Wednesday, May 28, 2008

AARP may offer much better Part D (precscription drug coverage) than do employer retiree (supplementary) plans

In looking at my own situation while turning 65, I’ve encountered an anomaly with Medicare prescription drug benefit plans. I talked to someone with United Health Care this morning and found that the prescription plans range from about $30 to about $64 a month if started within a certain time period of Medicare eligibility. A preferred plan would eliminate the copay for Atenolol if the prescription was filled by mail order (Medco).

But then why does the employer sponsored plan for Medicare-covered retirees for prescription drug coverage cost over $240 a month for the same coverage with the same carrier? The representative says, employer plans work differently and are often more expensive that individual plans arranged with a carrier having a business agreement with the AARP. Another factor is that the lower premiums with AARP are predicated on joining at age 65. Employer plans (which often "replace" Part D; one cannot be enrolled in both at the same time) are based on total claims experience and may cover people who have medication claims (like anti-cancer chemotherapy) of thousands a month. Heart medications, in persons with previous infarctions or surgeries, also add up. Often, retiree health insurance "rolls over" automatically into overpriced "supplementary" drug-only coverage without the retiree's noticing if he or she doesn't check. But to be more expensive by a factor of 6 does sound hard to believe. Also, remember that the drug plans have the “doughnut hole” or “coffee cup” effect.

I certainly welcome more feedback on how employer prescription drug plans for retirees work now.

Tuesday, May 27, 2008

Filial Responsibility Laws (continued) -- Utah, Indiana

I last covered filial responsibility laws state by state in Oct. 2007 on this blog, but here are a couple more.

Utah specifies an order that, after adult children, makes siblings, grand-children and grandparents (unlikely!) to support indigent parents. The link is here.

I could not make the link work for all states.

Indiana has a straightforward-lookibg law 31-16-17, here. It starts with the following:
Duty to furnish support for parents
Sec. 1. Any individual:
(1) whose father or mother provided the individual with necessary food, shelter, clothing, medical attention, and education until the individual reached sixteen (16) years of age; and
(2) who is financially able due to the individual's own property, income, or earnings;
shall contribute to the support of the individual's parents if either parent is financially unable to furnish the parent's own necessary food, clothing, shelter, and medical attention. The individual shall also provide financial support for the parent's burial if the parent's burial is provided under IC 12-20-16-12.”

Tennessee has a comprehensive statement on the problem if aging populations with PL 1093, here. I could not find Tennessee’s specific statues (71-5-115) readily online.

It's well to bear in mind that filial responsibility laws actually are based on the occurrence of poverty in the adult child's parents (or sometimes other relative). In practice, the most common reason for their potential use in the future would probably have to do with nursing home placement for the aged.

Sunday, May 25, 2008

High tech monitoring for "aging in place" develops complex systems, maybe relieving adult children

The capability of families, with innovative technology, to deal with eldercare issues and helping aging parents “age in place” is certainly developing. Such is the theme of the story on p A16 on May 25 of The New York Times, by Elizabet Olson, “High-Tech Devices Keep the Elderly Safe from Afar,” link here. There are systems involving motion detection, and some that can monitor blood pressure and respiration. Some systems do not involve the use of cameras, which would raise privacy concerns. Adult children fear that their parents will resist using these monitoring devices and sometimes parents may crave the personal attention, but experience in acceptance of these devices has been favorable, according to the report.

The development of these “James Bond” devices is important because assisted living facilities will fill up and become more costly, and home health services may get more difficult to hire at acceptable cost in the future as demographics increases demand.

I had written about some of the devices, like Life Alert, on this blog in Nov. 2007 (see archives) but the devices are turning into whole monitoring systems.

These systems may have their limitations, however, in many situations, such as Alzheimer's.

Wednesday, May 14, 2008

Early Alzheimer's testimony before Senate committee

Susan Levine has an important story on the front page of the May 14 Washington Post, “Man with Alzheimer’s Fights ‘Family Disease’; 5th Generation Patient Copes with Early Onset,” link here. This related testimony before a Senate Special Committee on Aging. The fact that such a committee exists means that some attention must be given now to long term care even though the major political candidates don’t talk a lot about it. The Post story online includes a video of some of the testimony, some of it quite direct from people with Alzheimer's.

