GBO NEWS: News Fellowship Deadline Extended; HuffPost’s Hospice Flub; & More
GENERATIONS BEAT ONLINE NEWS
E-News of the Journalists Network on Generations
June 26, 2014 — Volume 14, Number 9
Editor’s Note: GBO News, e-news of the Journalists Network on Generation publishes alerts for journalists, producers and authors covering generational issues. Send your news of important stories or books (by you and others), fellowships, awards or pertinent kvetches to GBO News Editor Paul Kleyman. If you receive the table of contents as e-mail, just click through to the full issue at www.gbonews.org.
IN THIS ISSUE: 50 Years Later, Mississippi Freedom Aging–But Not Quite Mature
1. EYES ON THE PRIZE: Extended Deadline for Journalists in Aging Fellowship, July 11
2. HUFFPOST MISSES PALLIATIVE CARE FOREST FOR HOSPICE TREES: Six-Month Exposé Important, But Fails the Big End-of-Life Picture
3. GEN BEATLES NEWS:Camille Thoman and Elizabeth Yng-Wong Winning Awards with The Longest Game Documentary; *** Chris Farrell’s New Book, Unretirement; *** Katy Butler on paperback Tour for Her Bestseller, Knocking on Heaven’s Door; *** Journalist Lincoln Caplan on “Fear Factor” of aging in The American Scholar
4. GOOD SOURCES: 2nd Long-Term Care Poll From Associated Press-NORC Center for Public Affairs Research; ProPublica’s New Treatment Tracker App on Medicare Doctor Data.
1. EYES ON THE PRIZE – Extended Deadline for Journalists in Aging Fellowships
***The Application has been Extended to July 11 for the Journalists in Aging Fellows Program, run jointly by The Gerontological Society of America (GSA) and New America Media (NAM). Fellows receive a $1,500 stipend plus an all-expenses-paid trip to the GSA conference in Washington, D.C., Nov. 5-9.
Now in its fifth year, the program, done in cooperation with the Journalists Network on Generations (publisher of GBONews.org), is continuing thanks to new funding support from AARP. Previously, it was sponsored by the MetLife Foundation, which no longer funds programs in aging.
For the past four years, this co-venture — responsible for more than 200 news stories by 65 alumni Fellows to date — has largely centered around GSA’s Annual Scientific Meeting and in-depth stories proposed by each fellow. The 2014-15 group will include 13 fellows. (Sponsoring one will be the John A. Hartford Foundation). About half of the fellows will be selected from general-audience media and half from ethnic media outlets that serve communities within the U.S.
The centerpiece of the program will be the fellows’ participation in GSA’s Annual Scientific Meeting. Fellows will deliver a story stemming from any research at the conference and a major in-depth piece or series in the following months. The conference draws 4,000 experts in aging from around the world, who present hundreds of talks and papers on subject areas in aging from cellular and social research to creativity and psycho-spiritual aspects of aging. On arriving in Washington, the fellows will participate in a one-day seminar before the full GSA conference begins.
Applications will be reviewed by a selection committee of journalists and experts in aging. Details are and the application form are posted online.
Some previous announcements included faulty links to the fellowship description and application page. If you have problems with the URL, please contact NAM senior editor Paul Kleyman, (415) 503-4170 ext.133; email: pkleyman@newamericamedia.org.
2. HUFFPOST MISSES PALLIATIVE CARE FOREST FOR HOSPICE TREES
“Hospice, Inc.: How Dying Became A Multibillion-Dollar Industry,” is the exhaustive new HuffPost Business Investigation by reporter Ben Hallman. His six-month investigation is a must-read for anyone reporting on end-of-life care,–a topic that is trending in the news this year. However, readers should be aware not only of the article’s disturbing finding, but also for it’s shortcomings. Like seemingly exhaustive efforts by too many “investigative” financial or political writers and editors with limited experience on health care or social reporting, this extensive investigation misses the palliative care forest for the dark shadows lurking in the hospice trees.
