GBO NEWS: Buttigieg’s Long-Term Care Plan; “Public Option” Safer? Guess Again; Queer Eye on LTC; Early Dementia Detection; Bipartisan Medical Failure; Warning on Holiday Pet Scams; Immigrant Elders’ Stressed for Lack of Regional Foods; Study: Old Dogs Can Show Humans Tricks; & MORE
GENERATIONS BEAT ONLINE NEWS
E-News of the Journalists Network on Generations – Celebrating 26 Years.
December 19, 2019 — Volume 26, Number 14
EDITOR’S NOTE: GBONews, e-news of the Journalists Network on Generations (JNG), 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. To subscribe to GBONews.org at no charge, simply sending a request to Paul with your name, address, phone number and editorial affiliation or note that you freelance. For each issue, you’ll receive the table of contents in an e-mail, so just click through to the full issue at www.gbonews.org. GBONews does not provide its list to other entities.
In This Issue: Executive Tweet—“Coals in every stocking ….. Great for the economy and the air, too—Greta!
1. HEALTH CARE REFORM SCHOOL: *** “Buttigieg Proposes An Ambitious—And Much Needed—Long-Term Care Reform Plan,” by Howard Gleckman, Forbes; *** “Why the Less Disruptive Health Care Option Could Be Plenty Disruptive,” by Margot Sanger-Katz, New York Times, plus, Sanger-Katz’s “Doctors Win Again, in Cautionary Tale for Democrats” (on Medicare4 All).
2. NEW GBONEWS COLUMN: LEADS FROM LIZ — by Liz Seegert (“A Queer Eye for Long-Term Care”)
3. THE STORYBOARD:
*** “The Looming Shortage of Caregiver Labor,” Mark Miller’s interview with former U.S. Administration on Aging head Robyn I. Stone (Retirement Revised podcast);
*** “The Decade in Retirement: Wealthy Americans Moved Further Ahead: “The affluent gained an advantage. Middle- and lower-income Americans didn’t,” by Mark Miller, New York Times;
*** “Fraudsters Sell Nonexistent ‘Pets’ During Holiday Season,” by Mark Taylor, AARP.com;
*** Disabled Minnesota Residents Often Live in Costly Isolation,” Chris Serres and photographer Glenn Howatt, Minneapolis-Star Tribune;
*** “What’s Behind My Mother’s Obsession with Food?” by Jaya Padmanabhan, India Currents;
*** “When Older Residents Can’t Make Ends Meet,” by Jaya Padmanabhan, San Francisco Examiner;
*** “A Dog’s life: New Study to Investigate Aging Process in Man’s Best Friend,” by Joanne Laucius, Ottawa Citizen ;
*** “How These Aging Experts Decided Where They’d Live in Later Life,” by Richard Eisenberg, PBS Next Avenue;
*** “Elder Employment Program Struggling to Find Kentucky Businesses to Hire Workers with Upgraded Skills,”by Rhonda J. Miller, WKU Western Kentucky Public Radio;
*** “If Dementia Can’t Be Prevented, Can It at Least Be Detected Early?” by Katherine Ellen Foley, Quartz;
*** “Rural Social Worker Develops Internationally Known Anti-Frailty Program,” by Jeanne Erdmann, PBS Next Avenue;
*** “Death and Dying: A Filipino American Perspective,” by Mariel Toni Jimenez, AsAm News.
1. HEALTH CARE REFORM SCHOOL
*** “Buttigieg Proposes An Ambitious—And Much Needed—Long-Term Care Reform Plan,” by Howard Gleckman, Forbes (Nov. 20, 2019): “Democratic presidential hopeful Pete Buttigieg has proposed an ambitious plan to reform long-term care finance and delivery in the U.S. It includes a public catastrophic long-term care benefit, enhancements to the private long-term care insurance market, reform to Medicaid long-term services and supports, and higher wages and benefits for direct care workers.”
Gleckman, noting that Mayor Pete became immersed in the issue while planning care for his late Dad, writes that the Buttigieg Long-Term Care America plan “is built around a universal, public $90-a-day catastrophic insurance plan for people over age 65 with physical or cognitive limitations.” (He has separate proposals for younger people with disabilities).
Gleckman, a policy analyst for the nonpartisan Urban Institute and long-time writer for Business Week, adds that public catastrophic insurance has been recommended by the Long-Term Care Finance Collaborative (which he helped convened) and the Bipartisan Policy Center. He provided non-exclusive advise to the Buttigieg campaign on this issue.
The mayor’s proposal would be means-tested, with coverage kicking in for the lowest earners after a waiting period of one year and for as much as four years for the highest income people.
Gleckman compares the catastrophic benefit to the plan adopted earlier this year by Washington State. He explains, “In effect, Washington State would cover more people sooner. Buttigieg would cover fewer people but focus public dollars on those who need help for the most time.”
