Elder Law Prof Blog

Air Travel When Using A Wheelchair

Did you see this article in the New York Times a couple of weeks ago?  Embarrassing, Uncomfortable and Risky: What Flying is Like for Passengers Who Use Wheelchairs is compelling and enlightening and makes the reader wonder if there isn't room for a lot of improvements from airlines and airports for these passengers.  If you haven't read it, you really must.  There is an audio version of the article also available at the same website, but the accompanying photos are also quite compelling. Follow the passenger in the story on his journey from arrival at the airport to arrival at his destination. 

Assessing Your COVID Risk To Go Outside When You Are Older?

When I read the following New York Times article, all I could think of was the Clash song, "Should I Stay or Should  I Go?  The article, You’re a Senior. How Do You Calculate Coronavirus Risk Right Now? focuses on the decision to stay home or to venture out into the world (with precautions of course) when you are in a high risk group (or any group for that matter but this is the elderlawprof blog!)

"Early on in the pandemic, most public health officials warned older adults to simply stay at home, except to buy food or medicine or exercise outdoors apart from others. Now, with states and cities reopening (and some re-closing) at varying paces, the calculations grow steadily more complicated."

What to do? What to do? One study from MIT economists "in a recent paper suggesting age-targeted lockdowns ... proposed protecting people over 65 by having them isolate for an estimated 18 months until a vaccine becomes available; younger people, facing less health risk, would return to work."  As the article notes, that "approach also assumes that older adults’ only  interest lies in not dying."  Well, that is a big one, but still.....

There's so much info out there, what is one to do?  The article offers a couple of insights

A calculator developed by researchers at the Cleveland Clinic may provide a clearer sense of individual risk.

Geography matters too. Older people in New Hampshire or Maine — where new cases were falling last week — may reasonably opt for less restrictive behavior than those in Florida and Arizona, where Covid has been surging. Pay attention to which counties are seeing cases rise and which are doing a good job at observing guidelines.)

So in the meantime, back to the question asked by the Clash..."should I stay or should I go".... places....

(P.S.-I'm from Florida, so I'm staying for now).

 

What Does It Mean to Do Contact Tracing for Communicable Diseases, Especially for Air Travelers?

Last month I made my first roundtrip, domestic airline flight following 90+ days of lockdown and gradual easing of travel restrictions.  I scheduled this quick trip cautiously, for family-related reasons, and with a goal of returning to my Pennsylvania home well in advance of any return to work with students in my law school. I'm not a timid flyer, but I did my best to try to minimize risk factors, including selection of an airline that advertised "vacant" middle seats, masking requirements, and updated standards for cleaning the airplane and social distancing. I am writing here because an individual on the return leg of my flight in my same row (but across the aisle) became seriously ill during the flight. This post is about my growing concern about what it means to respond to the potential for a communicable illness while traveling, especially but not exclusively in the time of COVID-19. 

When the individual became ill (seeming to lose consciousness and vomiting-- more ill than what I associate with "mere" air sickness), the flight attendants responded to his needs with plastic bags and napkins.  On the positive side, they kept everything low key and talked to the individual softly.  I think it was another, closer passenger who summoned them and everyone tried to respect the privacy of the individual.  Eventually, the ill passenger was moved to the rear of the plane.  Shortly after that, all passengers were informed the seatbelt signs had been activated and everyone should stay in their seats for the remainder of the flight.   There were no further announcements and nothing said about the ill passenger specifically. When the flight arrived at its regular destination, I did not see the individual leave the plane.

What does it mean for any state health department or CDC program official to say they will follow a plan for contact tracing?  Each step of the process needs clarity, including that first step of identifying the ill traveler and other potentially affected travelers, right?   

I received a traditional customer satisfaction "survey" form from the airline the morning of my return via email, asking me to describe the flight. This made me realize that I should be talking directly to the airline about this specific incident.  Was the individual in question experiencing a communicable illness, especially COVID-19?  I made a short, emailed report to the airline less than 12 hours after the end of the flight, and made a follow up inquiry and a second report by telephone and email.   The most I have learned is that the airline is "researching" whether there is any record of the incident or illness on board that flight.  Taking a week (or more?) to determine whether the crew made a report is not reassuring. At a minimum, shouldn't there be a record of that plane being taken out of service for some period of time for cleaning?  

