Wednesday, April 29, 2020

Nursing homes account for over half of Covid deaths in Maryland

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

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

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

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

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

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

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

Monday, April 27, 2020

Seniors living alone, and COVID19

As a senior living alone in a paid-for condo, I still wonder if “authorities” will get more nervous about the population I am part of.  I don’t have any special needs.
But from the perspective of others, the possibility of death alone, and not being found for some time, would sound like a concern that is heightened by COVID19, where possible infection could be unpredictable as would the course.
I expect more pressure on me as to why there is no one to “have my back”.  I’ve just never done that.
Update: May 9 
Jessica Contrera and Ian Shapera discuss the paradoxes that volunteers and non-profits have in serving seniors, in a world were "stay at home" is a privilege and a way to "volunteer".  Seriously, seniors who are active should be as self-sufficient as possible and shouldn't be excluded from volunteering themselves.  

Friday, April 17, 2020

Did the White House set an inadvertent trap for all "elderly" with its guidelines yesterday?

The White House’s guidelines, released yesterday, may contain a possible trap for some seniors if taken literally and interpreted that way by some states and health departments. This point has already been discussed somewhat on the “Bill on Major Issues” blog.

The problem is that the first two phases instruct “vulnerable” individuals to “shelter in place” and it defines all elderly individuals as “vulnerable”.   Even in phase three vulnerable individuals are to practice “social distancing.”

 How other language seems to allow them to work.
The problem comes that, on its face, that would require all seniors to arrange to have all their shopping done for them (although maybe delivery services could work).  Many apartment and condo buildings (for the general public, not 55+) are trying to arrange volunteer teams to do this.  But to do this for seniors who are active seems inappropriate.  Seniors without special conditions should not expect others to take the “risk” (whatever that is) for them. In practice, many situations are complicated enough that intact seniors are really better off taking care of these themselves.

This would raise the idea that seniors need to find “buddies” to do this for them and that those who could not could some day face legal attempts at forced conservatorship or guardianship.  Fortunately, in Virginia at least, that requires some time-consuming court supervision which would not be easy to pull off right now.

Keep in mind that many general public high rises and condos do have many seniors and disabled persons (using elevators) even though the buildings are not reserved for them.

(Update:)  Arlington County (I live in Fairfax, just barely) talks about a "buddy system".  I don't have anything like this in my social capital ("schizoid personality", maybe).  I wonder if a health dept interviewer would quiz me about this some day????   Thomas Friedman, talking to Wolf Blitzer on CNN, referred to the Trump plan as a "quarantine" for old and vulnerable people and recklessness for everybody else (no URL yet). 

Tuesday, April 14, 2020

How does Home Health Care work now with COVID19 risks (for both caregiver and elderly client)? It seems unpredictable right now

A good question will be, how will families who depend on outside companies to provide caregivers be affected by the COVOD19 crisis.

A comprehensive article from late March in Home Health Care News is quite non-specific as to how this will go.

Some families want to take over themselves.  Others may find the opposite idea, that pressure will be put on them for “do it yourself” rather than paying for outside workers.
There is little out there that is specific about caring for elderly patients at home (not already in an ALC)  quarantined (close contact) or isolated (tested positive) with actual Covid issues.  An article from a paper in Bangor ME give some clues.
We’re probably looking at a paradigm where (as time passes) health departments will acquire hotels to place these persons in and have nursing staff to watch them.  What will be controversial is what they expect other relatives (who themselves may be elderly and at risk) to do. 
One other point: many seniors who do own condos and live alone can have normal issues of repairs.  Recently, I had to have a flapper valve on a commode replaced when it suddenly failed (it could have flooded) by an emergency visit from a plumber.  It's not the expense, but I was asked if I had been notified of quarantine by a health department.  (I hadn't.)  I've also had issues with a small freon leak in my HVAC.  The condo is used.  In the past, the disposal had to be replaced.  The refrigerator is used, and those don't last forever, and a visit to replace one would be activity intense.  Another item that can issues is the closet washer, which might get used a lot during a pandemic.  I haven't heard this issue discussed much yet.  

Wednesday, April 08, 2020

Retirees with inherited trusts: what should be expected of "us" now given widespread hardship from COVID everywhere?

I’ve written some speculative columns on how this epidemic, as it plays out, might affect retired people with some savings or means, and I’ll go over some of it again.
Let’s make note of the fact that as a temporary measure, we’re printing a lot of money and giving it, however unevenly, to people thrown out of work. It won’t reach all of them, and it won’t be enough.
Some of these people may come back to work, outside of the gig workers and bars and restaurants. A big unknown will be, if we can test enough, will we find people who have antibodies (and how good are those?  There is the possible ADE issue). Some of that is based on the results from other countries showing that the percentage of totally asymptomatic, totally recovered people may be greater than we had though.  Uncertain.
You guessed it – we could put pressure on people with wads of unearned inherited wealth to help takle care of these people.
It will get murky and complicated. 
For example, we don’t know yet how well portfolios will hold up.  Even bond funds will get riskier if debts are totally forgiven (which the Left, with some justifiable moral outrage).  Could we get anywhere with suing China, or withholding our debt payments to them for their culpability?
If interest rates go below zero, then even cash is at risk.  I won’t rehearse all of Porter Stansberry’s stuff again.
My comments here are mainly about estates where much of the money lies in trusts.  Normally, trusts have rules as to how much can be distributed to each beneficiary, including the direct descendants (even if there is only one, as in my case). The trust executor (often the same person) has fiduciary responsibility for the value of the funds for the beneficiaries. Often the trust pays certain expenses (especially housing and supplementary medical care) for the holder, and most other disbursements until death are prohibited (except an initial one, which may be like 25%). The idea is to preserve funds for two major purposes: (1) long term care for “me” should something happen (2) special needs beneficiaries. 
Many families (especially larger ones) do make use of (2) and have beneficiaries with obvious special needs.
Still, we large trusts and balances, it sounds like it might be useful for states to consider changing their laws to allow more disbursement to those in need now, especially long-term unemployed workers, to help reduce the debt bubble for the entire economy.
Other ideas could be considered, such as encouraging trusts to take supervision and support responsibility for certain displaced persons (by adding them as beneficiaries, without legal expense).   Over time, that could become expected conduct of those capable of providing such assistance personally.
Persons with inherited resources would likely be required to pay for their own quarantine or forced isolation if they are taken to hotels.  And expect the debate on immediate means testing even for current social security recipients to come back. 

Wednesday, April 01, 2020

I tried senior shopping at Target this morning, and here is what happened

OK.  April fools.  I tried senior shopping at the Target store at Bailey’s Crossroads VA, a 1000-foot walk from my condo.

I got there and didn’t see the line at first at the other end.  Then I didn’t realize that the line (it was about 8:30 AM) was for “ordinary people”, not seniors or special needs.

Finally I woke up to this fact, and walked up front and they let me in. 

The store was not crowded.  Not many people had masks or scarves. It was pretty easy to stay 20 feet or so from people. I couldn’t find the box of separate oatmeal packages, although I have some.  I got bananas, some greens, desserts, frozen dinners, etc. and carried it back.

I won’t get into the issue of “decontaminating” the packaging of the food.  I really don’t think it’s necessary.

I’ll share CNN’s link by Scottie Andrew on virus-proofing your home.  If you live alone, it’s much simpler.
I’ll share “real David Hogg” (UNC Charlotte, not “that” David Hogg, although they are somewhat alike in social consciousness) shopping for a senior in Charlotte from WSOCTV.  Personally, I wouldn’t want to make this the point of what I did in public.  Check him on Twitter.