Monday, December 29, 2014

Researchers look for genes that lead to resilience against Alzheimer's; readers weigh in


An article in the New York Times Monday Dec. 29, by Gina Kolata, discusses “The Resilience Project”, which will look for extra genes that help individuals in families susceptible to Alzheimer’s or other degenerative diseases escape the disease when in fact they have the target gene.  The link is here. The article gave the story of a particular Doug Whitney, who has tested positive for a gene that causes very early dementia, but has not developed symptoms for years.  The question is, do some people have a second “resilience gene” that prevents the destructive gene from being expressed.
    
Page 19 of the Review Section, on Sunday December 28, 2014 in the NYT, in the column by Nicolas Kristoff, “The Readers Do Get It” (or “Alzheimer’s in the Open”), expressed that readers do get the nature of the moral problem the disease poses, link 

Friday, December 26, 2014

Court overrules Labor Department on mandatory overtime for some caregivers


On Dec. 22, US District court judge Richard Leon struck down a Labor Department ruling guaranteeing caregivers overtime in some circumstances.  Think Progress posted a big story on Facebook today here.   Sam Hanahel has a source story from AP here
  
The judge said that Congress simply didn’t give the administration the power to overrule the exceptions for primary “fellowship and protection” jobs, almost viewing them as a kind of servitude.
    
The ruling certainly is not good for immigrant women who often fill these jobs, and blunts the effect of the eldercare caregiving crisis on a personal level for upper middle class families. 
  
Picture: Start of Piney Ridge Trail on Skyline Drive, VA, site of my very first mountain hike in 1961. 

Tuesday, December 16, 2014

Some younger adults start looking at how to avoid Alzheimer's in the family; one idea is intermittent fasting


There is new interest among younger adults in being tested for genetic markers for Alzheimer’s and possibly making lifestyle interventions.
  
NBC Nightly News presented a 32-year-old musician whose mother is showing signs of dementia at 62.  He did some genetic work and found he has a genetically determined protein titer that has been associated with dementia.
  
  
Must stricter dieting may help.  There are studies that suggest increased social interaction will help, as well as brain exercises.  And music itself seems to help forestall dementia. 
  

There is a related story in Bloomberg about the idea of intermittent 2-day fasts forestalling Alzheimer’s.   It’s not clear while whole day fasts would somehow reduce the process of plaque formation. I can remember that one of the camps at Lama Foundation back in the 1980s (in NM) was "purification through fasting."  

Thursday, December 11, 2014

Congress agrees to let some multi-employer pensions plans cut benefits to existing retirees


The bipartisan, lame duck spending bill, designed to avoid government shutdown, will allow financially troubled multi-employer pensions plans to cut pensions, often by as much as one third, even to existing retirees, people receiving benefits.  The Pension Rights Center is obviously very critical of this measure, as in this article.
  
Michael A. Fletcher has a similar story in the Washington Post, p. A12, Wednesday, here .“Deal reached to allow pension benefit cuts; move, affecting current retirees, is an effort to save distressed plans”.
  
It would seem that affected pensioners have no recourse.  The PBGC is not part of the process.  
  
For more people all the time, our system is not working.  

Update:  Dec. 13

Michelle Singletary writes in the Washington Post, "Your pension could go poof.  Do you have a backup plan?"  here. PBGC has a deficit of $19.3 billion even for single-employer plans.  She warns, you're increasingly on your own. 

Wednesday, December 10, 2014

Are men taking on more parental caregiving now?; also, fasting and Alzheimer's


A Letter to the Editor of the Washington Post Wednesday, December 10, 2014, p. A20, “Elder care: Caregiving has challenges and rewards, no matter your gender” relates a male “shortcircuiting” his career, without spouse and siblings, to care for his mother in later years, link here.   The letter links to a Dec. 6 article by Frederick Kunkle, “Daughters tend to aging parents more often than their sons, but some are seeking a change.”
  
The letter points out changing gender roles, but longer life spans are a disability.  I was in this situation for seven years after I came back to “Old Virginny” (2003-2010), and one of the emotions was indeed a sense of humiliation, as I was in my 60s myself.  I landed well enough, but with new questions (another discussion – people wonder why I am not more “sociable” or “personally giving”).  We did hire help here for the last years, and mother had the savings to pay for it, thanks to my late father’s conservative investing habits for several decades (he never took chances with losing principal on anything and still made about 10% a year on what my parents had)  
  
The growing moral questions, about obligations to parents, taken on an increasingly personal (and gender-bending) nature and even raise fundamental questions about marriage and procreation.  
Update: Later Wednesday

There is a story that intermittent fasting may help forestall Alzheimer's.  I'll look into it further.  Here is an account in Bloomberg.  It was mentioned on WJLA in Washington local news this evening, 

Saturday, December 06, 2014

Should seniors be "expected" to volunteer or be part of national service?


With all the sporadic talk of national service, which always comes up after a national controversy (right now, police and race), and with some of the talk having focused on young adults (18-28 in McChrystal’s scheme), a fair question is, what about seniors?
  
After my layoff at the end of 2001 (when I was 58), I did vet the Peace Corps a bit while still in Minneapolis.  I was told that the oldest volunteer they had overseas was 82.  There are positions for information technology volunteers.
  
I actually got a paper application.  The questionnaire was relentless in seeing how socially connected the applicant was, including working closely with other people in very personal situations.  I did not have that kind of history so I did not pursue it.
  
  
I also heard about a position called “senior home companion” which paid a small stipend.  You could not be “hired” for that until you were 60.  I had no concept of how personal it could get.
  
There is a Senior Corps, as explained here

I’m not much on bureaucratized programs.  You can get an idea on what it does from the photo album there. There is a difference between local volunteering and "service programs".  


Saturday, November 29, 2014

Information on music therapy for Alzheimer's slowing becoming better known


How much progress has been made to make music therapy more available to seniors with dementia?
  
A good place to start looking is the writeup at “A Place for Mom” here.  There seem to be about 3200 therapists working now in the country.
  
