Tuesday, March 24, 2009

Alzheimer's Association: 5.3 million people have it, it triples health care costs for people over 65

Reuters is reporting that 5.3 million people now have Alzheimer’s disease, information contained in a report released by the Alzheimer’s Association Tueday March 24. The summary appears on MSNBC now here and was reported on NBC Nightly News.

The cost to Medicaid, families, and Medicare is staggering compared to patients without Alzheimers.

Elderly people sometimes develop milder dementia and memory problems without having Alzheimers plaques because of circulation problems associated with heart failure.

The Association is having a Public Policy Forum at the Omni Sheraton Hotel in Washington March 23-25 2009, and here is the text (PDF) of the report that it released.

The blunt truth is that Alzheimer’s triples health care costs for Americans age 65 and older. Because of the potentially staggering effect on all extended family members, this disease is becoming our number 1 public health problem, even dwarfing the predictions for HIV back in the 1980s. Since so much of the cost is custodial care and not medical, much of it is not covered by Medicare normally. Long Term Care insurance comes into consideration, as covered on this blog before; but the new report could affect actuarial data and premiums for LTC policies soon.

Picture: The Woodley Hotel on Rock Creek Park in Washington DC, near the Omni Sheraton, the closest picture that I have to the meeting site.

Monday, March 23, 2009

Superlongevity: Live to be 200? What happens to Medicare, social security then?

Early Monday March 23, 2009 ABC “Good Morning America” presented a brief report on Dr. Mehmet Oz and “superlongevity.” The claim is that even in less than ten years we could have the ability to double life spans. Age 99 could become the new 50.

Some of the tricks include severe caloric restriction starting in early adulthood (maybe after childbirth) and the growing of organs from animals with stem cell implants (livers, pancreas, arteries, even hearts). The research is going on at Wake Forest.

The link for the excerpt from Oz’s new book (“You: Being Beautiful”) is here.

There will be a more detailed report on Oprah Winfrey’s show Tuesday March 24.

It’s not clear if these measures are of any help to the aged now. But the possibility obviously raises new public policy questions. Will employers keep the super longlived working longer? Will we have to raise the retirement age (for social security) into the 100+ range? What happens with Medicare? How will the demographics of having more or fewer children interact with longevity?

Think of this another way, though. Super-longevity would give the individual more time for "dollar cost averaging" in the stock market and more ability to weather downturns.

Sunday, March 22, 2009

Family support could affect medical decisions about prolonging life, as life spans increase; a "demographic winter" problem?

Medicine has often been able to prolong life greatly, and lifespans for the elderly seem to be rising quickly, as many newer drugs are very effective in preventing death from cardiac arrest. Women may be “benefiting” from this development more than men, because women have always lived several years longer, and are more likely to use publicly funded medical services. Men may be more likely to feel a kind of “shame” in doing so.

A lot of written is about the “sandwich generation”, but the explosion in eldercare demands is likely to affect those who have never married and/or had children, including but certainly not limited to LGBT people. (Remember the exception that I took to a suggestion in a book by Nancy Polikoff, that an unpartnered gay person be willing to become “it” among siblings and move in with an elderly parent reviewed on the books blog in September 2008.) Eldercare, as a specific problem, may do more than any issue to make us rethink the idea of what generates “family responsibility.”

I’ve covered filial responsibility laws (or “poor laws”) extensively on the blog before, and the current financial crisis may well bring these to the fore; but the biggest issue could become something or subtle and emotional. Our culture has indeed become more individualistic and, until the Internet “reconciled” us, culturally segregated. Many single people invest in their own “work” rather than in familial and communal relationships for their own sake (what my father had called the “seeing people as people” problem). In short, our modern culture has come to see choice of intimacy and refusal of unwanted intimacy as a fundamental right (for the most part now built into the legal system), but that was not always so. Suddenly they are faced with caring for elders who have lived in a culture that rewards functioning in a family social structure and that expects attention on demand. And medicine must cope with the idea that an elder who does not have an emotionally supporting family structure immediately available may not survive life-prolonging treatment.

One technique that single people expecting such responsibility could use is to provide the facility themselves, to own a house large enough to care for parents and to plan for the need to have such a capability; in that way, they keep more "personal sovereignty".

But it seems that the medical world barely, if at all, has a grip on this ethical problem. One could look at this as an early frost or warning sign of "demographic winter".

Monday, March 16, 2009

State and local pension plans could be in serious trouble

State and local governments, and most of all school districts, face severe budget squeezes as they meet pension obligations with asset bases greatly reduced by the financial crisis. That is the story today from Michael Laris on the front page of The Washington Post, p A01, Monday March 16, 2009. The title is “Pension Check Guarantees Mean More Budget Woes” and the link is here. Pension plans for Maryland, Virginia, and the District of Columbia public and school employees (and teachers) have lost more than $28 billion since mid 2008.

The other complicating problem is rapidly rising retiree medical expenses.

It’s not clear how pensions are guaranteed if a state or lower government defaults or goes into bankruptcy, or how retiree rights compare to ERISA in the private sector.

There is a blog, called Pension Watch or “Pension Tsunami”, run by Jack Dean, that tracks pension problems in local governments here.

