Sunday, November 28, 2010

Government retirement security programs may become even more redistributionist

Ezra Klein has an important piece in the Outlook of the Washington Post Sunday, Nov. 28, “Good Reason to be Uneasy about Retirement Security,” link here.

He describes a basic process where the government has pawned deficit reduction back on to companies and worker, and companies have transferred the risk to individuals. He is skeptical about privatization, and admits that social security and Medicare might have to be regarded as wealth-redistribution entitlements and made much more progressive, mainly for the needy. He does give some interesting details about the history of 401(k), and says when it was invented no one had any idea that employers and government would use it as a cost-cutting device.

But he says it is a systemic problem needing big-top thinking.

Social conservatives are going to come back on this one, talking about the loss of the extended family as a motivator or personal identity.

Friday, November 26, 2010

Doctors cutting back on serving Medicare patients

Medicare reimbursement cuts are already “forcing” some doctors to see fewer Medicare patients, and to schedule checkups less frequently, according to a story by N. C. Aizenman today in the Washington Post. The story title is “Doctors say Medicare cuts force painful decision about Medicare patients”, link here.

All of that contradicts my own experience. When I went onto Medicare, I was “forced” to have a complete physical every year, and indeed got a quick hernia repair done (outpatient -- 67 minutes of my life gone!) No, I haven’t done the dreaded colonoscopy yet, nor have I offered my chest to the stress test.

There is some concern that in the past doctors have over-ordered tests out of fear of malpractice, and that specialists are over-compensated in comparison to family practice. In my own case, the family practice doctor’s billed rate ($200 for an appointment physical) is higher than some specialists.

Monday, November 22, 2010

Social Security reform likely to make it more "progressive", more like wealth redistribution than a personal "annuity"

Peter Orszag has a major op-ed in the New York Times, “Safer Social Security”, Nov. 14, where he starts out with “Social Security is not the key fiscal problem facing the nation.” He does say that measured over the next 75 years, the Social Security “deficit” would amount to 0.7% of the economy. The link is here.

There are several approaches possible to reducing the deficit (some of them incorporated into Simpson-Bowles). The most obvious is to increase the maximum social security wage base. Another is to reduce benefits in response to longer life spans. Of course another is to raise retirement ages and early retirement ages. Finally, and the most controversial, and related to “means testing” is to make the tax and benefit structure more “progressive”, offering mathematically more benefits to lower wage retirees and less to higher earners.

It’s the last proposal that has led libertarian-leaning conservatives to favor privatization, and absolute ownership of one’s own contributions, as with a life insurance annuity contract.

But it is the political fact that privatization, proposed during the Bush years, has fallen off the table that makes a "progressive benefit" structure and "wealth redistribution" model more likely.

Ultimately, the debate on social security mixes with a debate on “social responsibility” – whether shared through mandatory public programs like social security and welfare, or by increasing the requirements for personal family and filial responsibility. That makes proposals by Longman and others regarding having children interesting, to say the least.

Check also the letters in the Sunday times. Generally, the public seems to favor raising the wage base tax on the “rich.”

Sunday, November 21, 2010

Clarifying Longman's ideas on Social Security and "other people's children"

Is Phillip Longman right in maintaining that people who didn’t have children and who now receive social security benefits are getting their way paid by OPC, “other people’s children.”

Normally a worker earns his benefits (and sometimes those of his or her legal [opposite sex, for now] spouse) by paying FICA taxes on wages, which function more or less like annuity premiums.

The government (that is, the Social Security Administration) then has a legal obligation to pay the retiree benefits at retirement age (now 66, or allowing reduced early retirement). The “obligation” was earned by the FICA taxes being paid (which usually the employer matched, except in case of self-employment).

However, Longman is right in saying that the government’s ability to actually pay benefits depends on practice on the wages earned by “other people’s children” if you were childless. Without OPC wages (in a “Children of Men” world), the SSA would go bankrupt, and less benefits would be paid according to some court proceeding.

So his proposal to exempt parents from some FICA tax could make sense.

Saturday, November 20, 2010

Longman writes about "demographic seasons" in Foreign Policy Magazine, offers suggestions to reverse graying of population

Phillip Longman, author of “The Empty Cradle” in 2004, has a long piece in the November 2010 Foreign Policy, starting on p. 52. The title is “Think Again: Global Aging: A gray tsunami is sweeping the planet – and not just in the places you expect. How did the world get so old, so fast?” The link is here.  (I have a review of Longman's book on the Book Review blog March 28, 2006.)   Also see the review Jan 22, 2009 of "The Graying of the Great Powers" by Richard Jackson, Neil Howe and others.