The Pennsylvania governor, for reasons unrelated to my account above, has recently asked all residents returning from the departure state in question (and certain other states experiencing surges in COVID-19) to self-quarantine for 14 days. That makes sense.  Even though I had been exceptionally careful during my time out-of-state, the airline incident was a stark reminder that travel, even with the lessons learned during the last several months, involves factors that are completly outside the control of any of the passengers.  "Being careful" on an individual basis may not be enough and when something happens that involves risk to others, we need clear lines  for any investigation and communication.    

Everyday we are learning new things about how to deal with communicable illnesses, including ones that may be life-threatening. I think what I'm realizing is that as individuals and consumers, we cannot be passive about these steps.

I contacted the CDC and was told there is a process for "contact investigations" by the CDC, but that triggering such an investigation cannot be done easily, at least not if you are a mere passenger.  They recommended I contact the health department in the state where my plane landed.  Here is what CDC sent me by email:  https://www.cdc.gov/quarantine/contact-investigation.html

Weaknesses clearly exist in the protocols. The airline and CDC have been quick to warn me that they cannot give any information about the "patient."  I'm not asking to know the patient's identity in any way. But shouldn't any potentially affected traveler be entitled to know:

a. Whether there was a report of the illness made by the crew to the airline and/or other authorities.

b. The result of any investigation, especially in terms of public health implications.

c.  Whether a specific, communicable illness or disease was identified.

d.  Whether there are specific steps that should be taken by passengers in light of the history.

Shouldn't the CDC want to know whether others on that plane have experienced similar symptoms? (Thankfully, I have not, but although I was in the line of sight of his seat, there were others between us, and in front and behind him, who were much closer.)  I have realized that short of contacting every passenger on the plane, it might be difficult  for some airlines to help with "contact" tracing. They may be relying on a manifest rather than a chart for assigned seats.  Certainly, no one asked me or other, closer passengers on the flight for contact information. I hope the ill individual has recovered fully and quickly, and that for his sake this was a temporary illness.  I'm being calm, even as I'm frustrated.  I'm frustrated not just for myself, but for the larger public.  The  passengers on this plane included all ages, including older individuals.  Earlier during my trip, I overheard one older traveler say to another, "I just want to live long enough to see my grandchildren again."

UBER and LYFT as the Answer to Elder Transportation Needs?

The New York Times was considering that question in a recent article,Older People Need Rides. Why Aren’t They Using Uber and Lyft?

More than half of adults over 65 own smartphones, the Pew Research Center has reported. Yet among adults 50 and older, only about a quarter used ride-hailing services in 2018 (a leap, however, from 7 percent in 2015). By comparison, half of those aged 18 to 29 had used them.

In a survey by AARP last year, only 29 percent of those over 50 had used ride-hailing apps. Two-thirds said they weren’t likely to do so in the coming year, citing in part concerns about safety and privacy. (Given data breaches at Uber, that’s no baseless fear.)

So wouldn't these options help people remain more independent, especially while we wait for self-driving cars to become widely available for all of us? One expert quoted in the article said absolutely! "One reason for such optimism: evidence that with personalized instruction, older adults can master the mobile apps and take “networked transportation” to medical appointments, entertainment and leisure activities, social visits and fitness classes."

A recent study from U.S.C. covered in the article noted when the researchers "offered three free months of unlimited Lyft rides to 150 older people in and around Los Angeles (average age: 72) who had chronic diseases and reported transportation problems... [w]ith training, nearly all used Lyft, most through the mobile app (a few used a call-in service), for an average of 69 trips. On follow-up questionnaires, almost all riders reported improved quality of life."

That's great news but the companies are seeing an opportunity here. 

Lyft and Uber and others are contracting with third parties, bypassing the need for older riders to use apps or to have smartphones at all.

They’re joining forces with health care systems, for instance. In the past 18 months, more than 1,000 — including MedStar, in the Washington area, and the Boston Medical Center — have signed on with Uber Health for “nonemergency medical transportation,” the company said.

Case managers and social workers can use Uber or Lyft to ferry patients to or from clinics and offices, reducing missed appointments.

In addition, they are working with various senior communities and exploring other programs for those who have mobility issues, including the ability to order accessible transportation and training drivers of how to assist riders with mobility issues!  There are other smaller companies carving out a part of the market, whether portal-to-portal service or the ability to call for a ride by phone. The article also explores the potential costs in using ride-hailing services.

In the U.S.C. study, the typical trip cost $22; the cost per month, had users actually paid it, averaged $500. After the study, about a fifth of riders said they wouldn’t continue using ride-hailing, mostly because of cost.

Some Medicare Advantage programs now cover rides to medical appointments and pharmacies; Lyft expects to partner with most Advantage plans by next year....But most older Americans still use traditional Medicare, which doesn’t cover such transportation.

