's.  I immediately ordered the book and I'm still reading, but I can tell this is -- and should be -- an important resource for anyone trying to understand or explain the Alzheimer's or other progressive impairments in cognition.  Frankly, that means all of us.  He is taking on an essential question:  "What's a good life when you're losing your ability to determine that life for yourself?"  The subtitle of the book helps explain the scope:  "How science, culture, and politics turned a rare disease into a crisis and what we can do about it."

I'm sure I'll write more hear about this book as I plunge ever deeper into the clear prose, organized in logical chunks, where I'm finding "gold" embedded on every page.  It is not a soothing read, but that is exactly why it is so important.

June 30, 2021 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Statistics | Permalink | Comments (0)

Tuesday, June 29, 2021

HHS Inspector General Report on Medicare Beneficiaries' Deaths in SNFs

We all have heard the stories about the number of SNF residents dying during the pandemic. The Inspector General for HHS recently issued a report looking at the number of Medicare beneficiaries who died in SNFs during the pandemic, COVID-19 Had a Devastating Impact on Medicare Beneficiaries in Nursing Homes During 2020.

The executive summary explains:

Nursing home residents have been particularly affected by COVID-19, as they are predominately elderly, tend to have underlying conditions, and live in close quarters. However, data on the number of nursing home residents who were diagnosed with COVID-19 or likely COVID-19 have not been readily available, particularly for early in the pandemic. Nursing homes are not required to report cases and deaths that occurred before May 8, 2020.

This data snapshot provides objective, standardized data based on Medicare claims for all Medicare beneficiaries in nursing homes throughout the country. This data snapshot is the first in a three-part series. Subsequent work will address the characteristics of the hardest hit nursing homes and strategies used by nursing homes to confront the challenges of the COVID-19 pandemic.

WHAT WE FOUND

  • Two in five Medicare beneficiaries in nursing homes were diagnosed with either COVID-19 or likely COVID-19 in 2020.
  • Almost 1,000 more beneficiaries died per day in April 2020 than in April 2019.
  • Overall mortality in nursing homes increased to 22 percent in 2020 from 17 percent in 2019.
  • About half of Black, Hispanic, and Asian beneficiaries in nursing homes had or likely had COVID-19, and 41 percent of White beneficiaries did.
  • Understanding the pandemic's effects on nursing home residents is necessary if tragedies like this are to be averted.

Note that this is the first of 3 reports on the topic.  The full report is available here.

June 29, 2021 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare, Other, Statistics | Permalink | Comments (0)

Thursday, June 10, 2021

What Standards Should be Used for Seeking Consent for Alzheimer's Treatment, including Aduhelm?

The CEO for Biogen, the publicly-traded biotechnology company that developed Aduhelm, issued a statement about the company's policies and plans for the new drug in conjunction with the FDA's announcement of its accelerated approval of the drug for patients with Alzheimer's Disease.  He writes in part:  

The approval of ADUHELM represents a crucial inflection point in our collective battle against Alzheimer’s disease. By addressing a defining pathology of the disease, this novel therapy has the potential to help fundamentally change the way patients are diagnosed and treated. 

 

I have hoped for years that we would reach a moment like this. We all know the staggering numbers: there have been at least 100 drug development programs discontinued since 2003—the last time a new Alzheimer’s drug was approved. What it tells us is that the path for innovation is not straightforward, especially for something as complex as Alzheimer’s research. The journey during Biogen’s many years of research and development has been humbling, but we have learned from industry’s past research efforts and been determined to follow the science, always driven to address patients’ unmet needs. 

 

ADUHELM is a first-in-class approved therapy: I believe it will be the catalyst to a new era of innovation for Alzheimer’s disease, and the first of many new treatments available to patients. More resources will be drawn into research that can help patients through the disease continuum, explore new pathways, and find potential therapy combinations.  

The use of this drug involves some important questions about patient consent, precisely because the drug will most likely be used with people who have "confirmed presence of amyloid pathology and mild cognitive impairment or mild dementia stage of disease, consistent with Stage 3 and Stage 4 Alzheimer’s disease," the group of patients who took part in the pre-approval clinical trials.  What is the process for obtaining such consent with cognitively-impaired patients?