Sunday, March 15, 2009

"Senior Checked" checks out businesses catering to seniors

Local television stations such as NBC-Washington have been carrying spots for “Senior Checked” which is a private agency that certifies businesses as safe for seniors to do business with.

Senior Checked” costs a business $175 as of this writing and requires providers to meet certain standards in business practices, including insurance, information privacy protection and performing certain background checks of employees.

The website domain name and company name (which is USPTO-trademarked) has the past participle in it. There is another website “seniorcheck.com” that has nothing to do with this business.

Furthermore, the colloquial term “senior check” often refers to making sure that one is in the last year of high school or college.

Tuesday, March 10, 2009

Video on congestive heart failure

In the blog posting yesterday, I mentioned a long video “Living with Congestive Heart Failure” from the “Issue for Older Adults” series at UCSF (San Francisco) (link here), with Dr. Michael Harper. It appears to be a class lecture, but it made some interesting points.

One is that people may live a very long time, decades, with the condition, given proper medical supervision. Sometimes relatively little medication is needed other than blood pressure control.

Another is that chronic “rales” or crackly cough, without phlegm, often thought to be asthma, could be a symptom because it could indicate fluid in the lungs.

The most common cause is likely to be prolonged elevated blood pressure, often without symptoms.

Monday, March 09, 2009

Lifespan Respite Care Act; inventory of blogs about caregiving

Today, I looked through Blogger and Wordpress to see what people write on open blogs about their caregiving experiences.

First, and most important, I found a plea to support a Lifespan Respite bill to fund help for caregivers, The blog reads “Last week the House passed the FY09 Omnibus Appropriations bill that includes first-time funding of $2.5 million for Lifespan Respite….” and the URL (Caregiversupport) is here. I see that The “Lifespan Respite Care Act of 2006” already Public Law 109-442 so I’m not sure if this is simply a continuation of funding or an expansion.

Since Wordpress makes strong use of its “category” property, I found that Wordpress automatically indexes all its blogs with a “caregiving” label here. The most challenging entry for me was “Days of Darkness”.

On Blogger, one of the most interesting is HFAHospice, here. A February 23 2009 posting discusses Hospice care and the stimulus bill.

The CaregiversBeacon blog has a number of embedded YouTube videos, including one about recognizing dementia, and a 52 minute film about “Living with Congestive Heart Failure.”

WorkingCaregiver has an Essay Contest in the May 28 2008 entry.

On a site called “Everyday Health” a caregiver and blogger named Jeff Muise says farewell to the blog, here.

A particularly personal blog is this "Caregiver's Journal".

A number of trends are apparent from thumbing through these. Some people identify themselves as doing only caregiving. Some do it for a living, and some are family members who had no real choice. Many are not easily publicly identified, but some are.

Of course, in blogging in a public space about caregiving issues, it’s important to respect the privacy of patients and the “reputations” of caregivers, so in general they should not be easily identifiable, particularly to search engines.

There will also occur situations where a caregiver or a patient (either one, or even both) is already well known, in connection with other issues, including controversial ones, because of previous life’s work.

What’s important is to emphasize the issues, which these do.

Again, my own practice is to report on the political issues as I find them, as objectively as possible. I don’t just focus on one party’s needs, however compelling they may seem or how much immediate public sympathy they generate. These blogs are about putting all the pieces together in one large context.

Update: Oct. 4, 2009

There is an interesting members-only website Carepages.com, where families create their own care-pages websites, and have some control on how public or private they may become.

Wednesday, March 04, 2009

Is it OK to take a corporate buyout of early retirement?

Emily Brandon has an important article from US News and World Report, March 4, 2009, reproduced on Yahoo! Finance “Ten Tips to Evaluate Early Retirement Offers,” link here. I could not find it yet at US News.

It is certainly true that companies “buy out” highly compensated employees and often do not pay enough to justify leaving. The practice started with the LBO’s and hostile takeovers of the 1980s, but today, with the dire economic crisis and bankruptcies, some companies are not in a position to do anything but fire (even without much severance). Companies are faced with longer pension payouts because of early retirements and longer lifespans, and additional pension plans could wind up being picked up by the PBGC.

Brandon makes the important point that starting social security benefits will reduce your monthly benefit lifetime by an actuarial formula, which over time has become less favorable because of longer lifespans.

Monday, March 02, 2009

EBRI issues sobering report on 401K losses, especially for baby boomers

Emily Brandon has an article, “401K Fixes for Every Age” in US News and World Report, dated March 2, 2009, link here.

She says that the timing of the recession couldn’t be worse for baby boomers, and says that people who previously retired between 62 and 65 will have to consider working to 66 to 70, often in hourly or much lower paying jobs. 401K’s experienced a 25% loss last year on average, although some people with mostly “productive” stocks (for example, XOM and MCD have held up reasonably well) or with larger cash investments came out much better.

She also has advice for employees in their 50s, who sometimes can increase their tax-deferred contributions fro $16500 to $22500.

Brandon refers to the Feb. 2009 research report (or “Issue Brief”) from the EBRI, the Employee Benefit Research Institute (“The Impact of the Recent Financial Crisis on 401(k) Account Balances”), link here.