 

European Heat Wave Endangers Elders

So last week I posted how elders had an impact on climate change. Now I write about the impact climate change has on elders.  In case you weren't aware, there's a heat wave in Europe. In fact, one of my dear friends is teaching in our summer abroad program in Spain and he unexpectedly texted me to tell me how hot it was.  So last week's story in the Washington Post on the heatwave in France seems timely.

A heat wave killed 15,000 in France in 2003. As temperatures soar again, officials are taking no chances. explains about the various steps that French authorities are taking to offset the effect of the heatwave hitting their country, These record-breaking temperatures "scientists say are becoming more common in Europe as a result of climate change." Officials in Paris have taken a number of steps to help residents cope with the heat.  "The heat particularly threatens children, pregnant women and the elderly, city authorities warn. The city has set up a special phone service for elderly and sick people, and authorities have asked hospitals and retirement homes to be on alert. Older residents left alone made up many of the victims of the 2003 heat crisis."  The heat is record-breaking, according to the BBC.

Unusually hot temperatures are not limited to just Europe. The Tampa Bay area of Florida (where the College of Law is located), whose residents are used to hot and humid conditions this time of year, issued a heat advisory on June 26, 2019."[I]t’s rare for temperatures in Florida to climb beyond the low 90s in the summer ...  But with a high pressure system in the Atlantic blocking most of those cooling storms... the high ... should reach at least 96 – in the shade. Heat index values, meaning the temperature it feels like outside, will be 104 in Tampa and as high as 110 in the southern Bay Area."

 

Centralizing Call Centers: One Person's Story About Accessibility

My dear friend and colleague, Professor Mark Bauer, a frequent reader of this blog, shared a recent story about bumps in the road for elders in the family as they gathered for a funeral. He has given me permission to share this with you.

Sometimes many of us forget when we are privileged.  I was reminded of this last week.  Those of us who are fully able-bodied and adept at new technology already have every advantage.  Those of us with disabilities are already at a disadvantage, and the modern world rarely considers their needs.

A member of my family is an elder with devastating claustrophobia and two artificial knees.  Before making any hotel reservation, she needs to speak to the hotel and find out whether there are rooms on the ground floor because she has difficulty riding an elevator.  Sometimes a second floor room can work, but her knees prohibit her from long stairways, and frequently a dark, narrow, and foreboding staircase can be worse for claustrophobia than an elevator.  Substantially all hotel reservations are handled by national call centers and sometimes even outsourced to third parties.  They don’t have access to information about whether there are ground floor rooms, and they can rarely make a reservation for a specific floor.  Systems are designed today to prevent people from calling specific hotels.  Even if you can speak to the hotel, they often are prohibited from taking reservations directly.

We arrived in the Washington, DC area only to find out that the first floor of the hotel was actually on the sixth floor; the lower floors were a parking garage.  A desk clerk at the hotel had told us by phone in advance that there were ground floor rooms and even noted in our reservation the need for one.

I spent the next two hours trying to find some hotel within a few miles with ground floor rooms.  Even after looking up the hotel’s local number, calls fed directly into national reservations lines that were of no help at all.

I found a nearby corporate apartment complex that rented apartments on a nightly basis.  It took 30 minutes, but a supervisor at the national reservations number was willing to make a series of phone calls to the local property to verify they had an apartment available on the second floor.

I called an Uber and brought the two family members over to their new lodging.  While fairly close to the hotel where the other seven of us were staying, it was not walking distance for two elders.  The only thing that made sense at the time was to install Uber on their phones and give them a crash course in how to use a smart phone for more than calls, texting, and a few games.

I grabbed family member #1’s phone and tried to install Uber, only to find out he had already downloaded it.  But it froze up every time I tried to open the app because he had created a password, forgotten it, and then became locked out of the app.  I then deleted Uber and reinstalled it, and the same problem occurred.  It makes sense as a security matter to prevent reinstallation, but how many elders forget passwords and enter them incorrectly.

Since I thought myself clever, I tried to download Lyft.  But family member #1 couldn’t recall his Apple ID, so I was locked out of the app store.

I turned to family member #2’s phone.  I was able to successfully download Uber on to her phone and gave her a 20 minute course in how to use it, writing down the instructions and even going through several scenarios.  I knew it would probably work out (and it did) or we might never see them again.

