Sunday, May 31, 2020

Seniors staying at home can assist journalists covering protests by online coordination

George Floyd protests in Washington DC, Lafayette Square

Anthony Russo has an op-ed in the Los Angeles Times, of how to get out of the coronavirus catastrophe, with 10 suggestions.

Suggestion 9 is to incentivize older people to stay home, probably until there is a vaccine. 

It is not true that younger adults are safe from the virus.  It’s true that many younger adults show few symptoms and have a quick and robust antibody response. But some have developed the severe autoimmune M-CIS later.  A few have had blood clots.  And a few have indeed died, and others have had long periods on ventilators.

On the other hand, many young adults who went to beach parties and then protested in the last week are likely to develop antibody but very little illness from light exposure.

I stayed home last night, tracking two good friends separately covering DC’s violent protests (as independent journalists), telling them where new activity was, on Twitter, as reported on a local TV station.  One of them got an eye injury and had to stop.  I reported that to the local TV station but he seeks OK today.

It is true that seniors who stay home can sometimes coordinate volunteers or others active at events in crowds with social media.

But it is not acceptable to exclude people from public just based on age.

Picture from DC riots, May 30, Wikipedia, click for CCSA photographer attribution 


Monday, May 18, 2020

Washington Post accuses conservatives of wanting to "sacrifice" the elderly for the economy during Covid-19 pandemic


The Washington Post has a couple of disturbing pieces suggesting that younger Americans want to “sacrifice” the elderly or don’t care about them, as in this piece by Nina Kohn on May 8.  An earlier post in March (linked) by other authors after Spring Break was even more explicit.

NY State Andrew Cuomo plays up the moral aspects of this in his daily briefings, with his Matilda’s laws.

Not all seniors are helpless.  Many are capable to taking care of all their shopping and should not expect others to take risks for them, if they’ve already lived out their lives.

But the caring for the severely compromised still has to start in extended families, which are weaker than in the past. 

At 76, I have stayed OK so far.  There are situations that I can imagine that could become problematic. It is entirely possible I've already encountered the virus and not been harmed.  Maybe when I do the next blood donation (June 2) I will find out.  I would not expect to accept being put on a ventilator (the use of ventilators will diminish and newer ones, as from Canada, may be much safer). Given my own specific history, this would not be an honorable way to die.  Various op-eds have also noted that there has not been much attempt to honor "victims" who died (we have honored those who recovered), the way we would memorialize soldiers who fought and sacrificed in a conventional war.  

Picture: Enchanted Rock in Texas Hill Country W of Austin 


Saturday, May 16, 2020

Trump wants workers displaced by coronavirus to take Social Security early, and pay it back with reduced benefits later


Trump wants to let distressed workers (losing jobs to the pandemic) to take social security benefits early, with the cost of reduced benefits later, cnbc story.

Not to mention there’s no attention to Social Security solvency in this idea.

Saturday, May 09, 2020

Can organizational beneficiaries be changed on a trust (especially irrevocable) or even added as a result of external political trauma (like coronavirus?)


Can a trustee managing an estate, much of which has been lawfully distributed to him or her as an individual already, change beneficiaries of the estate?  Elderlaw Answers, for example, weighs in

The question seems relevant because, over a larger period of time, the trustee’s values or beliefs might change, often because of external events particularly if traumatic (like the coronavirus pandemic).  This might apply more to wanting to change organizational beneficiaries (non-profits) than persons.

A living person may have a trust in their own name only, and normally that will be set up as revocable. In that case, yes, the person can change the beneficiaries, although he/she must notify them.

A trust (which may have been made grantor trust by amendment) which has a deceased name on it is normally irrevocable.  Typically beneficiaries cannot be removed (except by death or bad behavior). A trust with only one person as Executor and committee of beneficiaries might be able to do so, although that would involve legal expenses for revisions – as among certain rights or powers that the executor explicitly retains.  Beneficiaries have rights, and in extreme cases could have executors removed.

I have maintained that an organization’s presence as a beneficiary does not mean that I am always politically loyal to them, raise money for them or call politicians for them, for example.  In 2014 or so, when I first said that, this made sense.  This position may not be as tenable now, with the social shocks from the coronavirus, particularly after I scale down my online presence as promised at the end of 2021, which I have talked about elsewhere. 

So this question sounds relevant.

Given the economic turmoil caused by Covid, there might be calls for people managing trusts to put more displaced persons on their own obligations as beneficiaries.  This probably requires a legal filing, and state laws protecting beneficiaries (and fiduciary responsibilities of the executor) might apply and need amending.


Wednesday, May 06, 2020

Wall Street Journal op-ed briefly states the case for locking down seniors (and those with health problems) and loosening up on everyone else -- but it can go Orwellian


The Wall Street Journal opinion piece “Targeted lockdowns are better” with the subtext “A new study finds they save more lives and do less economic damage” gets my attention again.

The MIT paper at issue is “A Multi-Risk DIR Model with OptimallyTargeted Lockdown” by the National Bureau of Economic Research” in Cambridge MA.  The paper at one point makes the seemingly offensive assertion that old people don’t make economic contributions.  (Ask who is running for president.)  Most of the paper, however, is a series of mathematical and statistical arguments, deriving equations and conclusions, that wind up with model estimates of lives lost or saved by partial v. total lockdown policy choices.  (The paper is a pre-print, not yet peer-reviewed.)