The particular family originated in Russia, with some of it migrated to Germany and then the U.S. Studies showed a specific genetic pattern, with a 50% chance of inheritance from each parent, and apparent dominance, meaning that inheriting the gene gives the person early onset Alzheimer’s. The particular individual developed symptoms around 50, but he had been a “default caregiver” for his mother when she was in her 40s. A child of two parents with the gene would have a 75% chance of developing it. This patterns follows the simple inheritance pattern for any inherited "trait" taught in high school biology (and often asked on tests) although more complicated patterns certainly occur. It’s obvious that the existence of a genetic lottery (however rare in general) creates obligations within a family and questions about interdependence and social values within and without a family. Other diseases with similar patterns (Huntington’s Chorea (link)) have been well documented in the media, in Britain as well as in the U.S. Questions have been presented about taking a genetic test early in life and whether to avoid having children. An episode of TheWB's Everwood in 2005 dramatized the agony of deciding to take such a genetic test.

In the 1950s, when I grew up, people would refer to a condition called colloquially “softening of the brain” with some trepidation, for early dementia, but it was thought to be rare, and unpreventable and untreatable.

As Ronald Reagan’s personal history shows (until his passing in 2004), people who develop the disease with aging now live much longer with the disease than they did a generation or two ago. As a result, adult children today often must be prepared to deal with it (and it can come as a shock), whereas a couple decades ago (before life expectancy started accelerating so quickly with medical advances that could prolong life) they would not have even thought about it. Can medications prevent the progress of the disease with age? NIH (the National Institute on Aging) has a paper “Alzheimer’s Disease Medications Fact Sheet” on this here. They may delay progress for mild to moderate Alzheimer’s, but the overall picture does not yet make it look preventable. The Alzheimer’s Association has a diagram of the organic processes involved here.

Dementia sometimes occurs “naturally” with age, and probably is not necessarily just the result of genetics. Heart disease, circulation problems, atherosclerosis, strokes – some of them augmented by diabetes or by behavioral issues like smoking and obesity – may accelerate symptoms and present issues for other family members. Persons used to mental activity may resist any loss of function with age, as demonstrated recently on Barbara Walters ‘s “Live to Be 150”. ABC recently showed a 94 year old woman in New York City who still worked as a financial planner. The question of personality and “locus of control” is potentially important. As an article on a community in Costa Rica showed (two entries back), an “external locus of control” may bode well if other family members are around to provide social feedback; otherwise, an introverted person who is mentally active may be more resistant to changes with age.

Also, today, former Supreme Court Justice Sandra Day O'Connor appeared on ABC "Good Morning America" to discuss Alzheimer's Disease. Here is the link "O'Connor: The Pain of Alzheimer's", here.

Caregivers, as with other eldercare situations, may experience a feeling of loss of personal or individual sovereignty, relative to the values of an individualistic society, and the potential logical consequences of those values (particularly for those who did not form their own families or who did not have caregiving responsibilities early in life for some circumstance). They may have to curtail activities and associations (even employment) that they would choose on their own because of the needs of other family members, needs they cannot prevent from occurring with their own chose actions. The moral issues here are not the same as they way we usually depict "responsibility for one's own acts" as in "deciding" to have children and then being ready to raise them. This is responsibility that exists regardless of one's own choices or acts. Perhaps this explains some of the teachings of the New Testament and some of Rick Warren's ideas for the "Purpose-Driven Life". It's not about you, he writes. Or perhaps another answer is to be better prepared for this eventuality much earlier in life.

Update: May 19

NBC4's Doreen Genzler reported on the 11 PM news tonight (Washington DC) about a generic test (called "Alzheimer's Mirror") for an increased risk for Alzheimer's, from a company called "Smart Genetics," a test for about $300. The link is here. It is not clear yet how much protection consumers would have from insurance companies's getting the information later to prevent anti-selection, and this is obviously a potential issue for Congress in health care reform and in addressing eldercare issues. The NBC4 report presented a family with a 94-year-old with the disease and with a daughter concerned about the high incidence in the family. But the disease may increase naturally with much longer lifespans unless something can be done with medication to stop its progression.

Sunday, May 11, 2008

Local government pensions may get into big trouble with demographics

Local governments and school systems do not have to meet federal ERISA rules as do private corporations in running their defined benefit pension funds, a major story on the Front Page of the Washington Post says today, May 11. The front page story is “Growing Deficits Threaten Pensions: Accounting Tactics Conceal a Crisis For Public Workers”, by David Cho, link here. Public pension funds do have a lot of leeway in their accounting practices. The result may be much bigger taxpayer bailouts in the future, particularly in Virginia and Maryland. The District of Columbia’s funds are said to be in better shape. Warren Buffett is quoted as having said, “fuse on this time bomb is long.”