The centerpiece for information seems to be the American Music Therapy Association, here.   There are about 70 colleges that offer degrees in Music Therapy, according to the AMTA.   The field seems to be developing, becoming standardized and has some bureaucracy.
  
Is music therapy a field for musicians who could use the income (performing in senior or assisted living centers)? Is it a field for IT projects?  We don’t hear a lot about in the news, outside of the film “Alive Inside: A Story of Music and Memory”, reviewed on the Movies blog July 26, 2014. 
  
Alicia Clair has a video on “Music Therapy, Alzheimer’s, and Post-Traumatic Stress” from the Library of Congress (2011).


Sunrise Senior Living has a link on the issue here.
  
Music therapy is also valuable in special education, with autism, but that is a different area. 



Monday, November 17, 2014

Employers start to offer elder-care benefits, out of enlightened self-interest


The Washington Post leads off its Metro section Monday morning with an important story by Brigid Schulte about eldercare, “As population ages, balancing jobs and parents”.  Online the title is more specific: “Aging population prompts more employers to offer elder-care benefits to workers,” link here. The story was findable by Google but not within the search box of the Post’s own site early Monday; this often happens.
  
The demographics drive the self-interest of employers, as a MetLife survey reported in the story indicates.  In 1999, my mother was offered coronary bypass surgery at age 85.  At the time, this was almost unheard of;  now it would be common.  There was a concern briefly that it might not be offered unless I got my employer to move me back to Arlington, but I had moved to Minneapolis to avoid a “conflict of interest”.  Fortunately, this did not happen.  My mother spent two weeks with a bad experience in a skilled nursing facility, where an employee did not respect the order that she was not supposed to raise her arms while the staples healed.  This could have caused a catastrophe, although it did not and everything finally turned out well.  She would live until the end of 2010.

In 1999, of course, there were no eldercare benefits, and the demographics were not known well enough to provide employers an incentive.  Today, medicine can keep parents alive longer in extreme disability, especially dementia and Allzheimer’s. 
  
Unpaid family leave up to 12 weeks was possible in 1999, however, according to the early Clinton-era FNLA of 1993.  I would have had to “sacrifice” paid vacation first however.  I remember a coworker in Minneapolis saying to me, “But Bill, she’s your mother.”  This situation is taxing in unusual ways for those who did NOT have their own children.  (In fact, the coworker said, “Your mother didn’t have enough children.”  Tacky.  She couldn’t.  Although my parents at one time considered adopting a sister for me.) 
  
  
I found a video on eldercare benefits in Canada, but there isn’t much on YouTube on employer benefits yet. 



Friday, November 14, 2014

Case in Virginia shows that elder-neglect laws do have some teeth; a tragic story with extreme age; the adult child was already 70 herself


A recent sad incident in Alexandria, Virginia provides a reminder that neglect when having eldercare responsibilities can result in criminal prosecution.  The story leads the Metro section of the Washington Post Friday, November 14, 2014, and is by Matt Zapotosky, link here
  
The case involves a 70 year old woman, Anne Bailey, caring for her 98 year old mother.  Apparently when the mother fell (from a wheelchair) the defendant left her alone on the ground for two days.  The mother eventually died, but from a heart attack not related to the fall.  And complicating the story is the fact that Bailey did call 911, and it is not clear why that call failed (technically) or why other attempts to get help failed (as detailed in the story).  Nevertheless, Bailey plead guilty to a single felony count of “neglect of an incapacitated adult”.  The text in the Virginia code is here. The sentence is likely to be limited to community service and there are legal maneuvers designed to keep a felony off the defendant’s record.
  
One striking aspect of the case is the extreme age of the mother, but also the daughter.  People, especially women,  are surviving into the late nineties or to over 100 with extreme disability (particularly dementia) much more often than in the past. Adult children do have a legal obligation to provide for their care in most or many states, about 30 of which (including Virginia) have filial responsibility laws.
  
Another relevant fact was that Bailey seemed to be providing care alone, and that the City of Alexandria had offered to provide home health services.  It is not clear from the story how these would have been paid for.  Medicare does not pay for custodial care, but Medicaid will pay for nursing home care for those without sufficient assets.  It is theoretically possible to require the daughter to pay for the nursing home care before Medicaid does, but so far, to my knowledge, the only state in which this has actually happened is Pennsylvania (May 22, 2012 story here, the Pittas case).  Readers of this blog may know of other cases and are invited to comment.
  
In my own case, I had returned home to Virginia in 2003 when I was 60 myself, after forced “retirement” (job buyout/layoff in Minnesota).  My own mother (born in 1913) started showing more serious problems in 2007 (with a parking lot fall that did not result in serious injury).  In May, 2009 she had a mild stroke and spent three weeks in Medicare-approved skilled nursing.  She was released with a diagnosis of dementia, which was believed to be more heart-related (vascular) than Alzheimer’s.  I arranged for occasional home health as soon as she returned home in June.  Usually, someone would come if I went out for an extended period.  In July she seemed to improve and I actually allowed her to be alone when I went out (usually not more than about four hours at a time).  Once she was allowed to drive to the grocery store, and came back without incident.   But in August the decline set in again, and home health was usually hired.  I had two different companies.  One of the companies sent a nurse for review and that nurse told me, sometime later in the fall of 2009, that leaving a patient on Aricept alone could be prosecuted as neglect.  (A physician later discounted this idea.)  By November we had care here during the day all weekdays, and by Spring 2010 we had day care every day, which extended to 24 hour care in September.  But care had been arranged throughout 2010 for most weekend evenings, as I often needed to go out.  Mother would pass away at 97 on December 14, 2010 after four days in Capital Hospice.  I had the services of Hospice (Medicare-paid) at home (nurse visits and social worker) starting in November 2009 (when there is a life expectancy of six months or less).  Medicare typically gets billed about $4000 a month for in-home visits.  Self-pay of 24 hour home health (from her assets) cost about $12000 a month, more than a nursing home (then about $7500) but she was determined to stay at home.  I had met with a lawyer and set up a trust back in early 2009.
  