Several articles have explored this topic outside of the specific drug in question:

In England, the nonprofit organization Physiopedia, offers a detailed protocol for informed consent in the context of cognitive impairment.  For example, it suggests assessment of competence involves paying attention to four main abilities:

  1. The person must have sufficient capacity to understand the information. If the study involves a considerable degree of risk, more information must be provided, particularly about possible risks and benefits, and the potential participant must be able to understand such information.
  2. The person must be able to retain, use and weigh up such information long enough to be able to make a decision. In addition, they must also be able to understand what the decision is about, why they are being asked to make it, and what the consequences of making or not making that decision might be. 
  3. Possible benefits, risks and inconvenience linked to participating in research must be understood and weighed against the person’s own values and goals, which means that the person must understand how participating might affect him/her personally (High, 1992 and Stanley et al., 1984 in Olde Rikkert et al., 1997).
  4. The person must have the ability to communicate his/her decision.

See also:  "Informed Consent in Two Alzheimer's Disease Research Centers: Insights from Research Coordinators," by Christin M. Suver, and others, published April-June 2020, and announcing the plan to use the research to assist in development of "an electronic informed consent (eConsent) designed to boost engagement, enhance trust, and improve understanding by supporting participants' direct agency in the IC process."  

June 10, 2021 in Cognitive Impairment, Consumer Information, Dementia/Alzheimer’s, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Statistics | Permalink | Comments (0)

Tuesday, June 8, 2021

In Search of the Abracadabra for Alzheimer's Medicines

I used to follow (and regularly blog about) new drugs in the pipeline for Alzheimer's treatment.  Then I realized that the drugs weren't making it to the market place.  While attending medical programs about R & D, I learned that it was going to be tough to find any magic treatments, much less "cures."

To it was interesting to read this week that for the first time in some 18 years,  the FDA has approved use of a new drug, with the marketing name  Aduhelm and the generic name Aducanumab  (kind of sounds like abracadabra, doesn't it?), manufactured by Biogen.   

Aduhelm is described by the FDA as an "amyloid beta-directed antibody," which was approved under an "accelerated approval pathway," to give "patients suffering from a serious disease earlier access to drugs when there is an expectation of clinical benefit despite some uncertainty about the clinical benefit of the drug." 

But there is a lot of sobering news accompanying this announcement:

First, the mechanism of delivery:  monthly intravenous infusions, which means a clinical visit lasting at least an hour per infusion.

Second, Biogen's own predictions about cost:  a "list price" predicted to average  $56,000 per year per patient!  Yikes.

Third, the critical response from a range of experts in relevant research, pharmacy and health fields about the approval process to date, indicating a history of interruptions in the clinical trials when preliminary results showed little to no evidence of clinical benefit. 

Fourth:  the need for assessment before the first infusion with an MRI, plus recommended follow up MRIs prior to the 7th and 12th infusions, to assess the potential for ARIA-H, which are amyloid-related abnormalities, also potentially associated with edema in the brain.

Here are some links (and I'll try to keep this list up-to-date as new info comes in):  

Draft Evidence Report dated 5/5/2021 from the Institute for Clinical and Economic Review on "Aducanumab for Alzheimer's Disease: Effectiveness and Value." 

Letter from American Geriatrics Society dated 6/2/2021 to FDA expressing concern about "premature" approval

STAT's commentary, dated June 7, 2021 on FAQs: What You Need to Know about the Alzheimer's Drug Aduhelm

New York Times, dated June 8, 2021:  FDA Approves Alzheimer's Drug Despite Fierce Debate Over Whether it Works

June 8, 2021 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare, Science, Statistics | Permalink | Comments (0)

Thursday, June 3, 2021

Unilateral Attempts to Change Scope of Services in Continuing Care and Life Plan Communities

With lockdowns being lifted in commercial arenas, I'm once again hearing from residents in Continuing Care Retirement Communities (CCRCs), also sometimes called Life Plan Communities, as well as other similar senior living settings.  The most frequently raised concern is "how can management of my community make major changes in services and amenities without asking us if we agree to a new contract?"  Sometimes I am able to recommend local legal counsel for the callers.