Longman, as well as Carlson and Mero, have been arguing that society has gone too far in making procreation a matter of personal choice and “responsibility”, making it too costly for many people to even have children. But here Longman, in an article surprisingly gentle in tone, makes the case that populations grow and ebb with trigonometric curves, just as “baby boomers” age, while fewer kids are there to “support” them. Hence the notion of demographic seasons, and what the religious right calls “demographic winter.” Longman is cautious about the ability of longer-living people to work many more years than now, and reports that disability is increasing rapidly with longer lifespans. He may view some of it as inevitable rather than “morally” preventable by better lifestyles as well as medicine.  He also argues that smaller families may make socieites too risk averse and stagnant.

Longman acknowledges that children have a moral and perhaps (in many countries, including the US) legal obligation to support their parents, and toward the end he summarizes the major opportunities. Parent-friendly workplace and government policies in countries like France and Sweden are not all that effective, and we don’t want a fundamentalist moral system (like the Taliban’s) to force everyone into rigid social roles in order to maintain a tribal population (he admits that wouldn’t cut it here). So he suggests returning to the idea of the family enterprise, to build back the notion that children are an economic asset as well as responsibility.

That does certainly invoke the notion of filial responsibility laws, or a cultural norm of “filial piety”. If young adults understand they will be held as responsible for their parents as they are their own kids, they might realize they can’t “afford” to remain childless. That certainly could reverse the moral norm of the past few decades, that family responsibility is chosen merely by having heterosexual intercourse. It could radically change the way we have come to view personal sovereignty. Ironically, depending on how one sees other things, it could support the idea of gay marriage and gay parenting, but, as Jonathan Rauch has written, they would have to “be used” if won legally or politically. It seems that man has becoming less social a creature than he once was, and writers like Longman want to reverse that.

Longman has made specific suggestions about social security: forgive 1/3 of the FICA tax for each child (for a married couple?) up to three children, for making the sacrifices of parenthood. He says this would help women and mothers especially. Ask John Boehner about this suggestion!  (We're broke!  Maybe deny benefits to all non-parents out of 'means tesing'??)

It’s curious that right next to this magazine at Barnes & Noble I saw (and picked up) the current Time Magazine issue (Nov. 29) “Who Needs Marriage?” A Changing Institution (story p 48 by Brenda Luscombe, link based on the Pew Report (previous posting),  But few commentators "connect the big dots" of an aging population and declining interest in marriage. It's pretty easy to imagine what Maggie Gallagher and Jenifier Roback Morse will come up with on this one. CNN: "we build our marriages on quicksand."  Does it take a village?



Correlated post: "Bill on International Issues" blog, Nov. 26, 2010, discusses NYTimes article on dementia epidemic in South Korea.

Thursday, November 18, 2010

Eldercare needs may affect the "social contract" in ways few see yet

There is a lot of talk about the Pew Report on the decline of (traditional) marriage, as in this direct link. Nevertheless, living in a social unit regarded as “family” is still very important to a majority of people, who will consider a number of committed social arrangements as families, even though in modern society the monogamous commitments are of a more serial nature. And many people (a significant minority of adults) spent much of their adult life economically productive while “standing alone” and prefer it that way.

But the exponentially growing need for eldercare may turn the tables on the uncommitted life. Think back about a half century, when many families were larger than they are today. People who didn’t marry and have children (often mainly women) were expected to remain close to home to become available to take care of their parents and other blood relatives. The pejorative term for such an arrangement was “family slave”. While such family members were taken for granted, the demands for eldercare tended to be short term; once the elderly were ill, they tended to not live long, and end of life was a natural and expected result. Medicine was less advanced, and lifestyles (smoking, high fat diets, etc) tended to limit lifespans. Of course, over decade, things changed, as women sought and won equal opportunities in the workplace (and exceeded men in school), and as LGBT were forced, somewhat by older legal sanctions, to make the single lifestyle work, which it often did in a wealthier and more tech-oriented society. But extended families began to break apart in Diaspora, while life spans increased, because of both better medicine and better health habits. Extended life spans could mean longer lives without disability (we all expect Jimmy Carter and Queen Elizabeth to make it to 100 fully active), it also meant that many seniors would be incapacitated and need many more years of long term care than they would have in past generations, when they just would have passed away sooner. Not all of this is the result of desperate and expensive life-extending treatments; much if it is accomplished simply, by much closer management of medications, many of which have become less expensive.