His Forbes story provides a crisp overview of the Buttigieg LTC plan’s key features, among them a $15 minimum wage for direct-care workers, Social Security job credit for them, and also family caregivers and expanded benefits, mainly under Medicare Advantage managed-care programs.
But Gleckman also cautions, “Buttigieg’s plan has some gaps. He leaves out many details, especially for his catastrophic insurance program. And he does not say how he’d pay for what would be a very expensive new package of benefits. Yet, his ambitious plan would fundamentally redesign the way we deliver and finance long-term care. And it would vastly improve the lives of frail older adults and their families who, as Buttigieg discovered himself, currently face immense—and unnecessary—challenges when they or their loved one’s need care.” (Jargon note: In health insurance debates, “catastrophic” refers to plans, generally favored by conservatives, that only pay when a member of the public faces catastrophically high costs.)
GBONews also asked for comment on Mayor Pete’s plan from Larry Polivka, executive director of the Claude Pepper Center at Florida State University and a leading national expert on long-term care. He e-mailed, “It’s certainly a good start on what’s needed, but it doesn’t go far enough. At a minimum LTC should be made a benefit under Medicare. Then I would go further and move toward a Medicare4All program over the next 4-5 years, as proposed by Sen. Bernie Sanders and the House progressive caucus.”
He adds, “I don’t see a good reason to stop LTC reform at the edge of making LTC a universal benefit, as Buttigieg does.” Polivka, a former director of Florida’s state department of aging, recently published sobering assessment of American eldercare in the Journal of Aging and Social Policy, titled “The Changing Role of Non-Profit Organizations in the U.S. Long Term Care System.”
*** “Why the Less Disruptive Health Care Option Could Be Plenty Disruptive,” by Margot Sanger-Katz, NYT (Dec. 3, 2019); “Democrats like the ‘optional’ part of the so-called public option. But the very existence of new government insurance could shake up the system . . . A public option would be less disruptive than a plan that instantly eliminated private insurance. But a public option that is inexpensive and attractive could shake up the private market and also wind up erasing some current insurance arrangements. Conversely, a public option that is expensive and unattractive might not do much good at all.”
Sanger-Katz goes on, “A public option . . . would cover a smaller population at first, and might have to negotiate with hospitals for good deals, just as other insurance companies do. In those circumstances, several economists said, the public option might look a lot like existing insurance: pretty expensive, and covering a limited set of doctors and hospitals. ‘What would happen?’ said Sherry Glied, the dean of New York University’s Wagner Graduate School of Public Service and a former health official in the Obama administration. ‘Almost nothing.’ Ms. Glied said that the public nature of the plan, alone, would not do much to distinguish it from private offerings.”
The principal question for journalists to raise when someone praises or attacks either M4All or the so-called public option is — which version do you mean? People don’t get that, whichever one is being discussed, the very complexity of health care means there will be many moving parts sure to be contested.
GBONews is watching to see which elements of proposed reforms survive as the presidential campaign unfurls. Will any of the plans that get to Congress in the next couple of years, if at all, include long-term care? It’s promising the Buttigieg proposed one, and that Bernie, Warren and Klobuchar have at least brought it up to varying degrees. People need to be informed not only about the presumed costs of any given proposal—with a reminder that green-eyeshade precision in such calculations projected years ahead are about as predictive as next week’s Dow Jones fluctuations.
As reporters field the claims of “my trillions are smaller than yours,” they should be asking what’s the actual effect of any plan and on how many people, for good or ill? How might the marionette strings of any policy proposals pull the strings of certain restrictions against health care outcomes—people’s actual health?
* Meanwhile, Sanger-Katz’s excellent reporting continues to get buried in the NYT National Edition and almost impossible to find online, if you didn’t know it existed in the first place and do a search. Case in point, her story, “Doctors Win Again, in Cautionary Tale for Democrats” published Dec. 18, 2019—on page 22, below the fold.
The subhead: “Surprise billing legislation suddenly stalled. Like ‘Medicare for all,’ the proposal would have lowered the pay of some physicians.” She reports that despite overwhelming public and bipartisan support for stopping doctors, such as anesthesiologists and certain other specialists who may be out-of-network, from sending patients huge, unexpected bills, the legislations died this week.
Sanger-Katz wrote, “In a final meeting last week, leaders in the House and the Senate met to decide what legislation would end up in the year-end spending bill. Surprise medical billing didn’t make the cut. Several people close to the negotiations said it did not have strong enough support from the Democratic leadership.” Nancy, Chuck? NYT online algorithms? Mr. Grinch?