The obligation of adult children (I am an only child) to provide for parents, while sometimes driven by family loyalty and emotion, is an important moral question, too, and it would have bearing on other major policy issues, especially marriage (even now same-sex marriage) and policies that influence the decision as to how many children to have (or even adopt).  Not everything in life is just a matter of personal choice and living up to the choice.  There are things we don’t have a choice about. 





Sunday, November 09, 2014

Estate or trust beneficiaries need to beware of the "dead hand", although we don't live inside George Eliot's novels


Here’s a good topic for estate planning:  the “dead hand”, where the distribution of an estate is conditioned on the beneficiary’s performing or behaving in a certain manner, as laid out in this this paper, “Dead Hand Control: Conditional Bequeaths and Devisements”, link here
   
The “dead hand” was often a plot device in Victorian novels, but has generally been less well known in the US in recent decades.  However, there have movies made about the issue, like “The Bachelor” (directed by Gary Sinyor, New Line, 1999), where the beneficiary has to get married within a certain time.  More practical is the expectation that the beneficiary raise the decedent’s or another relative’s children, which has the practical result of expanding the notion of “family responsibility”.  Consider the Disney film "Raising Helen".
  
It is possible for a “dead hand” to set up a test of the beneficiary’s sense of purpose or integrity, if his or her personal values in areas like marriage, relationships, sexuality, or self-expression are challenged.  However, courts in recent years have been more reluctant to nullify dead hand provisions that violate “public policy”, such as requirements not to marry outside of a religion or race.  Eventually, the public policy provision in some states might apply to gay marriage, but that’s probably a decade away at least.
   
Findlaw has a page on the issue, here and is somewhat lukewarm on the practice. 
   
The New York Times has a column on the topic, by John Masik, from March 2014, here.  The executor has to be separate from the beneficiary to monitor the behavior of any beneficiary.  

Sunday, November 02, 2014

Thoughts on an upcoming annual physical: for seniors with momentum, less treatment is more; concerns over arrhythmia


As my own annual Medicare physical approaches (Nov. 7 this year), I always wonder if there is the possibility of some kind of disruption based on the exam itself, as opposed to a symptomatic (and, at my age, possibly  suddenly catastrophic) illness.

For example, I have noticed a mild and stable heart arrhythmia for over twenty years.   It never has shown much on the ECG, although the ECG in Minnesota at the end of 2001 (the ING annual physical, that happened right before the layoff) showed signs of damage due to hypertension. That’s when atenolol started.
     
In 2012, the doctor noticed a slow heartbeat and changed the prescription to Losartan potassium.  Right after the medication changed, I did notice an increased tendency for jumpy heart rhythms, which declined back to “normal” with time.  He mentioned the idea of a pacemaker, but it wasn’t pursued.  The exam in 2013 went very well, without much comment. 
  
In 2010, some elevation of the PS antigen was noted, but it went back to normal on its own in 2011, with the stress of mother over with after her passing, and probably a lower fat diet (since there was no caregiver cooking).
  
I believe in my own momentum and in doing little.  That used to be the philosophy when I was growing up. You were dealt a hand, you lived your life, didn’t expect too much at the end, and then you died, because everyone will die of something.  People often reached normal or long lifespans, even with bad health habits, with relatively little medical disruption, until sudden death.  That was viewed as desirable.  So far, I’ve had only one major hospitalization, after an accidental and freakish hip fracture in early 1998 in Minnesota;  with new surgical technology I recovered fully and relatively quickly.  My paternal grandfather died at age 89 after breakfast on a Saturday morning, never missing a day.  My father died of advanced prostate cancer on New Year’s Day, 1986, just before his 83rd birthday, but he had been ill only four weeks.  But my mother had a long decline, starting with hip fracture in 1996, heart attack and several angina in 1999 which was finally resolved by coronary bypass surgery, and then doing pretty well until starting to decline in 2007, and steeply and requiring care after the middle of 2009 (to pass near the end of 2010, at 97).  On mother’s side, one uncle had a sudden seizure from a brain tumor at 60 and lived eight months.  That might suggest something running in the family, but it hasn’t happened to anyone else, so environmental exposure of some kind must have been involved.   Another maternal uncle died of cardiomyopathy at age 70 in 1995.  He had a sudden cardiac arrest at age 68 walking into a restaurant in South Carolina.   That was never explained, but medication issues (or accidental overdose) can lead to sudden death or sudden arrests. 
  
Physicians today feel pressure to do a lot, partly because of malpractice of other secondary liability concerns, and partly because of reimbursement incentives.  It might be a good thing to look into the arrhythmia, but that would mean many disruptive tests (stress test, echocardiogram, and a Holter Monitor with pre-shaving) and then likely pressure to do something.  I can see the idea of doing something like that in the winter, after New Years, and staying out of circulation socially for six weeks or so if that is necessary.  Any “elective” surgery and hospitalization could disrupt my being online, and I have no “social capital” to draw on.  
  
In a practical sense, I am with the “conservatives” and “The Washington Times” in believing that a lot of seniors do better if left alone – spending little and remaining productive well into old age, possibly before a more sudden end, or shorter period of disability at the very end (which will inevitably come from something).  But we know there are others to consider.  Individual health also relates to public health and safety.
  
Consider driving.  In more recent years, there has been more public attention to senior driver safety than there had been even a decade ago.  In Virginia, and probably in all states, medical professionals can write to the DMV and recommend that licenses be revoked (link here).  That could set up a situation where the senior must consent to a period of lengthy and intrusive tests and surgeries whether he or she really wants them (and needs them for “momentum”).  That could even be medically counterproductive.  Generally, if someone has a seizure, stroke resulting in unconsciousness, or cardiac arrest, the person is not allowed to drive for six months – which may make sense since something has really “happened”.  But could driving privileges be suspended if tests showed that an incident had a higher than usual probability of happening?  This sounds like the public health debate we are having with Ebola. 
Do arrhythmias fall into this area?  WebMD has some guidelines, that factor in the idea that an ICD or a pacemaker (not the same things, link  ) could have been implanted, here. Generally, if a patient has had an episode which required a shock from an ICD (or defibrillator machine), the person is not allowed to drive for six months.  But without such an episode, someone can generally drive a few days after surgery.
 