Because I am a (slightly) younger and able-bodied person, it never occurred to me that hotels centralizing reservations at call centers could be an impediment to elders and those with disabilities.  And while I knew Uber was unavailable to anyone without a smart phone, or anyone who doesn’t know how to use their smart phone, I had never previously considered Uber to be an indispensable utility.

It seems to me that if we’re smart enough as a society to save all this money with call centers, and to create paradigm shifting inventions like smart phones and Uber, we should also be smart enough to figure out how not to further disenfranchise elders and persons with disabilities in the process.

Smarter Driving Technology Makes for Safer Drivers and Safer Drives

Ok, ok, I know I've blogged several times about self-driving cars and how I can't wait to try one.  I know they are being extensively tested. But in the meantime, it looks like I don't have to wait for a self-driving car for drivers to be safer.  Driving tech is already supplementing many driving tasks for drivers as reported in an article published in the NY Times. Tech May Help Steer Older Drivers Down a Safer Road explains that tech is making cars smarter, allowing cars to do things that make driving safer (for the driver, passengers and other drivers).

[S]marter cars ...  can detect oncoming traffic, steer clear of trouble and even hit the brakes when a collision appears imminent.... A few of these innovations, such as blind-spot warning systems, are already built in or offered as optional features in some vehicles, primarily in more expensive models....But more revolutionary breakthroughs are expected in the next few years, when measures such as robotic braking systems are supposed to become standard features in all cars on U.S. roads.

Sure, sure drivers of all ages will benefit from smart cars. But, as the article notes, the application for elders has great value.

[T]hose in their 70s and older are more likely to become confused at heavily trafficked intersections and on-ramps. Aging also frequently limits a body's range of motion, making it more difficult to scan all around for nearby vehicles and other hazards. And older drivers tend to be more fragile than their younger counterparts, suffering more serious injuries in traffic accidents.

"Anything that reduces the likelihood or severity of a collision is really a technology that is primed for helping tomorrow's older adults," says Bryan Reimer, research scientist for the Massachusetts Institute of Technology's AgeLab and associate director of the New England University Transportation Center. "We are moving toward an ecosystem where older adults will increasingly be supported by the technology that may help enhance their mobility."

Thinking about buying a car in the near future. Well consider this.  "The presence of safety technology will be a key consideration for three-fourths of the drivers older than 50 who plan to buy a car in the next two years, according to a recent survey by auto insurer The Hartford and MIT AgeLab. In an indication that priorities are shifting, only one-third of the surveyed 50-and-older drivers who bought a car during the past two years focused on safety technology."

Some of the driving technology is already available, with rear view backup cameras proliferating.  There are cars that can parallel park for the driver, and as seen on commercials, do other tasks to make driving safer. The article mentions several that are either in use, can be added to a vehicle, or will be available before much more time passes.

[T]he auto industry vowed  to make automated emergency brakes a standard feature by September 2022, but it won't be that long before the technology is widely available. Toyota plans to build it into most models, including its Lexus brand, by the end of next year....Cameras on a dashboard screen that show what's behind the car have become commonplace in recent years and will be mandatory on all new cars by May 2018. The equipment is expected to be especially helpful for older drivers with a limited range of motion....Other technology expected to assist older drivers includes automated parking, and adaptive headlights that swivel in the same direction as the steering wheel and adjust the beams' intensity depending on driving conditions and oncoming traffic. ...Robotic systems that temporarily assist with highway driving already are available, most notably in Tesla Motors' high end Model S. The electric-car maker released its Autopilot feature last fall, prompting some Model S owners to entrust more of the driving to the robot than Tesla recommends while the system is still in testing mode. For instance, some drivers have posted pictures of themselves reading a newspaper or book with the Model S on Autopilot, or even sitting in the back seat.

(On that last point, Yikes and should I point out that we're talking about driving technology, not self-driving cars). All of these safety innovations are great, and maybe they will allow people to continue driving longer than they would be able to do without the innovations. Of course, we still want to be sure that unsafe drivers are off the road. At least it looks like I have some cool options while waiting for my self-driving car.

The Surprisingly Complex Law of Descansos (a/k/a Roadside Memorials)

When I was growing up in Arizona, my father and I spent a lot of time on the road, and we would often comment on the small white crosses found along the highways marking the locations of fatal car accidents.  Perhaps this conversation was a bit morbid in retrospect, but the presence of the crosses made an impression on me, demonstrating just how significant a momentary lapse of awareness can be for drivers operating at high speeds.  I'm not sure when those state-sponsored memorials ended, but you still sometimes see markers installed by families. They can vary from simple to elaborate. In the Southwest generally, they are sometimes known as "descansos," a Spanish word for "resting places," and there is a long tradition behind them.  