As a matter of theory, there's a traditional  "law-based" answer to this question, with state-specific tweaks.  And then there is what happens all too often in real life. 

Generally speaking, the law provides that unilateral attempts by one party to make significant changes in the parties' duties under a contract are not legally effective.  Here's one state Supreme Court's typical statement of the rule of law (written in the context of considering an employer's unilateral attempt to change an employment contract):

The cases dealing with employment contracts are merely part of the general rule that recognizes no difference between an express and an implied contract.... As a result, to effectively modify a contract, whether implied-in-fact or express, there must be: (1) an offer to modify the contract, (2) assent to or acceptance of that offer, and (3) consideration."

Demasse v. ITT Corp., 984 P.2d 1138, 1144 (Az. 1999).  As my law students know, "consideration" is a legal term of art, and generally means a "bargained for exchange." In the context of modification of existing agreements, this often involves new financial terms or mutual concessions in the parties' respective duties.

But, the real-life situation is that the party with the greater bargaining power simply ignores the bargaining process altogether. In employment contexts, that's the employer.  They treat their notice of major changes as "the new agreement" simply because no one objected.  That's not how the rule of law is supposed to work, but it does, all too often.  Indeed, I will confess that the very reason I started teaching Contract law was my growing familiarity with disputes in senior living scenarios that made me wonder if there was something about contract law I'd missed back in my own days as a law student.  There wasn't (although the full explanation would require a law review article) -- but the world keeps spinning along with the more powerful party in many commercial contexts able to avoid the contract because they are "in charge."  

Residents don't, however, have to put up with this.  Resident groups in individual CCRCs and those living in states where there are regional organizations have learned to flex their considerable muscle, both in negotiations with management and with state regulators or legislators.  I'm also hearing from more attorneys who are representing residents in negotiations, or when necessary, in arbitrations or on  lawsuits alleging breaches of contract and fiduciary duties.  Plus, I'm hearing from more states officials who are asking good questions.

It not a secret that I like CCRCs and I like them a lot.  I've visited CCRCs throughout the U.S. and they tend to be vital examples of senior living, offering community engagement, social networks, friendly-settings, caring service providers, and the reassurance of assistance if needed.  Many forms of senior living options are struggling with the impact of the pandemic, with enhanced pressures on facilities to balance their budgets. This is probably triggering a new upswing in attempts to make unilateral changes.  

I have worried, long before the pandemic, that an episodic  history of paternalistic or peremptory changes by management in CCRCs can undermine public confidence in this format as a viable alternative for seniors.  CCRCs have their highest value for consumers when residents are making the transition before becoming too frail to appreciated the amenities and services.  New residents may be unlikely to  "invest" in CCRCs if they lack confidence that promised services will be available when needed.  

June 3, 2021 in Consumer Information, Current Affairs, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, Housing, Property Management, Retirement, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Monday, May 31, 2021

Roundup on Nursing Home Articles

Starting off the month of June with another roundup of articles about nursing homes.

First, from the New York Times at the end of April, Cuomo Aides Spent Months Hiding Nursing Home Death Toll.

Then, also from late April, this article from Politico, Will the Nursing Home of the Future be an Actual Home?

Then, a recent report from the GAO, COVID-19 in Nursing Homes: Most Homes Had Multiple Outbreaks and Weeks of Sustained Transmission from May 2020 through January 2021 (the link takes you to the page with links for highlights, the full report, fast facts, and a podcast).

On another topic related to SNFs, as we approach hurricane season, this important report about facilities in Florida with emergency power backups.  See, generators by Florida county for ALFs and SNFs.

May 31, 2021 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Friday, May 21, 2021

Folks Want to Age At Home

Long-Term Care in America: Americans Want to Age at Home covers recent poll results about long term care.

In the wake of a pandemic that was especially devastating for nursing homes, the vast majority of Americans want to age at home and want government action to help them do so, according to a new study from The Associated Press-NORC Center for Public Affairs Research.