I used to joke, "never go to the doctor."  You know what happened to David Letterman in 2000.  He did not pass Go, he did not go home.  Right into coronary bypass surgery.  They were all ready for him, and he didn't know he was walking into a trap, to get cracked open like a lobster.  When he came back on the air, he belonged to the Zipper Club.





Tuesday, October 28, 2014

Washington Post covers hospice care with onine guide


The Washington Post offers a “Consumer Guide to Hospice”, link here , organized by state, and also alphabetically.  Sometimes the alphabetic collation is out of sequence, and there are multiple occurrences of the same hospice.
   
Monday, the Post featured a cover story Peter Whorisky and Dan Keating, “Selecting hospice is roll of dice for families; quality of care varies, and information about providers is lacking”, here,, from the “Business of Dying” series. 
   

For my own mother, we started with Capital Hospice, which has a facility in Arlington VA which happens to be the same building in which I went to grade school in the 50s (Woodlawn, now replaced by Glebe Elementary a half mile away).  There were typically two nursing visits a week, a social worker visit, and occasionally a chaplain.  She went into the facility on Dec. 10, 2010 and passed away Dec. 14 at age 97.  The chaplain noted my mother’s sense of humor. 

Friday, October 24, 2014

Heart transplants from deceased people could extend lives, but can we afford it?


Surgeons in Australia have accomplished the first heart transplant from a person with complete circulatory death, according to a BBC News story by James Gallagher, link here. The operation is said to increase the pool of patients who might benefit from heart transplant by 30%.
  
Would there be an age limit (say the mid 90s), or some requirement that the patient not have developed severe dementia?  Life spans are already increasing longer than we are able to support them financially, at least without having more children than we do.  
  
Just because we can do something like this doesn’t mean we should.  We have to consider the impact on others in the family. 

Dick Cheney has done very well on his heart transplant, Huffington story here


Wednesday, October 15, 2014

Nursing home fine underlines problems of unreliability of care, an issue for adult children


One of the country’s largest nursing home chains, Extendicare Health Services (site ), has agreed to settle with the US DOJ for $38 million for a quality of care suit.  The Washington Post has a story by Daniel Salazar on p. A17 today.  The story was not online yet Wednesday morning, but Eric Tucker has an AP story on WCPO in Cincinnati here.  The company and subsidiary Progressive Step Corporation operates in Kentucky and other states.  
  
The litigation apparently involved two sorts of abuses: overbilling of Medicare for “unnecessary” or unauthorized rehabilitative services in skilled nursing situations (for patients who are supposed to get better), and inadequate custodial care of many patients, with regard to falls, infections, bedsores, malnutrition.
  
My own mother was in an SNF (not belonging to this company) for two weeks in May 1999 after her sudden coronary bypass surgery at age 85.  I was living in Minneapolis at the time and did not return until June.  But I heard about serious problems at the facility, and a peer female friend of hers did register complaints with an ombudsman. 
  
My mother passed away in December 2010, after a long period of care at home from home health aides, and four days in a hospice.  But she was never in a custodial nursing home, but I was having to consider it.  A nursing home costs about two-thirds of what round-the-clock home health costs (unless you use a live-in, which is morally much more problematic).  

Wednesday, October 08, 2014

A major primer on Medicare for those approaching 65


It’s important to prepare for Medicare as you approach 65.  The “Health and Science” section of the Washington Post has an important insert by Caroline Mayer today, “Ready or not, you have a date with Medicare”, link here
  
Mayer explains how Part B Medicare premiums and deductibles work.
    
Health insurance sales people will deluge seniors with Medicare Advantage pitches, as well as long term care.  I had the experience of people trying to recruit me to sell it during my own “retirement”, I don’t like to knock on doors.  My own experience is this.  I joined AARP a number of years before 65.  (Yes, I looked at their job openings, too, since I’m in the DC area.)  I found that I did get a sizable discount to start Medicare Part B Supplemental, which has continued (now I’m 71).  The provider is United Health Care, and I have had no problems with claims (the main one was hernia surgery in 2010, when I was 67; again, the coverage paid for everything after the first $135, and the fact that I had the coverage at all causes the surgeon and the Virginia Hospital Center to discount the basic fees about 65% to start with, based on their “volume discount” contract with Medicare and UHC.  

Wednesday, October 01, 2014

Motley Fool debunks common myths about Social Security


The Motley Fool has tweeted a piece “5 Huge Myths about Social Security”, link. 
It debunks the idea that Social Security adds to the deficit (remember John Boehner in 2011, before the first debt ceiling crisis?).  But more important, it plays down the “demographic winter” argument, saying that life expectancy, given that one has reached age 65, really hasn’t risen all that much.  It also maintains that rising worker productivity helps offset the numerical loss of workers available by “head count”. 
  
It also says that we need to come up with only 1% of Gross Domestic Product to makeup the shortfall for the next 75Years. 
  
It’s true that Social Security provides disability benefits as well as retirement benefits.  But I would disagree with the idea that it “isn’t a retirement savings plan” but an insurance plan (or welfare).  I really did use if as “retirement savings”. 
  
The URL link is here.

Tuesday, September 30, 2014

Can blood transfusions from younger adults help people with Alzheimer's?


The Washington Post has a story Sept. 30 in Health and Science by Helen Thomson, reporting experiments giving the elderly blood or plasma transfusions from younger people, to reverse the symptoms of Alzheimer’s and other diseases.   The link is here
    
 There have been reverse “vampire” experiments with mice where the retrograde happens:  young mice age more rapidly. 
    
The practice might make sense in reversing early Alzheimer’s or dementia.  It sounds as though it would be less appropriate for the extremely elderly.
     
But the question as to whether a person should look at himself as a repository of spare body parts for others still seems disturbing to me.  But, after all, I am banned from giving blood because of the exclusion of MSM.  