More recently in Arizona, the tradition has been challenged, with state authorities aggressively removing the impromptu memorials as "safety hazards" in early 2016, citing long-standing laws prohibiting such markers.  An Arizona newspaper chronicled the issues earlier in the year: 

For the past 15 years, Pete Rios would say a special silent prayer as he drove past a large white cross that sat on top of a rocky hill just alongside the road on his way to work.

 

As a little boy, he said, he was told “that’s what you do to show respect” for the many memorial sites that line Arizona highways, marking the deaths of loved ones.

 

One in particular was special to the Pinal County supervisor.

 

It bore the initials of his sister, Carmen Rios, who had been killed near that spot by a drunken driver in 2000. It sat surrounded by a 3-foot angel, faded in color from years of sun beating down on it, and ceramic vases that held new flowers with every passing holiday and changing of seasons.

 

Last week, the memorial disappeared.

When dozens of crosses along Arizona highways disappeared suddenly, families protested.  They countered the "safety" argument, pointing to the absence of any evidence that the small crosses caused drivers to stop or otherwise change their course of driving.  The Arizona Department of Transportation offered "alternatives" as memorials, suggesting families could participate in Arizona's "adopt a highway" program.   

The grassroots advocacy of families took hold, and recently the Arizona Department of Transportation announced a new policy:

Recognizing the need of families to grieve in different ways for those killed in crashes, the Arizona Department of Transportation has established a policy allowing memorial markers along state-maintained highways in a way that minimizes risks for motorists, families and ADOT personnel.

 

Developed with input from community members, the policy specifies a maximum size and establishes standards for materials and placement so markers present less chance of distracting passing drivers or damaging vehicles leaving the roadway....

 

• Size and materials: A marker may be up to 30 inches high and 18 inches wide, and the wood or plastic/composite material components used to create it may be up to 2 inches thick and 4 inches wide. It may include a plaque up to 4 inches by 4 inches and up to 1/16 of an inch thick. It may be anchored up to 12 inches in the ground, but not in concrete or metal footings.
• Placement: In consultation with ADOT officials, families will place markers as close as possible to the outer edge of the highway right of way. Markers may only be placed in front of developed property if the property owner gives written permission to the family.

It turns out that states across the nation have different laws and policies governing roadside memorials.  And, I guess I'm not entirely surprised to discover law review articles on this very subject. Florida Coastal Associate Law Professor Amanda Reid has two very interesting pieces, including "Place, Meaning and the Visual Argument of the Roadside Cross," published in 2015 in the Savannah Law Review.

Accessible National Parks: A Goal by 2020?

With summer winding down, and the fall semester bearing down on us, hopefully everyone had a fabulous summer. For many of us, summer vacation included a trip to a national park.  I was lucky enough to spend some time in the Rocky Mountain National Park. One day I was walking along an accessible trail, and noticed 4 folks using wheelchairs within the first 100 feet of the trail. This particular trail also offers an accessible campsite. That got me thinking about how many trails in national parks are accessible. That led me to an internet search  (yay Google) which led me to this report, All In! Accessibility in the National Park Service 2015-2020.  The report explains the creation of a task force on accessibility which developed a "strategic plan with specific strategies on how to make parks and programs accessible to a broader range of audiences. These strategies are focused on actions needed to build momentum, augment capacity, and accelerate real improvements over the next five years (2015–2020)." 

The parks are definitely not as accessible as they could be-or should be for that matter.  "[T]he National Park Service is underserving people with varying abilities and their traveling partners. Without accessible parks, the National Park Service loses an opportunity to reach the widest possible audience and share a spectrum of experiences. This lost opportunity is a direct failure to carry out our mission. Both long- and short-term solutions are needed to build momentum and advance the program."  The report sets out 3 goals for the NPS:

1. "Create a welcoming environment by increasing the ability of the National Park Service to serve visitors and staff with disabilities."

2.  "Ensure that new facilities and programs are inclusive and accessible to people with disabilities."

3.  "Upgrade existing facilities, programs, and services to be accessible to people with disabilities."

 

 

 

More on Elder Driving

The latest issue of Experience, the magazine of the Senior Lawyers Division of the ABA is devoted to elder driving. Eight articles are devoted to the issue of driving. The magazine also includes articles on estate planning, technology and ethics. The entire issue is available here. Links to individual articles are also accessible from here.