This is longstanding problem, not merely with Huffington, which otherwise posts fine material on issues in aging. Last year, for instance, PBS’s Frontline similarly missed the contextual boat in a report on assisted living. In a week when the Investigate Reporters and Editors (IRE) association is meeting in San Francisco, the HuffPost piece raise the concern that while investigative journalism entities represent the award-glossed pinnacle of journalism—and these days much of the funding, especially in nonprofit journalism—the “Gottcha!” tendency of exposés that dotes only on dollars and government records can frequently overshadow the deeper contexts of an issue.
Alternatively, some investigative units, such as the one on health issues at ProPublica (noted later in this issue), work from a base of richly experienced journalists who grasp the wider issues they delve into.
In HuffPost’s “Hospice, Inc.” piece, significant as its revelations are, even at its almost 8,000 word length, the article falls short of providing readers vital context about what hospice-industry fraud and government’s regulatory laxity means when it comes to our aging – and eventually dying — population’s greater need for humane and intelligent care. What’s more, the article seems to have missed accounting for a gaping statistical disparity between a damning figure that the story uncovers – and equally disturbing numbers that evidently contradict what it reports.
Gaping Statistical Disparity
To be sure, the findings should be heeded. HuffPost found, for instance, that since 2006, the U.S. government has accused nearly every major for-profit hospice company of billing fraud, including the many now owned by private-equity investment corporations =, notably Kohlberg, Kravitz. That fact especially stands out with the news last weekend of the death at age 91 of Dr. Arnold Relman, the great editor of the New England Journal of Medicine. Relman had warned repeatedly and eloquently since 1980, about the growing “medical-industrial complex” – his deliberate play on President Eisenhower’s “military-industrial complex” — that threatened to overtake quality health care with its drive for profit.
HuffPost’s investigation also reveals that:
*Hospice companies hold illegally-obtained hospital records, have insufficient documentation of patients and inadequately train their staff caregivers;
*More than 1,000 hospices have not been inspected in over seven years;
*Many hospice employees are being pressured into wrongfully enrolling patients and adjusting health records in order to obtain more government funding, while health care staff, who object and whistleblowers are punished.
Yet, the article also errs in a way that puts this non-science writer in mind of the great late “Dean of Science Journalism” Victor Cohn of the Washington Post and author of News and Numbers. One of Cohn’s principal rules was always to check the mean (average) against the median, or midpoint. Averages, while they can expose anomalies, can also be skewed. As the 4’11” former Labor Secretary Robert Reich often observes about averages, “Shaquille O’Neal, the basketball player, and I have an average height of 6’1.”
In the case of HuffPost’s “Hospice, Inc.” report, the mean vs. median gulf is more than a matter of statistical nitpicking: It signals an expanse between America’s “death panel” fears and the quest for earlier and more humane palliative care intervention before people get funneled – as far too many Americans are in their final days – into high-tech medical treatment beyond the point of therapeutic value and frequently against their written wishes.
Dedicated experts on care at life’s end – people largely absent from HuffPost’s scary article – have focused on moving the public conversation from terminal hospice care to palliative, or pre-hospice coordinated care. This approach starts a combination of medical intervention and comfort care as needed very soon after one is diagnosed with a severe, life-threatening illness. It’s one of the few models—not always reimbursed—this editor has seen designed to deliver appropriate treatment under consultation with a health care team that includes patients and their families.
I recently reported, tough, on a Stanford University Medical School study published in the journal Plos One. It shows that almost nine in 10 Americans and their doctors say they want to spend their final days in comfort and without all-out medical treatment. And, yet, there’s been a continuous rise in the percentage of people channeled in high-tech, specialist-driven care by 10 or more doctors during the final months of their lives. Revelations such as this are coming out all the time in the health care literature.