The media has reported dire predictions of increase in Alzheimer’s Disease, partly because many people will not die of other things sooner, and partly because lifestyle and social habits may be exacerbating the appearance of dementia at advanced age. All of this means a potential impact on the “social contract” that goes beyond merely calculating the math of long term care insurance, Medicare and Medicaid (and government deficit spending). The need to have people around to physically deliver the care and become open to the emotional bonding and “joining in” will grow rapidly, perhaps uncontrollably. Like it or not, the “religious right” may be doing a service with the talk of “demographic winter.”

This column has already noted that many states with pressed budgets are likely to notice the filial responsibility laws on their books. That can certainly mean that adult children of parents without adequate long term care insurance or savings have not choice but to give up or sacrifice their own lives t perform care themselves (it gets beyond the talk of the “sandwich generation”). But in practice, it’s likely to lead to a rethinking of the way we view our basic rights to select our adult relationships and give or withhold consent to bonding and intimacy. Other cultures have certainly regulated people’s inner lives (arranged marriages) and even ours has, not too long ago, viewed parenthood within marriage as a vehicle for imposing demands of loyalty and affection on others within the family, a power which they achieve only by carrying on lineage within marriage themselves.

Adults today value their rights to selectivity in choosing significant others, more on the basic of psychological polarity than older notions of adaptive complementarity as laid out for them by others (their own family and parents and church) That can sometimes lead to resistance to relating to those who are less intact until we make a conscious decision that we want to (usually by having our own children, sometimes adopting). But eldercare may force us back to the view that “complementarity” is a basic moral obligation of every one in a community, transcending the act of an individual choice (with its libertarian, modern interpretation). Elders and other disabled individuals may be able to “survive” much longer than we had thought if others are willing to sacrifice some of the “calling of their own shots” to remain bonded to them in extended family units, as they had been understood in the past. That could even affect the way filial responsibility is implemented in the future.

Tuesday, November 16, 2010

PBGC payouts increas 22% in FY2010, but it gets tougher (800000 retirees under the agency now)

The Pension Benefit Guaranty Corporation (PBGC) announced Monday that it paid out 22 percent more to retirees in FY2010 (ending Sept. 30) than it had in FY2009, about $5.6 billion to 800000 retirees. Yet, it treaded water, with a deficit of $23 billion, by better return on its trust fund, and by more disciplined treatment of companies nearing bankruptcy.

There are new rules forcing companies to put more money in their pension funds during plant closings and layoffs. 35 companies kept pension plans intact during restricting, including Visteon (a spinoff from Ford), Lear Corporation, LyondellBasel Industries and Smurfit-Stone Container Corporation.

The PBGC has had to attack a corporate strategy in some industries, like steel, where companies terminate pension plans to relieve themselves of debt.

The New York Times story by Mary Williams Walsh is “As payouts rise, new tactics by the US Pension Insurer”, link here.

British, Australian researchers claim to have quick test in middle age for future risk of Alzheimer's; does it do any good?

An British online newspaper, The Mail, in a story by Fiona MacRae, reports on research in Britain on a reaction time test on people in their 40s which corresponds to findings of small amounts of plaque in turn related to the plaque found in autopsies of people who have died of Alzheimer’s Disease. The link is here. The British story predicts that routine screening could be available in two years and be regarded as like a blood pressure test. In the United States especially, there would be fear that insurance companies would use the test for discrimination, particularly if the GOP rolls back Obama’s health care reform to protect people with pre-existing conditions (which is not yet all that effective). People with the lesions performed inconsistently on the strobe-light-based reaction time test, whereas people with no lesions performed the same all the time (whether slow or fast). The news story headline called it an “Instant Test” and spoke of “Routine Screening”, somewhat callously. I recall this sort of talk with HIV tests twenty years ago.

Screening would make sense only if medications were available to prevent the disease from developing eventually, which is going to become necessary anyway to forestall a massive eldercare crisis, in the entire developed world. Some comments on the story reflected that sentiment.

People with a family history of Huntington’s already face a similar dilemma (as in the WB show “Everwood”), as a genetic test can predict whether someone will develop the disease in middle age.