Monday, September 29, 2014

More calls to limit social security payments even to existing retirees, by means testing or by actuarial math


Here we go again, with talks about means testing to stopping Social Security. On a site called “Against Crony Capitalism”, Nick Sorrentino argues that current retires could be paid back (by an actuarial formula) what they put in, and nothing more.  People should not retire until 70, or later.  The link is here
   
The “young cannot fund the old” – partly because there are fewer of them as people have fewer children, and as people live much longer.  The writer says that the Baby Boomers were not particularly concerned about future generations. 
   
In fact, when I was working in my “mainline career”, 55 was thought of as a good corporate retirement age.  Some company pensions then would pay a “Social Security Bridge” until age 62.  Nobody took the demographics seriously.
   
Also, when I was back home looking after my mother, I was already in my 60s (as a never-married homosexual man with no children), while my mother was in her 90s.  The situation seemed unprecedented.
   
But if you couldn’t retire until, say, age 75, I would have had to take all those unsolicited entreaties to become a huckster much more seriously. 
   
“Sales” won’t replace “making things” or developing real wealth as a source of reliable income for older workers, either.  

Friday, September 26, 2014

Medicare reimbursement policies discourage discharging elderly from hospitals into home care


The health care system, with Medicare reimbursement policies, sometimes discourages the elderly from being discharged back home in cases where there are relatives to care for them.  Home day care is said to cost only about 20% of that, according to the New York Times front page article Friday September 26, 2014 by Nina Bernstein, link here.   However 24 hour care would cost much closer to the Medicare amount (unless a live-in is used, which is usually less expensive but perhaps exploitive).
  
It is common for people to be discharged from hospitals into skilled nursing facilities, where Medicare can reimburse for 20 days.  Supplementary insurance may help pay for up to 100 days in some cases.  My own mother stayed in an SNF after coronary bypass surgery in 1999 (with a bad experience), and then after a mini-stroke in 2009 (a much better experience).  

Friday, September 19, 2014

IOM recommends major reforms in reimbursement for end-of-life care


The Institute of Medicine has recommended massive reforms in the country’s end-of-life care systems, according to a story by Pam Belluck in the New York Times Thursday Sept. 17, on p. A17, link here.  The master link for the report itself is here
  
Changes include reimbursement for end-of-life counseling discussions, more emphasis on home care, and removal of unnecessary incentives for hospital care. 
  
In my own mother’s situation, I was offered the opportunity to send her either to the hospital or to hospice for her last crisis in December 2010, after many hospitalizations already, at the age of 97. 

Saturday, September 13, 2014

Can insurance companies rescue public employees's pensions with "private" annuities?


As someone who worked in the life and annuity industry for twelve years, for USLICO-ReliaStar-ING, the story by Michael A. Fletcher in the Washington Post on Friday, Sept. 12, Economy and Business, p. A16, about whether private insurance companies should take over public employee pensions, intrigued me.  The title is “Can insurance companies save public pensions? Hatch’s bill would turn over assets; Retirement groups endorse proposal”, link here.
    
That would indeed mean whole new lines of businesses to code in existing annuity systems (probably Vantage). 
    
Workers might wind up with smaller payments, the article says.
    
The bill seems to be S1270, the SAFE Retirement Act of 2013, or “Secure Annuities for Employment Retirement Act of 2013”, govtrack link here
  
So, MetLife and ING, have at it.  

Friday, September 12, 2014

Social Security garnishes benefits to pay student loan debts


People with unpaid student loan debt are finding that Social Security garnishes their benefit payments, CNN is reporting today in a story by Patrick Sheridan, link, with  assistance from legal advisor Joshua Cohen.  The public may be surprised that a number of baby boomers are now reaching 62 with unpaid student loan debt,

It is possible to negotiate a payment schedule, which will be inflexible once set up, with the institution that holds the note.  

Thursday, September 04, 2014

Are women more susceptible to Alzheimer's, even allowing for longer life spans?


On Thursday, September 4, 2014, the Washington Post carries a story by Fredrick Kunkle examining “Why do more women get Alzheimer’s?” The link is here.
  
The rather common sense answer would be that women live longer than men.  But research shows that women may be more susceptible to a particular gene, APOe4, and, particularly when having two copies of it (not possible for men) might be more likely to develop it at a particular age. 
My own anecdotal observation, however, seems to be that longer lifespans are the main reason.  An Emeritus facility told me a few years ago that its Alzheimer’s wing was 70% female.
My own mother had significant dementia by age 94.  Although examination showed some plaques, I think most of her dementia was vascular in nature, related to congestive heart failure and small strokes.

About a year before her passing, a neurologist had given her an exam, in which she answered 18 out of 27 questions.  She could not remember President Obama’s name, but could remember Bush.
High profile men have developed Alzheimer’s. Ronald Reagan was diagnosed with it in 1994, and Maria Shriver made an HBO series about it in her dad, Sargent Shriver, reviewed here May 10, 2009 on the TV blog.  
  


Sunday, August 31, 2014

CBS 60 Minutes: "Living to 90 and Beyond": surprising finds about dementia for those in their 90s


Sunday, Aug 31, CBS 60 Minutes aired “Living to 90 and Beyond”, link here

The program started out by debunking the myth that if you reach 90 without dementia, you’ll never get it.  

My own mother’s history proves that.

The report indicated that some people in their 90s have plaques but without the disabling memory and cognition loss of Alzheimer’s.  On the other hand, some people in their 90s have dementia but not the plaques, but instead display a history of multiple mini-strokes.  That seemed to be the case with my mother (who lived to 97), who had very mild plaques but did have a significant stroke 19 months before her passing. 

Another finding was surprising indeed. At age over 90, low blood pressure is often associated with dementia.  That is true even though throughout most of life, high blood pressure is a bad thing.  When my mother took medication to reduce fluid in the lungs, her blood pressure dropped.  Ironically, the day before her final lapse into coma, her medical examination was relatively normal.

Today, there was another announcement om CNN, of a new medication for congestive heart failure, which may well reduce dementia further.  