Some of interpreting this is, what do you mean by lockdown of seniors.  If you tell them to do grocery shopping only in senior’s hours that’s one thing.  I do that pretty much.  I can’t guarantee, though, I never violate it.  I probably comply with this idea 90% already.  (There is also plenty of drive-through takeout where you don’t go into a store.)   Maybe theaters could have seniors’ hours (some of them did before COVID, on weekday mornings.)   Travel gets to be an issue.  Hotel rooms are solitary, but when I travel I need to eat in places, too (well, there is takeout).  Air travel will eventually be necessary again (for me at least).

The danger is how this could escalate.  It could mean, if you don’t have someone [family] to have your back (that is, take the risk of being outside for you), we’ll put you away (guardianship).  Hopefully the courts wouldn’t allow that. But again you wonder in the future about seniors on the Metro, seniors allowed to keep their driver's licenses, and the like.  This idea can run away very quickly. You force someone who is independent into shameful social dependency (so that everyone else who is already dependent feels better -- this is psychological communism -- a surprising irony for a Wall Street Journal op-ed, although not for Massachusetts in general.) 

You may find businesses (bars) not allowing people over a certain age inside – right now public accommodations laws would discourage that, as young people sometimes want to stay segregated and not be the object of attention that can’t be reciprocated.  This gets into an entirely different area.

One big piece missing from all this:  younger adults have had severe disease, including strokes and heart attacks without as much lung disease.  Generally they haven’t died from these.  But you could have many young adults become disabled (neurological, kidney, sterility, etc) with many decades to deal with this, whereas some of the elderly (myself included) may have gotten through these decades without disability. Even children can have serious unusual “toxic shock” syndromes.  You have to be very careful about the “state” reallocating risks by force from one population to another (remember the military draft?)

The authors do assume that a vaccine (or “pseudo-vaccine”) becomes available some day.  You can still imagine testing everyone repeatedly, once a month in the meantime. You need the contact tracing, with the rules very carefully though out – for everybody.


Tuesday, May 05, 2020

Health departments could target seniors living alone if the fomite issue turns out to be even more important


Yesterday, on my “Issues” blog, I embedded a video from an ophthalmologist in New York City who maintains that hand hygiene is the key to shutting down the epidemic (as opposed to obsession with the six foot rule, maybe).  I won’t tell people to believe one theory over another if it varies from official advice .

There is a question of the fastidiousness needed, although the latter portions of his video perhaps play this aspect down. 

Many older people live alone (often widowed and many childless, but also singles, including LGBTQ)   Younger adults living alone tend to have fewer and newer possessions which are easier to keep clean (although in large cities younger adults may not have much space to move in).  The fewer possessions are partly a result of a culture where music and literature can be kept online in the cloud rather than possessed physically as a cd or dvd, vinvyl, or printed book. Older people are likely to have downsized from a house (as I did) and have a lot of clutter which makes hygiene (of the kind that this particular virus might demand) harder.   After moving into a smaller high rise space (with the attendant risk mow of being around more people on elevators) physically removing the clutter gets challenging.

Of course, residential homeowners are finding now that city services are getting a lot stricter about how trash pickup works.

There have been proposals that seniors over certain ages be isolated, and forced to depend on others to do all shopping for them.  I’ve noted here on this blog and the idea is offensive. 

But I can see that health departments could decide to focus on seniors, over a certain age, living alone, and interviewing them to see if they can handle the fastidiousness needed at home, particular if future research shows that the fomite issue is more serious (relative to the more common issues like being in crowds for a long time) than we had previously thought. Those who could not might be forced into guardianship in some states.

Gov. Ralph Northam’s (D-VA) phased plan for Virginia has a Phase 1 (starting May 15) where “vulnerable populations” (which by definition includes all seniors over 65 or 70) are “safer at home”, but the Phase 2 (more opened up) seems, taken literally, to require vulnerable populations “stay at home”, a rather alarming paradox. (Northam is an M.D. with military medicine experience.)

Slide 1

 

Slide 2


 

One observation that is a little scary.  In a few cases (maybe many in China), people's personal possessions have been destroyed when they were quarantined.  This seems to have happened a few times in other Asian countries, and at least once in he US in 2914 with respect to Ebola.  With a life's work at stake, you can't afford to be caught in this kind of trap. 

(Tuesday May 5 10:30 AM)


Wednesday, April 29, 2020

Nursing homes account for over half of Covid deaths in Maryland


In Maryland, nursing homes account for more than 50% of the deaths related to coronavirus, the Baltimore Sun reported today, in a story by Scott Dance, link

This is likely to be common in other states, as in Virginia there were over 40 deaths at one nursing home near Richmond.  And the first nursing home outbreak in Kirkland WA had been widely publicized. 

Confinement in a restricted space and lack of ability to move around and exercise obviously greatly increases the risk.

Families would have to consider bringing patients back home with doing their own intense caregiving.

My own mother stayed at home until the last four days in a hospice in December 2010. Imagine what this could have been like had this epidemic happened while she was alive. 

  
On the other hand, there are other reports suggesting that COVID deaths in the general population are undercounted because of people dying alone at home, particularly of strokes related to the coronavirus even if they had few other symptoms.

As an artifact, I can remember back in 1977-1978 when I worked on Medicaid MMIS for New York (for Bradford), on the reporting system, about a quarter of all the work we did was on reporting nursing homes.