Much of the problem is demographic, with longer life spans now averaging 79, and somewhat longer for women and often for surviving spouses. Will state and local governments have to raise retirement ages, and would unions let them do it out of the “common good”? Don’t count on it.

Thursday, May 08, 2008

AARP studies Nicoyan centenarians for longevity: a lesson in "family solidarity"?

The May and June issue of AARP Magazine has on page 56 in print an article by Dan Buettner,
“Living to Be 100: A remarkable group of centenarians living on Costa Rica’s Nicoya Peninsula share their secrets,” link here.

The article discusses the native Nicoyans who live in what anthropologists call “Blue Zones.” The article discusses the longevity factors that include, besides genetics, lifestyle habits. These include eating less (especially at night) and eating largely plant foods (sort of the Gabe Mirkin low fat diet advice from the 1990s) and sociological factors. The most important seems to be “focus on family” and the tendency for extended families, through great grandchildren, to live together or in close proximity. The people also accept what psychologists call “external locus of control,” willing to relinquish control of their lives to God and receptivity to attention from others.

Doesn’t this contradict modern values of independence and personal sovereignty, and even “extreme capitalism”. Probably so. In this culture, at least, it has to be OK to accept and expect help and attention (that might seem gratuitous to modern individualists) from others, and others in the family must accept the idea that it is expected. They probably accept it because they grow up in a culture that offers a simple life and not much else.

The report makes for an interesting comparison to the New York Times story discussed on this blog a couple days ago. That article took a pessimistic tone assuming that most seniors in the 80s and 90s would become frail and dependent.

Also see the review of Barbara Walters ‘s “Live to Be 150here.

Tuesday, May 06, 2008

Dartmouth Medical school offers "soft medicine" for some elderly

The New York Times has a story on Monday May 5, “For the Elderly, Being Heard About Life’s End,” link here.

The article, using a study at Dartmouth Medical school discusses the concept of “slow medicine,” which emphasizes comfort rather than prolonging life as long as possible. The article admits that medicine has developed a culture of pulling out all the stops to prolong life as long as possible, and that this practice is financially and productively unsustainable in the long run.

The article also suggests that most people who reach their 80s and 90s will become frail and dependent. Women live longer than men and may remain dependent longer. The report also suggests that once someone reaches that age, reviving someone after a cardiac arrests is unlikely to prolong life for long. But this contradicts other, much more optimistic views of aging as recently shown on the ABC “Live to be 150” in early April 2008 (see my TV blog). However, multiple media reports and a recent PBS documentary (also on the TV blog) depict the extreme levels caregiving attention required from other family members, when there are repeated life-extending treatments. This is a situation that has evolved in the past fifteen years or so.

What is unclear is whether lifestyle changes and preventive care with health care reform, as discussed by the presidential candidates, can extend quality and activity of life (and independence) as well as longevity itself.

Thursday, May 01, 2008

Serious shortage of eldercare workers may be developing, complicating Long Term Care availability

Eileen Powell has a summary AP story from April 30, “Study finds increase in nursing home, assisted living costs,” link here.

The story was carried April 30 on p A6 print of The Washington Times as “Costs for elderly care soar; study warns about shortage of industry workers.”

The study was by Genworth Financial, from Richmond, VA. I reported on my own debriefing of that company’s long term care plan on Jan 22 2008 on this blog (see archive links).

The eldercare industry is going to need to recruit 200,000 people a year to keep track with demographic changes. This may be somewhat challenging in a technology-driven world where many workers do not like “forced intimate contact” meeting the basic physical needs of other people, and where not as many people have reared children of their own. Often these jobs are filled by immigrants, who may be affected by government crackdowns in anti-terrorist immigration policy.

Long Term Care insurance is predicated on finding home health workers (not all of which are certified), sometimes with a live-in need for personal care, as well as assisted living and nursing home attendants. Residents in these facilities often purchase plans to receive extra personal care. A shortage of workers could modify the lives of adult children and force them to keep elderly parents at home or move in with them.

Medicine has been prolonging lives without always prolonging independence and vitality, a subject that was covered in some television programs in early April, such as ABC’s “Live to be 150”, review link.