Friday, August 08, 2014

Federal Reserve survey shows that 1 in 5 people have zero savings as they approach retirement


A study released by the Federal Reserve on August 7 showed that 20% of workers have zero savings as they approach retirement.  The Fed’s own story is here.  Jonnelle Marte has a story on this item in the Washington Post Wonkblog on Friday, link here.  The results came from a survey of 4100 people.  The biggest source of income for such workers will be Social Security.  One third said they had delayed their retirement during or after the 2008 financial crisis.  Only 18% envisioned a traditional retirement.  Many people wind up going into commission sales jobs that turn out to be manipulative or cheesy.  But a few companies have done a good job of hiring seniors as valued help, like Home Depot.

Saturday, August 02, 2014

You can accumulated wealth with a 401(k): just do the math


A website called “Personal Capital” has a useful chart showing how much your “low end” and “high end” wealth balances vary according to a 401(k) savings plan and how long you stay in it.  It assumes you start working at age 22 (I started at 26 – we had a draft then, for one thing).  The link is here.  The article is useful in challenging some assumptions that, if retired and you have some wealth, you should start spending it because you can’t take it with you.  You may live longer than you think.
  
It is critical that the employer provide some match. 
  
Only you can save yourself, the libertarian-oriented article suggests.
   
Another issue, of course, is the stability of the entire financial system, and whether “entitlement” programs remain stable, or become more means-tested.


Monday, July 28, 2014

NBC Today show gives quiz on "biological age"; music therapy can halt dementia


The NBC Today show on Monday morning offered a quiz to help a viewer to assess her own biological age, link here. I couldn’t get the NIH link on body mass index to resolve, so I had to estimate mine.  I wound up with a score of -20, or 2 years credit, making my biological age “just” 69.
But some of the questions were interesting. 

One of the most critical was level of social engagement.  Volunteering is a big plus – but that means time and personal contact – especially giving less intact people (children or adults) personal attention and “love” – not just writing a check (or even working alone on a website or Wikipedia article for a charity). Another was to have a web of people who can help “you” in a pinch.  This sounds like social communism or collectivism and might come across as morally objectionable to some.  It certainly is not what Ayn Rand believed.  It’s more what happens in closed knot communities, like the Amish, or intentional communities.  People do tend to live longer in these circumstances.

Mehmet Oz (somewhat discredited recently) has said that, as a heart surgeon, he is much more likely to recommend aggressive treatment to a married patient with a partner whom he or she loves and who loves the person back – or to someone whose extended family is close knit. It’s much more likely to work if others will sacrifice.

As far as getting help in a pinch, that is indeed double edge in another sense.  Bad things happen to people.  I’m not talking about the normal aging issues – because everybody dies of something eventually, without exception (except for Christ).  I am talking about sudden harm because of the malice of others – whether street criminals, who are becoming more brazen, or war or terrorism.  I’m also talking about natural disasters, particularly if they are unusual for the area in which someone lives.  An F4 tornado in this area would be devastating, but an F0 (which I think has happened “to me” once) would not.  But if I lived in Florida, on the Gulf Coast or much of the Midwest, I’d have a full disaster plan in place, with an alternate place to go and set up operations temporarily.  (Funny, when I lived in Dallas and Minneapolis, or was a student in Kansas, or in the Army, I never thought about this.)  What would be bad for me would be a disaster so calamitous (including a terror attack like a dirty bomb) that normal preparations (like generators, hotels, homeowner’s insurance, availability of contractors) didn’t work as they are supposed to.  I’ve never had to stay in a shelter before and deal with others there (or have them deal with me).  But it could happen to anyone.
  
So I try to be more cautious about a lot of things,  avoid “mistakes” and some kinds of dangerous situations.   I was mugged at a Metro station, on an escalator, in Washington in March 2013, not injured and with no financial losses resulting – the banks and particularly Metro ate all the losses (in many thousands) – as a security camera wasn’t working.  But what if I had been pushed down the escalator?  It could have been much worse.  And twice I’ve faced a possible carjacking (once was in Ohio) and simply gunned and sped off and called police when at a safe distance (Mark Zuckerberg did the same thing on time right after moving to CA to start Facebook).   But I may have been “lucky”.

On a weekend trip at the end of June to NYC for Pride, I almost got hit by a car (or had a foot run over) in lower Manhattan Sunday morning as I was racing to the 9/11 Memorial site (I was late), the car speeding and making a very illegal turn.  I jumped out of the way just in time. 
   
The survey gave no "credit" for hot having ever smoked (or used recreational drugs); but it penalized tobacco use heavily.  It gave modest uptick for very occasional alcohol use. 
  
The survey didn’t mention some others things.  While it asked about regular exercise, it didn’t ask about mental exercise.  Playing chess is good (or any game requiring strategy – card games like bridge or poker – and Las Vegas is probably pretty good for stimulating cognitive thinking).  So is jotting down dreams as soon as you wake up before you forget them.  I don’t think that the Bingo, popular in assisted living centers, does much.

  

One idea for improving cognition and longevity is music therapy, as shown in the film “Alive Inside: A Story of Music and Memory” and promoted by the group “Music & Memory”, as reviewed on my Movies Blog July 26 (with the QA, at Landmark E Street Theater in Washington DC, July 25).  



Update: July 29

NBC Nightly News cited a report that regular running or fast walking, even for only about ten minutes three times a week, can reduce the risk of heart attack by up to 45% at any age over 50. 

Tuesday, July 22, 2014

Another elder abuse case involving a hot car, this time at a casino near Baltimore, MD


There is a second conspicuous case of elder neglect reported by station WJLA n Washington DC, this time closer to Baltimore, in northern Anne Arundel County.  A man, Dwight McGinnis, 67, from North Carolina, is alleged to have left his mother, 98, in a car for a number of hours while he was in the “Maryland Live!” casino. But it appears to have been inside a garage, which would have been shaded, with a temperature of about 81 degrees F.  However, the mother was not able to get out on her own. The mother is wheelchair bound.  A passerby called police.  WJLA-7 has the detailed story here.  The man was arrested and charged with “vulnerable adult abuse” as the law is written in Maryland.