Widely reported in such research is a striking figure that would seem to contradict one of “Hospice, Inc.’s” principal revelations. HuffPost found that from 2000 to 2012, the average (mean) length of stay in for-profit hospices grew to 105 days, compared with 69 days for nonprofits. That’s very likely accurate. But so is another fact, according to figures from the National Hospice and Palliative Care Organization: Nationally, the median length of service in 2012 was 18.7 days, a decrease from 19.1 days in 2011. Researchers and clinicians in end-of-life care have been alarmed that Americans—especially those of lower-income and minority groups—end up in hospice too close to death and too late to benefit from the treatment coordination of palliative care.
How could that be—an investigative journalism team with six months to report a story might have asked? GBONews.org did ask, and the answer is essential to informing the American public accurately about this complicated and often fear-driven issue. To be sure, HuffPost’s evidence on commercial system-gaming is part of problem and demands closer scrutiny and action.
Bad Medicare, Good Medicare
But the other factor extending hospice stays at the extremes derives from sometimes legitimate referrals of frail elders with multiple chronic conditions. Those people often don’t fit neatly into Medicare’s original six-month payment limitation that most suits patients with conditions such as terminal cancer or heart disease. Major authorities in end-of-life care have argued against this Medicare hospice limit almost from the beginning. But despite defying logic as a way to help so many to die in peace—the more open approach was not on Congress’ budgetary clock. At least until now.
In fact, while HuffPost did dig up striking information on Medicare’s poor inspection rate for American hospices—with comprehensive hospice inspections happening only every 4½ years (yes, on average)–the agency has also acted recently to limit rising lengths of stay. For instance, CMS ruled last August that doctors can no longer used the more open-ended diagnoses of “non-specified debility” or “failure-to-thrive” as primary indications for admitting a patient into hospice. Whether this change will reduce those outlying cases that seem to prolong hospice stays inordinately—for legitimate or illegitimate reasons—is a question we’d have liked HuffPost to explore.
Actually, they might listen to or read the report broadcast/posted this week (June 25) by health policy journalist April Dembosky of KQED public radio’s “California Report.” Dembosky, examined one of the Medicare demonstration programs under the Affordable Care Act aimed at stabilizing patients in dire health as much as 18 months before they’d be likely to die, not six months.
People who may be over-treated in acute hospital care before spending their final 18.7-days in hospice, long after they might have benefited from good palliative care, face a reality quite different from the fraudulent and painful story told by HuffPost in “Hospice, Inc.” But it’s a story that needs to told along with the fear-factor reporting, lest the horrors lead merely to more “death panel” policy fallout.
According to V.J. Periyakoil, MD, Director, Palliative Care Education and Training, at Stanford, the author of the Plos One study cited above, explained in an e-mail, “The true question is what are the needs of patients in the last years of life and how can we best serve them? What we cannot afford to do is ignore the needs of seriously ill older adults in the last two years of life as they will become frequent flyers in the hospitals — which is how they expend 32 percent of the Medicare budget in that period.”
Any system awash in billions of dollars will attract incompetence, corruption and gaming. That’s always the fodder for good watchdog reporting. The trouble is that while HuffPost’s “Hospice, Inc.” exposé seems thorough and may well prompt public action, it falls into an unsettling pattern this editor has observed in the coverage of aging for 30 years—crap-kicking reportage against facility operators, without the insightful journalism necessary to contextualize the issue in terms of what individuals and society wants and can achieve.
In my role directing the Ethnic Elders Newsbeat at New America Media (NAM), I’ve spent much of the last year or two covering this issue and organizing fellowship training seminars for reporters aimed at opening the taboo discussion of how we die. (Much of our ongoing coverage appears on NAM’s special “Palliative and Hospice Care” website funded by the California Health Care Foundation). Besides Dembosky’s story, you’ll also find Gary Rotstein’s article originally for the Pittsburgh Post-Gazette, “Life’s Journey: A Hospice Nurse’s Frank Approach to Death.” Both he and Dembosky did their stories with support form the Journalists in Aging Fellows program through New America Media and the Gerontological Society of America, a program coordinated by this editor.
Out of context, the fear factor may, as with the HuffPost report, have significant results. But so will the consequences of a missed opportunity to tell the whole story.