Capacity to Drive

The latest issue of Biofocal from the American Bar Association Commission on Law & Aging is out, and the cover story is an article by Erica Wood on Evaluating the Capacity to Drive.  Ms. Wood explores the question of what is the needed capacity to drive, and notes the skills one needs to be a safe driver.

[E]valuating capacity to drive is of course different from evaluating capacity to make decisions or execute legal transactions. First, driving involves a mix of mental, physical, and sensory abilities. Second, driving has serious risk not only for oneself but also for others as well. And third, the determination of capacity to drive initially rests not with a judge but with the commissioner of the state department of motor vehicles—although judges may well be involved in decisions about drivers licenses, as described in the “View from the Bench” by Judge Lyle. While state laws vary, the Uniform Vehicle Code provides that a license may be denied if the state commissioner finds that a person “by reason of physical or mental disability would not be able to operate a motor vehicle with safety upon the highways” (National Committee on Uniform Traffic Laws and Ordinances).

Using the ABA/APA handbook for psychologists "general capacity evaluation framework," Ms. Wood breaks down the assessment elements for capacity to drive: the legal element, the functional component, diagnosis, values, mental health assessment, risk assessment, and clinical judgment that is needed in order "to integrate all of the evidence from the previous steps on supports, conditions, risks, abilities and limitations." The article underscores the need to examine the driver's values, consider emotional factors such as hallucinations and whether the person has capacity with support. Capacity with support is explained as "supports and accommodations that might enhance ability."

In the driving context, this might mean a change of eyeglasses, a higher seat or pillow, a revolving seat, or pedal modifications. With such supports, a functional assessment will test for visual acuity; flexibility to look behind and check blind spots on the road; and strength for control of the steering wheel, brakes, accelerator, and clutch. An assessment also will test the driver’s knowledge about driving rules and what to do in emergency or unexpected situations.

A pdf of the article is available here.

Articles on Elders Driving

The most recent issue of Experience, the magazine of the Senior Lawyers Division of the ABA, is focused on elder driving. There are nine articles on the topic, each taking a different focus. The topics include a view from the bench, licensing, psychology issues and technology.  Great resources!

America's Love of the Automobile: A Trend the Boomers Keep on Driving

Ok, that title was supposed to be somewhat tongue in cheek, but there is some reality to it as well.  According to an article in the Wall Street Journal on December 8, 2015,  The Fastest-Growing Group of Licensed Drivers: Americans Age 85 and Up,  "[n]ew data from the Federal Highway Administration shows people age 60 and above represented almost 26% of all driver’s license holders in 2014, up from 20.6% in 2004. Those younger than 30, on the other hand, make up about 21% of drivers, down slightly from 22% in 2004." Discussing the trend that younger generations are moving away from driving, the article notes

[S]ince 2000, people of every age cohort under 60 have been slowly letting their driver’s licenses lapse or have not been getting them in the first place.

Those 60 and above, meanwhile, are now more likely than before to have a valid driver’s license in their wallet.

People age 85 and up represent the fastest-growing group of licensed drivers, the FHWA said.

The article explains this trend is slow moving and offers reasons for its occurrence, especially costs.  The article concludes with a comment that this changing demographic is also changing the highways: "[t]o help older drivers navigate the roads, the agency said it is working on new laminates to make highway signs brighter from further away."

Information about the Federal Highway Administration report is available here.  The Administration's Handbook for Designing Roadways for the Aging Population is available here. The 2014 Highway Statistics Report is available here.

Questions About the Infrastructure of Traffic Safety -- and How it Impacts Aging Populations

Recently I witnessed a nighttime accident on Interstate-81 in Cumberland County, Pennsylvania. There was an unmistakable "boom" signaling a rear-end collision. One truck (that appeared to be a large rental truck) had rear-ended an 18-wheeler behind me -- and I watched the faster moving rental truck continue past me on the road with heavy damage on its right side, before eventually veering to a shaky halt in the median. As far as I could tell, both drivers were alive, but at the first safe spot, I called 911.     

I got off of I-81 at the next exit.  I paused both for gas and to take a breath of crisp night air, before taking a back road the rest of the way home. While I was fueling, an older man in the car next to me, a car with West Virginia license plates, pointed to the I-81 overpass where traffic was crawling through more flashing lights.  He asked, "Is it safe for us to get on the road to get home? We live about 75 miles from here."  Frankly, I had no way to answer that with any confidence.  He shook his head and said to his companion, "I think we should stay in a motel tonight."

Continue reading

"Safe Travels" (but, should you pass away, can I have your Frequent Flyer Miles?)