I had been told that a patient on memory-enhancing medication (Aricept) should not be left alone, by a case worker from a home health company, when my mother had started it in 2009.  I don’t know if that would be absolute, or would be on a “case by case” basis. 
  
Maryland does have a filial responsibility law (see July 7, 2007).  Apparently North Carolina does, too, according to a list from the New York Times by Jane Gross (link), mentioned here May 15, 2014.  There was a case in Washington DC (which does not have a filial responsibility law) reported here July 9, 2014. .
 
The fact that an adult is incapacitated (even if not elder) may be more important than age itself.  Family relations may not matter when someone takes "responsibility" for an incapacitated adult, for example, by giving him a ride in a car.  People should bear this in mind when volunteering.  





Monday, July 14, 2014

Eye doctor's retinal exam may predict future Alzheimer's


NBC News reported tonight on a new eye test that looks for changes in the retina of the eye for possible early warning signs of future Alzheimer’s Disease.  Apparently the plaque buildup that occurs eventually in neural brain circuits can be seen on certain areas of the retina.

               


NBC also reported on a study in Finland where people ages 62-77 were monitored as to memory function after an aggressive healthful lifestyle program compared to a control group.  After a few years, the people on the aggressive program did better on the memory tests.  It wasn’t clear if this had been correlated yet to the retinal test.  Other studies report that dementia is less prevalent at any age group than it was 50 years ago (apparently 40% less prevalent by population percentage at age 75, according to a Finnish study).    
 
A good question, though, is what can be done with the "bad news".         


Wednesday, July 09, 2014

Washington DC case shows that prosecutions for elder neglect and abuse can occur


It is possible to be prosecuted for criminal neglect of elders (including parents) within one’s care.  A disturbing incident in Washington DC, reported by ABC affiliate WJLA-7, demonstrates that point.  A 29-year old mother is charged with criminal neglect after leaving her 63-year old mother, a stroke survivor, in a hot car all day.   The story with a video (an attempt to interview the suspect) is here. The parties seem to be from North Carolina. 
The case might get more attention in the media because of a horrific case in Georgia of child abuse where a child died when left in a hot car.  

Tuesday, July 01, 2014

Supreme Court limits right of public unions to collect dues from non-member home health workers


The Supreme Court has ruled that home-care workers in Illinois cannot be forced to pay dues to a union that negotiated their compensation, even those not belonging to the union.  But the ruling does not necessarily apply to non home-care workers, even those in other lines of work who are not union members but who benefit from negotiations.  The Washington Post analysis on p A8 Tuesday by Michael Feltcher is here.    The Supreme Court slip opinion (Harris v. Quinn) is here. The Court ruled that requiring dues payment would force home care workers to subsidize political speech that they do not personally support, possibly in part because of the sensitive problems associated with the eldercare issues.  The case could be of significance to those hired to give home health care to elders.  See also story on June 3. 

The New York Times weighs in with an editorial "Limiting Rights: a Hit to Collective Bargaining" (link), which is paired with a similarly motivated editorial on the contraception and religious employers ruling, "Limiting Rights: Imposing Religion on Workers"/ 

Thursday, June 26, 2014

Live-in caregiver refuses to leave when unable to work; a nanny case, but could apply to eldercare (in CA)


A case of a live-in nanny hired to take care of children may have significance for people who hire live-ins as caregivers for the elderly, too.
  
Sarah Figalora reports a case in California of a live-in who became unable to work and was asked to leavr but has refused.  Eviction would follow civil procedures similar to those for roomers or apartment leases, apparently.  The link for the story is here. The possibility could exist that a live-in caring for an elder person would become unable to work, but possibly have the right to stay.  

The caregiver in this case  was reported to have behaved as a "vexatious litigant" but this could happen with eldercare when hiring a live-in directly in some states. 

Saturday, June 21, 2014

Can you inherit your dead parents debts? Another warning about filial responsibility laws


CNN Money has published a new article by Jeanne Sahadi, “Can you inherit your dead parents’ debts?”, link here. The article recoups some important points.

Of course, all debts still in the estate must be settled before money can be distributed to beneficiaries.  Generally, outside of the estate, adult children or other beneficiaries are not responsible for the parents’ debts on their own.

But there are some caveats.  The article mentions that up to thirty states have filial responsibility laws, a topic not often discussed.  If there is not enough money in the estate, then adult children in these states can be held responsible for leftover medical bills or nursing home and caregiving bills with their own funds.  These laws have not been enforced often.  Outside of the Pittas case in Pennsylvania (discussed here May 22, 2012) I am not aware of another case recently where this has happened.

However, if parents used Medicaid, in most cases states can recover Medicaid payments from estates made between ages 55-65. 

Estates must continue to make mortgage payments, which would become the responsibility of whoever inherits real estate.  Lenders cannot call in mortgages.  But upsidedown mortages present problems discussed in the article.  In spousal situations, people have sometimes sold property to pay taxes, which is one reason why same-sex marriage has become an issue.  

Tuesday, June 10, 2014

"Pension predators" act like paday loan artists


Slick salespersons are talking some retirees into forking over most of their pension income streams for upfront cash advances, often for exorbitant interest rates, according to a story in the AARO Bulletin, June 2014, p. 16, the “Your Money” column, article by Marsha Mercer (link). The article (“Beware of pension predators”) gave an example of a Navy Retiree who paid back $42100 in interest for an advance of about $103,000, to Structured Investments Co. of Southern California.
   
It strikes me that a lot of people feel pressured to go to work selling these kinds of instruments.  I got calls about doing this (in northern VA) a few years ago, while my mother was still living.  Could I say “No” to these kinds of approaches forever?  I did, but I was lucky.


Monday, June 09, 2014

Once you get paid while not working, you know your remaining days can be counted


Okay, I will “celebrate” my 71st birthday in less than a month.  I look back to see that I formally “retired” from my mainstream IT career at ING at the end of 2001 (in conjunction with a layoff), and took pension, severance, and eventually unemployment, all at the same time, at age 58.  I took Social Security at age 62 (full retirement age was 66 + 2 months), because my pension did have a slight Social Security offset.