3. GEN BEATLES NEWS
***The Longest Game, a feature-length documentary now making the film festival circuit—with some success—had GBO’s editor wondering, when I popped the DVD into my rustic Go Video last weekend, whether it might be another dreary or cloyingly sentimental invasion into the privacy of seniors. The new film’s thirtysomething director, Camille Thoman, had e-mailed via another generations-beat colleague about her foray into the world of elderly white guys, octogenarians who play ‘paddle tennis’ (or platform tennis) throughout the winter in the bucolic village of Dorset, Vt. Oy, I thought, not another filmmaker discovering the wisdom and misery of old age. But my partner and I were soon drawn into this richly layered, absorbing and poetic film.
Paddle tennis, which I’d never heard of, is an outdoor game played with over-sized ping-pong style paddles on platforms one-third the size of tennis courts and enclosed in chicken wire. As in squash, participants can play balls off of the fencing. The small group of Dorset elders, some in friendly competition for over 30 years, plan from September to April, with the heated platforms fending off the snow winter long.
Unlike other films – fiction or nonfiction — The Longest Game – which has already won three best documentary awards and an honorable mention at four film festivals – is engaging past the point of mere sentimentality or pathos. Thoman and her producer, Elizabeth Yng-Wong, hang with Maurie, Hal, Charlie and the gang long enough to capture them in their best instances of humor (“I’m a lapsed Republican, with a capital L”) and their deepest moments of candor (“Keep moving. That’s the secret of old age.”)
The film effectively uses Super 8 home movies preserved by its older subjects from their family lives in the 1950s and ‘60s, not merely for charming moments of nostalgia, but to bridge time of a first wife or children, for instance, as they can live in one’s palpable memories.
What prevails in their easy-going joshing and their honesty about loss is their widening acceptance that very old age can bring. Hal, reflects on one of the principles underlying the attitude of these men. He comments that his goal at 87 is “to be totally understanding of people who have a completely opposite view of how to live life” from him.
During the year of filming, Yng-Wong bonds closely with the paddlers as she explores the mystery of her relationship with her father, a scientist who moved to the U.S. from China, She bonds with the older men partly by linking their avid activity an living example of her father’s theory that motion is principle element of human interaction. She volleys jokes, laughs and paddle balls with the seniors, as Thoman deftly threads their interaction into intergenerational warps of wefts of the film.
Disparate elements—1950s TV game shows, Paul Newman and Joanne Woodward, volcanoes, show tunes, a wife’s garden, and Maurie’s reports on voice-mail of his dreams about going home alone – somehow all make sense, the way a good poem does.
Throughout The Longest Game, I found I could have easily hung with these guys for another 69 minutes, maybe with some hot cocoa in a thermos.
The Longest Game is currently scheduled for this weekend (June 27-29), at the Frederick Film Festival near Baltimore; and the Woods Hole Film Festival July 26th-August 3rd in Woods Hole, Mass., with more showing to come.
GBONews regulars can find more about the film at various social media — https://www.facebook.com/TheLongestGame; camillethoman.com; thelongestgame.com. And writers can download the full documentary to view online. The password is: paddlehut. Or for a DVD contact Thoman at cthoman@aol.com.
*** Unretirement: How Baby Boomers Are Changing the Way We Think About Work, Community and the Good Life (Bloomsbury Press) by Chris Farrell will be published in September. Journalists can request bound, uncorrected proofs now from Marie Coolman, (212) 419-5318; e-mail marie.coolman@bloomsbury.com. The Minneapolis-based Farrell, is a long-time contributor to Marketplace, Bloomberg Businessweek, Minnesota Public Radio and others. The new book challenges the “fear frenzy” predicting that Social Security will sink American under the Silver Tsunami of aging. Instead, he examines the older population’s untapped potential for continued work and community productivity. Those interested in reaching Farrell directly can do so at cfarrell@mpr.org.