I hope everyone is lucky enough  to have a colleague such as Professor Laurel Terry here at Dickinson Law.  In addition to being the guru on regulation of lawyers, particularly for lawyers working across international borders, she's a good friend, organized, AND a guru of travel.  Whenever I have a travel question, I know she probably has sorted out the options and will have  great advice. 

So, I wasn't surprised on this holiday Labor Day weekend that she had considered "generational" travel issues, including whether you can devise or inherit "frequent flyer miles." 

Turns out you can ... depending.  Professor Terry pointed to this Smarter Travel blog, addressing which airlines have clear policies on inheritance.  You will want to look for your own favorite (least unfavored?) airline, but to summarize:  "In sum, American, Continental, and US Airways say "yes," Air Canada says "maybe," Jet Blue and United say "no way," and the others ignore the issue."

Looking to Cuba for Comparative Law, Aging and Health Studies

Light blogging ahead for me, as I will be leaving in a couple of days for my first visit to Cuba, as part of a small Penn State University faculty group.  I'm confident I will have plenty of things to do with my time other than searching for an elusive internet café!

Seriously, I'm excited, on a number of levels.  First, I lived for several years in a Cuban-immigrant neighborhood in Miami at the end of law school, and many of my fellow judicial clerks and friends were the first generation sons and daughters of Cuban refugees.  Second, I've been educated by my Irish friend, Dr. Una Lynch, to appreciate the world-wide significance of the Cuban health care system, and I'm eager to see how they accomplish much with comparatively few resources.  Third, my Elder Law colleague, Amos Goodall Esq., State College, PA, has shared great suggestions for art and food. Plus, Attorney Karen Miller (NY and Florida) has shared her contacts with me from her travels and studies about law in Cuba. ¡Gracias a todos!

Here are a couple of items from some of my background reading on Cuba, including health care and aging statistics:

Turning to Cuba, let us examine the possible consequences of the tendency towards population aging that we have described. In the economic field, the consequences include an accelerated demand for the funds to cover social security expenditures. In fact, since 1970 funds budgeted for old-age, disability and death benefits have quintupled.  National budget expenditures for social security are higher than those of any other sector (e.g. education, health, defense, etc.) (Cuban National Statistics Office, 1999 "c"). 

   

At the same time, as the average age of Cuba's workforce increases over the coming years, we will see a deficit of workers for labor requiring greater physical effort, especially for agriculture, construction and industry, among others.  Consequently, the main economic difficulty Cuba faces today-as it did during the colonial period and at the beginning of the 20^th century-is an insufficient workforce.

From Aging in Cuba, Realities and Challenges, byAlberta Duran Gondar and Ernesto Chavez Negrin.

During her recent visit to Havana in July of 2014, Margaret Chan, Director-General of the World Health Organization (WHO), impressed by the country's achievements in this field, praised the Cuban health care system: "Cuba is the only country that has a health care system closely linked to research and development. This is the way to go, because human health can only improve through innovation," She also praised "the efforts of the country's leadership for having made health an essential pillar of development." 

From Opera Mundi, translated into English for the Huffington Post.

Dying to Visit

Naomi Cahn, our colleague at GW Law who frequently alerts us to interesting stories, sent me a note about this recent story from the Washington Post on suicide tourism.  Tourism to Switzerland for assisted suicide is growing, often for nonfatal diseases reports on an ongoing study in Switzerland that shows an increases in tourists in the Zurich area seeking assisted suicide.

The study, on "Suicide Tourism",  was reported in the Journal of Medical Ethics.  The August volume contains the article about the study:  Suicide tourism: a pilot study on the Swiss phenomenon. The full article requires purchase (or subscription) but the abstract of the article is available and summarizes the article:

While assisted suicide (AS) is strictly restricted in many countries, it is not clearly regulated by law in Switzerland. This imbalance leads to an influx of people—‘suicide tourists’—coming to Switzerland, mainly to the Canton of Zurich, for the sole purpose of committing suicide. Political debate regarding ‘suicide tourism’ is taking place in many countries. Swiss medicolegal experts are confronted with these cases almost daily, which prompted our scientific investigation of the phenomenon. The present study has three aims: (1) to determine selected details about AS in the study group (age, gender and country of residence of the suicide tourists, the organisation involved, the ingested substance leading to death and any diseases that were the main reason for AS); (2) to find out the countries from which suicide tourists come and to review existing laws in the top three in order to test the hypothesis that suicide tourism leads to the amendment of existing regulations in foreign countries; and (3) to compare our results with those of earlier studies in Zurich. We did a retrospective data analysis of the Zurich Institute of Legal Medicine database on AS of non-Swiss residents in the last 5 years (2008–2012), and internet research for current legislation and political debate in the three foreign countries most concerned. We analysed 611 cases from 31 countries all over the world. Non-terminal conditions such as neurological and rheumatic diseases are increasing among suicide tourists. The unique phenomenon of suicide tourism in Switzerland may indeed result in the amendment or supplementary guidelines to existing regulations in foreign countries.