I think that when you retire, “you” have to start thinking about the fact that a day will come when the world does without you.  That there is a last day, a “last supper”, a last movie, etc. is a mathematical certainty, for everyone.  Society (whether an employer with a pension, or Social Security, or even through income from accumulated and possibly inherited wealth) cannot afford to pay people like me an income indefinitely; that would not be sustainable.  And the rapidly increasing life spans, and the longer periods of disability, as was the case for my mother who passed away at 97 in December 2010, will provide a real challenge for individual freedom, as we have gotten used to it.  I was in my sixties when I came back and looked after her, a previously unprecedented set of circumstances.

There is a bit of a paradox.  Old fashioned “family values” did keep extended family members taking care of their own elderly, and away from being public charges, even in decades when perhaps most old age deaths were rather sudden and when most elderly did not live a long time once they were seriously incapacitated.  Now people do live much longer, when many families are much less cohesive, and when people, partly out of economic pressures when young adults, have fewer children.  All of this has to be faced some day.


Tuesday, June 03, 2014

Can caregivers who work as contractors still be unionized?


There is a case before the Supreme Court, Harris v. Quinn, where a caregiver in Illinois (who, in this case, cares for a disabled son) is fighting being required to pay mandatory union dues. 
  
The care arguably has huge potential implications for labor unions, and the “right to work” concept, in many states, first for public employee unions and eventually maybe for all unions.  Right now, though, another aspect is that Harris is actually a self-employed contractor.  I’ve never heard of contractors themselves being unionized;  I would have thought that in other occupations, the “freedom” of no unions could be a good thing.  But caregiving is a totally different kind of work. 
  
The objection to mandatory union dues is that they amount to “mandatory political activism” violating the First Amendment, at least in a public sector scenario.
  
There is a precedent for normal public employees, Abood v. Detroit Board of Education which says that this is OK.  I’ll probably come back to all of this later on other blogs.  The interesting thing here is that the caregiver is an independent contractor, but her rates are set by state laws.  Arguably, she gets the benefit of the rates without have to “pay her dues”. 
  
Matthew Yglesias has an article about the problem on Vox,here
  
Generally, as I know from my own experience in my mother’s care before her death at the end of 2010, home care workers earn relatively little, and the ability to collect overtime has been controversial (and there is also the issue of live-ins).  As the load of eldercare (especially dementia and Alzheimer’s) will only increase the labor needs. 

Friday, May 30, 2014

Before starting Social Security benefits, look at the top 35 years of your earnings


Here’s a good point that just occurred to me.  I did start Social Security benefits at age 62, partly because my pension “social security offset” kicked in (that is, my “social security bridge” expired).
   
Had I kept working full time even at an hourly wage until age 66 (full retirement age in my case) however, the mathematics would have worked out better for me (SSA explains it here).  Not only is the benefit higher because actuarially it is drawn over fewer years, but the important number that averages the top 35 years of earnings improves.  Social Security explains it here.  I worked as a “salaried professional” for 29 years (there was 19 months as a federal employee in 1971-72, before federal employees contributed to social security).  The rest of the years were dribs and drabs,  A reasonable hourly wage full time (let’s say, as a postal carrier, which I almost got in 2004) would have added to the average of the top 35 a little. 


Saturday, May 17, 2014

Well known cartoonist describes experience with eldercare; is hoarding a possible sign of dementia?


New Yorker cartoonist Roz Chast describes the last years of her parents' lives and of her caregiving experience in a book "Can We Talk About Something More Pleasant", published by Bloomsbury, in a Washington Post interview here, May 12, link.
   
Chast mentions the decline in housekeeping and the beginning of a big of hoarding, as an early sign of dementia.  Her parents had been punctilious housekeepers.   My own mother, on the other hand, tried to keep everything clean even when her memory was failing,  And not keeping everything picked up and orderly can result from just having too much one's plate.  The brain can keep up in detail with only six or seven activities at a time.
 
Picture: Mine, from 1979, Big Bend in Texas (from a Sierra Club trip);  favorited on Twitter.  No one writes about seniors and outdoor activities much.   

Thursday, May 15, 2014

A federal filial responsibility law had been proposed in 2005; a master index of articles on the issue


I found another link that gives an index to many Internet articles on filial responsibility laws, which remain a somewhat obscure topic.  The list (which includes some of my articles) is here.

A few of the article sources are eye-catching.  The American Catholic has an article relating the concept to the Fourth Commandment. The New York Times has a list (supplied by Jane Gross) of states with the laws. The Wall Street Journal has a list of 29 states from June 2012.  I’ll give the indirect link for Katherine Pearson’s paper here. Brigham Young University (of the LDS church) gives a comparison to the laws and duties between the U.S. and Italy. MSN  Money has an article (based on the Pittas case), “Will you get Dad’s nursing home bill?” Matthew Pakula proposes a federal filial responsibility statute here,  a link that requires registration with MyJSTOR (which Aaron Swartz had “illegally” downloaded from), from the Family Law Quarterly (from the American Bar Association), Fall 2005, Vol 39, #3, “A Federal filial responsibility statute; a uniform tool to help combat the wave of indigent eldery.”  Pakula does discuss the issue in terms of the lack of the ability of the adult child to have chosen to make a voluntary contract.  I could not find this item on Amazon, but it would be desirable for the ABA to make the PDF available for purchase or for download onto Kindle.  

Saturday, May 03, 2014

It's cheaper, but maybe riskier, to hire your own caregiver (for parents) than use an agency


Ann Carnns is pretty much right on the mark in the New York Times article “Tips for choosing care for an aging or ailing family member”, Saturday, May 5, 2014, p. B7, link here
 
It’s true that it can cost less to hire the help yourself.  But then you have to deal with all the IRS issues, among other things.  During my own experience with this process from 2009-2010, it did not want to be a direct employer of anyone because of my journalism activities, which I perceived as possibly creating a conflict.


The issue of overtime for caregivers (other than live-ins) is still controversial.  They should get it.  And there is at least the possibility of liability if you know a home health agency is not paying it.  Knowing less is legally safer, but not morally.