*** Katy Butler has hit the paperback trail for her New York Times bestseller, Knocking on Heaven’s Door: The Path to a Better Way of Death (Scribner). The paperback release has her today (June 26) at Colorado’s Boulder Bookstore at 7:30 p.m. Then she’ll be at the Bookshop in Santa Cruz, Calif., July 10, 7:30 p.m., and Copperfield’s Bookstore at Montgomery Village, Santa Rosa, Calif., July 17, 7 p.m. The press kit for the book on her website is at http://katybutler.com/site/press-kit/. The book’s media contact is Kate Lloyd, Scribner, (212) 632-4951; Kate.lloyd@simonandschuster.com. Butler’s own website Events schedule stops somewhere in June, but Lloyd should be able to let you know if Butler has other dates set up during the summer, perhaps at a bookshop near you.
*** In “The Fear Factor”, the lead essay in the Summer 2014 issue of The American Scholar, distinguished journalist Lincoln Caplan says “long-held predictions of economic chaos as baby boomers grow old are based on formulas that are just plain wrong.” More about the essay in our coming issue.
4. GOOD SOURCES
*** 2nd Long-Term Care Poll From Associated Press-NORC Center for Public Affairs Research: The Associated Press-NORC Center for Public Affairs Research in Chicago, with funding from The SCAN Foundation, released its second national poll aimed at better understanding who is providing and receiving care, how caregiving impacts family relationships and personal experience, how Americans 40 or older receive information on long-term care, and which policy measures they think would improve long-term care.
Overall findings are:
- • Few are prepared for long-term care, yet they expect to need it in the future;
- • Even fewer understand the financial costs involved; and
- • Majorities support a variety of policy options for financing long-term care.
One difference from the 2013 poll results, says the new report, is that “compared to one year ago, Americans are currently more supportive of a government-administered long-term care insurance program, similar to Medicare, and think a number of measures would be helpful for improving the quality of ongoing living assistance.”
According to the AP-NORC report, “Demographic projections show the population age 65 and over nearly doubling by the time the last baby boomers have reached 65. Specifically, while seniors made up only 12 percent of the U.S. population in 2000, they are expected to comprise about 20 percent by 2030, with roughly 73 million Americans over the age of 65. U.S. Department of Health and Human Service projections estimate that 70 percent of Americans who reach the age of 65 will need some form of long-term care in their lives for an average of three years.”
Complete findings from each study can be found in their Project Pages.
*** The Treatment Tracker is ProPublica’s newest app based on the Medicare data. Senior Reporter Charles Ornstein and crew noted in an announcement that when Medicare recently released its trove of doctor data, “a number of large news organizations published quick-and-dirty searchable databases that allowed users to see how much doctors earned from Medicare in 2012,” that information “showed results in isolation and out of context. They did not allow patients to see how their doctor’s numbers compared to their peers, only really how much money they made.”
Instead, Treatment Tracker “allows you to compare your doctor to others in the same specialty and state. While it may satisfy your curiosity to know how much money a doctor earns from Medicare, it tells you little. We think it’s more useful to look at how a doctor practices medicine (the services they perform, the percentage of patients who got them and how often those patients got them). Our app gives you that information in context. You can easily spot which doctors appear way different.” The app’s red notes and orange warning symbols help consumers (and reporters) see questions they should be raising.
Ornstein also coauthored a storylooking “at how doctors bill Medicare for office visits, the bread and butter of their practices.”
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The Journalists Network on Generations (JNG), founded in 1993, publishes Generations Beat Online with in-kind support from New America Media (NAM). JNG provides information and networking opportunities for journalists covering generational issues, but not those representing services, products or lobbying agendas. NAM is an online, nonprofit news service reaching 3,000 ethnic media outlets in the United States. GBO News readers are invited to visit the NAM website, and click on the Ethnic Elders section logo on the right side. Opinions expressed in GBO do not represent those of NAM. Copyright 2014, JNG. For more information contact GBO Editor Paul Kleyman.
To subscribe of unsubscribe, or if you have technical problems receiving issues of GBO or if you’d like to be removed from the list, e-mail me at pkleyman@newamericamedia.org or phone me at 415-503-4170 ext. 133.
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Wally Roberts