The Washington Post story discusses some possibilities for individuals seeking assisted suicide when they are not terminal; traveling while they are still able and having a terminal condition but not yet in the terminal phase were two of the reasons mentioned in the story. The Post story was produced by NewScientist and is also available here.

Thanks Naomi!

 

 

 

 

 

Health & Science

Tourism to Switzerland for assisted suicide is growing, often for nonfatal diseases

A Psychiatrist Shares Her Personal Journey with Grief

In Psychiatric Times, Dr. Anandhi Narasimhan, California-based and board certified in psychiatry and neurology, compares her professional and personal experiences with grieving following the death of her father.  She writes well, and in additional to offering suggestions for coping, she shares this poignant detail from her father's life, which also served to introduce me to a new and intriguing idea, "dialysis at sea."   She writes:

"My father was a distinguished scientist who placed value on education. Although he did not believe in lavishness, he always liked to present himself in a well-groomed fashion. I miss his sense of humor, and I have discovered how important such a quality can be when faced with tough times. Remembering his witty repertoire reminds me to celebrate his life.

 

The picture I have included [with her essay in Psychiatric Times] is from an Alaskan cruise my family took. We had talked about taking a cruise as a family in the past; this had been a dream of my father’s. When he was placed on regular dialysis treatments, he said, 'I guess now I won’t ever be able to go on a cruise.'

 

It wasn’t until I saw a poster advertising 'Dialysis at Sea' that I realized we could make his dream come true. With some logistical planning, transferring of medical records and such, we were able to take my father on an Alaskan cruise, an experience he both treasured and loved.When I was growing up, my father had a sort of utilitarian view of vacations—we often had to be doing and seeing things; they had to be productive. This vacation was different—it was nice to see him relax and enjoy the awesome beauty of Alaskan glaciers. His smile in the picture is how I would like to remember him: intelligent, positive, humorous, and charming."

Read more of "My Father's Influence" here. 

When You Need a Passport to Visit Mom

The NY Times ran an article a few days ago about retirees who are spending the rest of their lives (or a substantial part thereof) traveling...abroad.  The August 29, 2014 article, Increasingly, Retirees Dump Their Possessions and Hit the Road focuses on the rising number of individuals who choose to travel when they retire. The article cites to statistics from the Commerce Department that "[b]etween 1993 and 2012, the percentage of all retirees traveling abroad rose to 13 percent from 9.7 percent...." As well, over a quarter of a million Social Security recipients receive their benefits at an oversees address,  close to "48 percent more than 10 years earlier...."  The article discusses the value of post-retirement travel, from checking items off one's bucket-list, to quoting experts on how today's retirees are changing the notion of a "typical" retirement.  One expert describes the travel value this way: "an extended postretirement trip can assuage a sense of loss from ending a career."  Of course, many chose domestic travel over international, but the opportunities are there-whether to see the world, or to give back to a global community. 

The article highlights a trend of sorts. Of course, not everyone may choose this path for retirement. But it does make for an interesting question when deciding where to spend the holidays when mom is now living in another country ....

Thanks to Stetson Law student Erica Munz for bringing the article to my attention.

Crossing the Street Isn't a Race But It Seems Like It Sometimes

Ever try to cross a busy street within the time of the walk light at a normal pace? Ever cross with someone using a walker or a manual wheelchair? Is the light long enough?  If the light seems too short, perhaps it's not timed for the users.  I ran into an article recently that studied this. Published in 2012 in Age & Ageing, Most older pedestrians are unable to cross the road in time: a cross-sectional study concludes that

most older adults either cannot walk 8 feet safely or cannot walk fast enough to use a pedestrian crossing in the UK. The health impacts on older adults include limited independence and reduced opportunities for physical activity and social interaction. An assumed normal walking speed for pedestrian crossings of 1.2 m/s is inappropriate for older adults and revision of these timings should be considered.

Although this is a UK study, it's instructive if we are to move more toward walkable communities and away from communities designed around cars.