Even as concerns about the safety of nursing homes decline as more and more COVID-19 vaccines are administered, 88% of Americans would prefer to receive any ongoing living assistance they need as they age at home or with loved ones. Just 12% want to receive care in a senior community or nursing home. With that objective of aging in place in mind, more than 6 in 10 support a variety of policies that would facilitate aging at home including a government-administered long-term care insurance program, similar to Medicare.

Here are three highlights from the poll

Three Things You Should Know About The Long Term Care Poll on Aging at Home
Among Americans Adults:
1) 88% would prefer to receive any ongoing living assistance they need as they age at
home or in a loved one’s home
2) 51% think Medicare should have a large responsibility for paying for ongoing living
assistance, and 49% expect to rely on it to pay for care they need as they age.
3) 53% have already received health care at home during the pandemic through telehealth

The full report is available here.

Thanks to Morris Klein for sending me the article.

May 21, 2021 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Statistics | Permalink | Comments (0)

Monday, May 17, 2021

Increase in Retirements During Pandemic

The New York Times published an article,  In Reversal, Retirements Increased During the Pandemic. "After decades in which it decreased, the retirement rate rose during the pandemic, according to the latest government data. This makes retirement one exception to the many ways that the pandemic accelerated pre-existing trends .... "  The article examines the explanations for this trend, such as losing employment, an employer going out of business, and the higher risk of illness for those employees who are older.  The article predicts that the trend won't continue. "Even though the retirement rate increased during the pandemic, it won’t necessarily rise further. It’s worth emphasizing that the retirement rate rose around the start of the pandemic but did not continue to do so. After the initial spike in joblessness at the start of the pandemic, the share of those 55 to 64 who were out of work but not retired fell rapidly without a further rise in retirement."

May 17, 2021 in Consumer Information, Current Affairs, Retirement, Statistics | Permalink | Comments (0)

Thursday, March 18, 2021

California Releases Master Plan FOR Aging

California has released its Master Plan FOR Aging.  Here's the rationale for having a master plan:

Aging is changing and it’s changing California. California’s over-6o population is projected to diversify and grow faster than any other age group. By 2030, 10.8 million Californians will be an older adult, making up one-quarter of the state’s population.

The Master Plan for Aging outlines five bold goals and twenty-three strategies to build a California for All Ages by 2030. It also includes a Data Dashboard on Aging to measure our progress and a Local Playbook to drive partnerships that help us meet these goals together.

This is not a plan simply for today’s older adults. Instead, the Master Plan is a blueprint for aging across the lifespan. The Master Plan calls on all California communities to build a California for All Ages: for older Californians currently living through the many different stages of the second half of life; for younger generations who can expect to live longer lives than their elders; for communities of all ages – family, friends, neighbors, coworkers, and caregivers – surrounding older adults. As Californians, we can create communities where people of all ages and abilities are engaged, valued, and afforded equitable opportunities to thrive as we age, how and where we choose.

The five goals address health, housing, equity and inclusion, affordable aging, and caregiving. The plan is available here.

PHI issued a report regarding the direct care workers and the California Master Plan For Aging. Quality Jobs Are Essential: California’s Direct Care Workforce and the Master Plan for Aging

[P]rovides a detailed overview of the state’s direct care workforce and examines how California’s Master Plan for Aging can improve jobs for this rapidly growing workforce. It describes how the Master Plan supports this workforce, highlights where it incorporated the LTSS Subcommittee’s recommendations, and proposes where and how the Master Plan can be strengthened. This report also includes various stories from direct care workers in the state.

The report is available here for download.

March 18, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Other, Retirement, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Monday, February 22, 2021

The "Forgotten for COVID" Elders?

Despite projects to vaccinate those elders who are homebound or lack internet access, we are still lagging behind on reaching them, according to a story today in Kaiser Health NewsCountless Homebound Patients Still Wait for Covid Vaccine Despite Seniors’ Priority starts with the good news-recognizing the unique outreach efforts by hospitals, health systems, and paramedics, for example. These folks are home are highly vulnerable. Described by one expert in the article as a "hidden group", they are at great risk, "[b]y virtue of their age and medical status, these seniors are at extremely high risk of becoming seriously ill and dying if they get covid-19. Yet, unlike similarly frail nursing home patients, they haven’t been recognized as a priority group for vaccines, and the Centers for Disease Control and Prevention only recently offered guidance on serving them." The article notes that those professionals whoa are regularly in contact with them are not those with access to vaccines.  Medicare's reimbursement rates for time-consuming house calls doesn't allow the health care professionals to recoup their costs, notes the article.  Not only that, knowing the storage requirements for the vaccines doesn't mean a health care professional can just hop into their car and drive around with the vials in a cooler.