AOL (Nov. 16) had a similar story by Deborah Huso that called it a “30 second test” and read “Future risk could be determined in your 40s”, link here. Some of the research has been conducted in Australia, too.

Sunday, November 14, 2010

MD, VA state employee pension fund melting away

The seriousness of state pension systems in Maryland, and slightly less so in Virginia, was analyzed in the Washington Examiner Sunday Nov. 14.  Hayley Peterson’s story is “Md. Facing $33 billion pension gap, analysts say”.  The Pew Center on the states will report on both states in February 2011.  In Maryland, pension contributions and general fund payments will not account for the increase in teacher pensions. Virginia’s situation is slightly more flexible because it has a local board system. The link is here. 

Thursday, November 11, 2010

Current deficit commision plan could means test top 50% of social security recipients, but when?

The latest specifics on social security changes include gradual raising of the full retirement age to 69, and eligibility for early retirement to 64. It’s not clear how long this would take.

The biggest story (Lori Mongtgomery) appeared Thursday morning in The Washington Post, “Deficit panel leaders propose curbs in Social Security, major cuts in spending, tax breaks, link here, all related to the Bowles-Simpson Blueprint, balancing the federal budget by 2015 or by 2040, depending on who you ask.

The wage base would rise from $106,800 to $190000 in 2020 (ten years out). Benefits would be cut for the top 50% in wealth, but it’s not clear whether the law would look at total assets (how?) or just income tax returns. It’s also not clear how soon means testing could start, but it may be sooner than we had thought, maybe 2015. The view of social security FICA payments as “annuity premiums” (rather than intergenerational wealth transfer) does not seem to be holding up. Another way to look at it is that benefits for low-income wage earners could increase while they decrease for high-income earners, but again that defeats the idea of "annuity" (it sounds like "expropriation"), which is one reason why many people called for privatization.

Social security reforms would be aimed at making the system solvent without the accounting gimmicks (double entries) that let social security balance off the fedral debt.

Other changes include elimination of tax expenditure deductions, and perhaps mortgage interest tax deductions.

Also, a supposed “Sustainable Debt Act” could trigger automatic and sudden reductions in social security and Medicare benefits. The link from the Peterson-Pew Commission on Budget Reform is here.

USA Today has a similar story here.

AOL also has a similar story with a scare headline "Debt Panel Calls for Huge Cuts in Social Security," link here, but the story details don't support the scare.

Wednesday, November 10, 2010

Slate has letter and reply about the limits to "filial piety"

Here’s a “lonely heart’s” letter and response by Emily Yoffe on MSN Slate about the moral boundaries of filial responsibility, “A son’s burden: should he support the abused and drug-addicted brother who abused and abandoned him?” link here.

I’ve covered filial responsibility laws (and “filial piety”) on this blog (particularly back in July 2007), and in practically none of the 28 states that have them would an adult child be required to support a parent who had abused or abandoned him or her.

The letter, however, points to the heavy social expectations of family loyalty and solidarity (and the imputed rewards for marital parenthood) in many elements of society, that seem to be beyond the reach of an intellectual examination of the law. Here, the grandparents are offended, and the son reports being pressured to help raise a half-brother to keep him out of foster care. This sort of thing happens in families more often than the media generally reports, except that Hollywood loves the theme. (Remember “Raising Helen”? Remember “One True Thing”?) Note here in the letter and response the discussion of what the young man has to “give up”.

Filial piety is a moral issue that does not relate easily to the idea of choices and consquences and "personal responsibility" in the usual sense. If is more about belonging to a community (or family), and that for some people translates into perceiving society as imposing "unfunded mandate" obligations on persons, almost like male conscription used to be. Ironically, in a world where we try to stop teen pregnancy and couples postpone babies for education and career, the best "defense" against filial responsibility is to have children yourself.  Otherwise "the buck stops with me."

Monday, November 08, 2010

New prostate cancer "vaccine" ups the ante on Medicare cost containment; also, the Epill

Check the Washington Post article Nov. 8 by Rob Stein, “Review of prostate cancer drug Provenge renews medical cost-benefit debate”, link (website url) here. I guess it’s time for me to cover a “male problem” in my column. My own PSA (at 67) was reported higher (540 over the normal max 400) in September 2010 and I was urged to see a urologist. I haven’t done that yet. Most prostate cancers (with a few exceptions) are indolent and the male will die of something else, but it can certainly explode suddenly. My father died in 1986, just before his 83rd birthday, after prostate cancer “blasted” but he was ill only four weeks; he was never disabled or inactive or dependent for any significant time. He did not want the most aggressive treatments possible (very unpleasant to contemplate for some men). That’s the way I would want it.