So this brings us to this story, a new hero for all of us! Last week in the New York Times, Woman, 90, Walked Six Miles in the Snow for a Vaccine
explained how after that recent snow storm, driving was out for her, but given all her previous failed efforts to get the vaccine, she wasn't going to miss this opportunity.

Where's Rosie the Riveter when we need her?? Surely "we can do it" or at least do better?

February 22, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (1)

Monday, February 15, 2021

What Did NY Cause When Transferring COVID Patients From Hospitals to SNFs?

Read these three articles, to get a full picture of what happened. First, the AP story: AP: Over 9,000 virus patients sent into NY nursing homes. Next, the CNN story: New York governor's top aide apologizes and says administration 'froze' after inquiries on Covid-19 deaths at long-term care facilities. Finally, Politico's story: Top Republicans call for Cuomo's ouster following nursing home revelation.

This follows the release a few weeks ago of a report by the NY AG that indicated the state had failed to accurately count deaths.  The NY AG report is available here

 

February 15, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (1)

Thursday, February 4, 2021

NY Nursing Homes and COVID

A couple of recent articles about NY SNFs will make you stop and think.... hmmmm.. First, Politico noted a recent NY AG report New York undercounted nursing home deaths by as much 50 percent, report finds.. Nursing Home Response to COVID-19 Pandemic report includes preliminary findings

OAG’s preliminary findings are:

» A larger number of nursing home residents died from COVID-19 than DOH data reflected.

» Lack of compliance with infection control protocols put residents at increased risk of harm during the COVID-19 pandemic in some facilities.

» Nursing homes that entered the pandemic with low U.S. Centers for Medicaid and Medicare Services (CMS) Staffing ratings4 had higher COVID-19 fatality rates than facilities with higher CMS Staffing ratings.

» Insufficient personal protective equipment (PPE) for nursing home staff put residents at increased risk of harm during the COVID-19 pandemic in some facilities.

» Insufficient COVID-19 testing for residents and staff in the early stages of the pandemic put residents at increased risk of harm in some facilities.

» The current state reimbursement model for nursing homes gives a financial incentive to owners of for-profit nursing homes to transfer funds to related parties (ultimately increasing their own profit) instead of investing in higher levels of staffing and PPE.

» Lack of nursing home compliance with the executive order requiring communication with family members caused avoidable pain and distress; and,

» Government guidance requiring the admission of COVID-19 patients into nursing homes may have put residents at increased risk of harm in some facilities and may have obscured the data available to assess that risk.

Then consider this article in the Washington Post. Andrew Cuomo’s bad ‘who cares’ answer on coronavirus nursing home data

Facing a brutal report from his own party’s state attorney general that said the state had undercounted nursing home deaths from the virus, Cuomo essentially argued that it’s neither here nor there.

“Look, whether a person died in a hospital or died in a nursing home, it’s — the people died,” Cuomo said. “People died. ‘I was in a hospital, I got transferred to a nursing home, and my father died.' ‘My father was in a nursing home, got transferred to a hospital, my father died.’ People died.”

It does matter. As the article notes "there are major and very valid questions about whether nursing home policies led to unnecessary ones. To the extent that more deaths occurred in or came from that setting, it allows us to evaluate how significant that problem was and how much corrective action is needed."

February 4, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Sunday, January 31, 2021

COVID Vaccine and Elders

Friday, January 29, 2021

ABA BIFOCAL Latest Issue Released

The ABA Commission on Law and Aging has published vol. 42, Issue 3 (Jan.-Feb.2021),  its current issue of BIOFOCAL. The issue contains several articles, including a couple on Social Security Rep Payees, with the lead article, How Does Social Security Select Representative Payees for Adults? Results of an Independent Research Study

Almost four million older adults and adults with disabilities have representative payees appointed by the Social Security Administration (SSA) to manage their Social Security or SSI payments. How does SSA determine if a payee is needed? How do SSA staff select a payee? How do they choose an individual versus an organizational payee?  What are the considerations in long-term care residential facilities serving as the payee?  What about guardians serving as payee? How and to what extent does SSA maintain consistency in payee determinations?

In 2018, the Social Security Advisory Board (SSAB) charged researchers at Virginia Tech and the ABA Commission on Law and Aging to conduct an independent study focusing on these compelling questions.  The study team addressed SSA processes for selection of payees for adults. The underlying assumption was that a better understanding of selection practices ultimately could lead to process improvements, as well as a reduction in the potential for misuse and abuse of beneficiary funds while maintaining beneficiary rights.

A pdf of the full issue is available here.

January 29, 2021 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Federal Statutes/Regulations, Other, Social Security, Statistics | Permalink | Comments (0)

Monday, December 28, 2020

Florida COVID SNF Deaths Rise

The Tampa Bay Times reported recently on an uptick in the numbers of COVID deaths in Florida . Why are coronavirus deaths doubling in Florida’s nursing homes? references a recent report from AARP  "that the COVID-19 death rate among Florida nursing home residents doubled in the three weeks around the Thanksgiving holiday, and infections continue to climb among the state’s most vulnerable residents. The death toll spike was so alarming that AARP decided to report on the data rather than wait for its scheduled monthly release on Jan. 10." One expert quoted for the article pointed to the state's failure to "to provide accurate, rapid-result testing of everyone entering elder-care facilities — staff, visitors, family caregivers and vendors."  The AARP report with the Florida data is available here. 

December 28, 2020 in Consumer Information, Current Affairs, Health Care/Long Term Care, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Monday, December 7, 2020

Is It Bad Money Management or is it Dementia?

JAMA Internal Medicine published the results of a recent study, Financial Presentation of Alzheimer Disease and Related Dementias.

Here are the key points from the study: 

Question  Are Alzheimer disease and related dementias (ADRD) associated with adverse financial outcomes in the years before and after diagnosis?

Findings  In this cohort study of 81 364 Medicare beneficiaries living in single-person households, those with ADRD were more likely to miss bill payments up to 6 years prior to diagnosis and started to develop subprime credit scores 2.5 years prior to diagnosis compared with those never diagnosed. These negative financial outcomes persisted after ADRD diagnosis, accounted for 10% to 15% of missed payments in our sample, and were more prevalent in census tracts with less college education.

Meaning  Alzheimer disease and related dementias were associated with adverse financial events starting years prior to clinical diagnosis.

The full article is  available here.

December 7, 2020 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Other, Statistics | Permalink | Comments (0)

Friday, December 4, 2020

The COVID Crisis in One Florida LTC Facility

The Tampa Bay Times ran a profile of  a local long term care facility that experienced a significant COVID outbreak last spring.  Death at Freedom Square  is an in-depth story about the people who live and work at Freedom Square and the spread of COVID within that facility. The article provides detailed reporting (In fact the TBT refers to this story as a "project").  The article is written in a way that tells the story of the people impacted, which makes it a compelling--- and sad---- read.    

Nine months into the pandemic, the virus has killed more than 19,000 Floridians. About 40 percent of the deaths have been among senior care residents. In Pinellas County alone, more than 2 out of 3 coronavirus deaths are connected to nursing homes and assisted living centers.

Freedom Square, a 15-acre retirement complex built around a town square and a gazebo, was the early epicenter in Tampa Bay.

Of course, we all know that this is not the only facility that experienced a COVID outbreak, whether inside Florida or in other states. The human interest angle makes this a compelling read, but it also includes important information about the Florida responses and about the corporate structure for this facility.

The article is as gripping as it is saddening; the reporters use of the human interest angle helps remind us that we aren't talking about numbers---we are talking about people.

Read it!

December 4, 2020 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare, State Statutes/Regulations, Statistics | Permalink | Comments (0)