The “vaccine” (a misnomer) Provenge is said to extend life for four months or more, but is very expensive. Probably Medicare will eventually cover it, but the debate on Medicare cost control could lead to “rationing” and not covering some treatments with only short term benefit. The Centers for Medicare and Medicaid Services (CMS) will examine the drug, and it is not supposed to consider cost, but in practice it may.

Also, today, ABC Good Morning America had a segment on a device that text-messages caregivers when an elder living alone takes medication, Epill link here. Is this a bit like a medical alert device, commonly offered with security systems?

Saturday, November 06, 2010

NY Times analyzes whether social security is really a "pension" or "annuity"

A “High & Low Finance” article by Floyd Norris in the Business Day section of the New York Times on Friday, Nov. 5 (p B1, left side) tackles the question of whether social security is like an annuity. The title is “Is it really a pension? It’s a problem” and the first sentence becomes “Is Social Security a pension plan?” which is not quite the same as an annuity. The link is here.

See where he can go with this?

Generally, Norris agrees, that since high earners get a little more because they contributed a little more, it seems that way. But studies show that upping the social security ceiling (which also contributes to the notion of social security as being like an annuity) does not proportionally benefit higher income earners.

On the other hand, social security was originally sold as having it both ways. It was a bit like savings, but it was also a way for the working to take care of the elderly. In fact, social conservatives have blamed social security for tearing apart extended families by removing family responsibility from the individual, a misplaced criticism, I think. (Think of Jennifer Roback Morse and her criticism of the “laissez-faire family” but I’ll come back to that.)

John Boehner, anointed soon as House Speaker, says “we’re broke” and to retirees with other means “we can’t afford to pay what we promised you.” That’s expropriation. Ohio is the second most important state in my own history, and it prides me that one of its sons is House speaker. But I’d like him to talk more about ownership and privatization (even like most other Republicans, including George W Bush, and including “The Log Cabin”). I wish Mr. Boehner would pay a visit to the glass tower – the Cato Institute (link ) – on Massachusetts Ave before taking power. It’s time for laissez-faire again.

Friday, November 05, 2010

Low interest rates and low returns make it hard for people to save enough for retirement

Here comes another dire warning that Americans need to save more principal for their retirement, in the MSN New Investor Center, “Warning: Retirement Disasters Ahead”, republished from Brett Arends of the Wall Street Journal, link here .
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The basic problem? People approaching retirement make less on their principal. Interest rates are low. Bank of America recently renewed a 7 month CD for me at just 0.45% annual interest (at least the early withdrawal penalty is limited by the interest earned).

Stocks are again priced high relative to earnings (especially this week because of recent GOP election gains, along with rhetoric from Boehner and others on cutting deficits), and bonds are higher than is sustainable.

The article notes compound interest (like you study it in middle school math) is less effective now. 10000 saved every year for 30 years would generate $760000 at 5.5% but only $420000 at today’s 2.5%.

Pension fund managers face the same kinds of problems. The article suggests that higher returns could come from stock buybacks, and emerging overseas markets.

Wednesday, November 03, 2010

Will GOP carry out its "threats" on social security? (Look again at Boehner on means testing)

The first day after the Republican rout in the House and Senate gains, there were some offhand comments about social security. Rand Paul , Michele Bachmann, and John Boehner seemed to be floating the same general comments.

Paul has talked about raising the retirement age for younger people, not too radical. Bachmann has talked about “notching up eligibility requirements”, rather vague. Boehner has also talked about the retirement age increase and CPI indexing, but the scariest idea is means testing, which at least in some of his remarks sounds like they could be put into place right away.

Maybe the ploy is to get Americans to accept the idea of “owned private accounts” – regulated and managed to keep principle safe – but safe from means testing or any kind of expropriation. That really was a hidden appeal of President George W. Bush’s proposals a few years ago. Nobody wants to admit it, but “means testing” is a bad word and third rail because it sounds like such a slippery slope. (Look at my situation, which I won’t describe here in detail, but there are so many ways that other moralists or pundits could interpret it, that they (or the government) could do anything to me they wanted.) Maybe the public missed this point in recoiling from privatization (suddenly Bush’s ideas don’t sound so bad). The folks at the Cato Institute get this, but it doesn’t seem like anyone else does.

Some news accounts today discussed just the idea that the GOP might shut down a proposd $250 extra social security payment to seniors next year since there will be no COI raise again. But that seems superficial.

Other reports suggested that the GOP might help "wealthier" estates by extending exemptions on the inheritance tax over $1 million.

Tuesday, November 02, 2010

Medicare rules on paying for skilled nursing care challenged by 2 federal court rulings

Generally, the rule for eligibility for Medicare coverage for skilled nursing care has been that the patient is expected to get better. At least that’s the popular, vernacular explanation. But federal courts in Pennsylvania and Vermont, in widely different cases, have said that such a standard is too strict and that patients may qualify for coverage for skilled nursing care if necessary to maintain stable condition and prevent deterioration that would cause Medicare more medical expenses later.

The New York Times story is by Robert Pear, “Medicare standards are too strict, 2 Courts find”, p A19 on November 19, link here.  One case involved a woman, 81, with hip replacement surgery, and another involved certain home health care services to a 66 year old woman with strokes. Some medical problems, such as multiple sclerosis, may require extensive skilled care just to prevent or delay deterioration.  But not all maintenance care would be regarded as skilled care.

The Obama administration had actually followed the stricter interpretation of the law, often quoted to patients. A group of 17 House Democrats have written the administration urging rules changes. The current political climate, however, may not seem encouraging unless more courts force the issue.

Monday, November 01, 2010

Can family caregivers be paid for their time?


Unpaid family members indeed form a backbone for elder caregving in the United States, and demographics may stretch the demand for paid services to the breaking point, so it is said. Neverthtesll, given the sacrifice involved, it’s appropriate for family members to ask if it is legitimate to be paid for their services.

The general answer is a guarded yes. There are three major potential sources. One would be the elder’s own savings, if they are sufficient. The adult child would need to consult with a lawyer and draw up the necessary powers of attorney and perhaps create a living trust. The adult child(ren) should also consult a tax advisor. It’s also possible in some states to be paid by Medicaid if there are insufficient assets, and some long term care insurance policies are structured to allow family caregivers to be paid about the same rate as home health.

The best document on the topic seems to come from the “geriatric care manager” site here, an article called "Family Caregiver Agreements", from NAPGCM (National Association of Professional Geriatric Care Managers), by Linda Fodrini-Johnson.



There’s a lot here. For example, the reference suggests drawing up a contract. Consider whether free room and board is included. Tax laws generally allow this to immediate family members, but it could be a sensitive matter if the adult child insists and maintaining “independence” (ask a tax professional). In some cases, it may be appropriate to pay room and board (which is taxable to the parent) and be paid for services (which is taxable wage income reportable to the IRS and to social security, included in social security records like wages from any employment). There could be other issues to consider here: If the adult child is receiving unemployment, there could be conflicts (with number of hours worked a week); if the adult child is between 62 and full retirement age and drawing social security, there could be issues with the Annual Earnings Limit. Be careful if estate funds are used if they are likely to be used up, as Medicaid lookback periods and state filial responsibility laws [which generally presume an adult child most prove he or she could “support” a parent and himself or herself if demanded to do so, as if the elder were a conventional dependent] could come into play. And there can be issues about the compensation itself, for example, if there are other siblings or potential heirs sensitive to the estate. If agency caregivers are brought in, the adult child should probably not be paid for services given by the hired caregivers, but could be paid for other work not done by caregivers, such as financial management (bills), medication, property management (repairs), anything that takes time and draws of education or professional skills. (He or she could also be paid for human resources or supervision time if he does not use an agency to provide the caregivers but handles their payroll, withholding tax, immigration I-9, performance appraisals, etc; this is sensitive and can lead to other conflicts). The over all arrangement should be fair (itself a subjective concept because most federal and state laws leave a lot of wiggle room for interpretartion); otherwise there could be risk of being reported for elder abuse or comingling. The appropriateness of compensation can involve other factors, too: whether professional management services are used, and whether hiring agencies are used, both of which account for some time that the adult child might want to be compensated for.

I found several other sources, such as this “Suite 101” here, home care here, and “Caring” here. Generally they assume that the adult child is doing physical personal caregiving as well as management.

Pictures: From Jon Stewart's Washington DC rally.