2. LEADS FROM LIZ
Queer Eye for Long-Term Care
Editor’s Note: GBONews is pleased to announce our new monthly column by Liz Seegert, program coordinator for GBONews’ mother ship organization, the Journalists Network on Generations (JNG). Liz has been instrumental in JNG’s collaboration with the Gerontological Society of America on our 10th annual Journalists in Aging Fellows Program. In GBONews, she will contribute tips and sources for reporters on aging. Anchoring her extensive freelance writing is her ongoing work on the Association of Health Care Journalists Core Topic section on Aging.
By Liz Seegert
A striking new two-minute video focuses on the need for more and fairer long-term care (LTC) resources for the estimated 4.7 million LGBTQ elders in the United States. It cites a 2018 AARP national survey of LGBTQ older adults showing that more than 60% voiced concerns about how they would be treated in a long-term care setting. Discrimination has sadly been common around the country. The video, sharply produced and informative on needs, numbers and diversity in the LGBTQ community, is part of the launch of the Long-Term Care Equality Index (LEI), described as “a much-needed new venture that will assess the care being provided to the rapidly-growing number of LGBTQ older adults in long-term health care facilities.”
The LEI is an assessment tool for residential long-term care communities to adopt policies and best practices that can help them care appropriately for LGBTQ older adults. It covers essential policies, such as on non-discrimination and visitation rights; resident service and supports, staff training on issues like respectful communications; employee benefits, or additional support for LGBTQ staff and community engagement of LGBTQ elders in facility marketing.
LEI is a joint project of national gender-orientation advocates the Human Rights Campaign Foundation and SAGE, long devoted to LGBTQ seniors. For more information, contact HRC’s Madeleine Roberts.
3. THE STORYBOARD
*** “The looming shortage of caregiving labor, and what to do about it,” by Mark Miller, Retirement Revised podcast (Dec. 13, 2019): Interview with former U.S. Administration on Aging head, Robyn I. Stone, PhD, covers a range of topics from the generally poor prospects for direct care workers, also aggravated by the immigration crisis, to escalating drug prices, such as “predatory pricing by the insulin cartel.”
Stone, senior vice president of research at the nonprofit trade group, LeadingAge, and co-director of a research center on long-term care at the University of Massachusetts, Boston, is among the nation’s principal authorities on eldercare.
*** Separately, see Mark Miller’s analysis in the New York Times (Dec. 15, 2019): “The Decade in Retirement: Wealthy Americans Moved Further Ahead.” Subhead: “The affluent gained an advantage. Middle- and lower-income Americans didn’t.” Miller provides the most compact and incisive summaries of Americans’ retirement prospects GBONews has seen. His analysis begins at age 55: Will you be OK boomers and Gen-Xers? Each section provides first-rate statistical comparisons between the recession and now. One story segment, “Retirement Savings: Up for the Affluent,” shows racial gaps with only 58% of white households having a retirement account, the amount is 33.6% for African Americans and 27.8 for Latinos.) Others are: “Health Insurance: ‘How Will We Pay?” “Employment: Gains, But Some Permanent Damage,” “Housing: It’s a Big Part of Security, and It’s Wobbly,” and “Social Security: Net Benefits Are Down.”
*** “Fraudsters Sell Nonexistent ‘Pets’ During Holiday Season,” by Mark Taylor, AARP.com (Dec. 4, 2019): Subhead: “If you’re buying a cat or dog, don’t let scammers spoil your holidays.” Taylor explains, “Experts say several thousand Americans a year are victimized by scams that promise a new dog, cat or other pet but deliver only sadness and regret. These scams peak at Christmastime and Valentine’s Day, they warn. Scammers’ websites are adorably convincing, with photos of saucer-eyed puppies and cuddly kittens imploring buyers to take them home. But they shouldn’t grab their wallets. These puppies and kittens don’t exist, not those showcased on scam websites.”
*** “Disabled Minnesota Residents Often Live in Costly Isolation,”
Chris Serres with photographer Glenn Howatt, Minneapolis Star Tribune (Dec. 8, 2019): This story, the latest in an ongoing series, begins, “Tim Healy calls the time he spent in a Twin Cities group home ‘my lost years.’’ Healy, 32, has an intellectual disability and needs help with basic living tasks. But for 12 years at a group home in [suburban] New Hope, he got little of that. He describes a facility so short-staffed that residents were ignored for hours at a time and rarely allowed to venture outside. He says it was a period of numbing boredom, loneliness and doubt. Today, living with his mother in West St. Paul, Healy feels reborn. Cradling a guitar, he describes his plans to get married, find a job, start a rock band and take sky diving lessons. ‘It’s like I was a prisoner,’’ he says. ‘I’ve been away too long.’”
The piece stressed, “Healy and his family remain furious at state and county officials who administer aid to Minnesotans with disabilities. They say no one told them that Minnesota’s Medicaid program pays for the kind of services that would enable Healy to live at home and independently. ‘We are spending Medicaid dollars on an entrenched system that segregates people and leaves them with little choice,’ said Barnett Rosenfield, supervising attorney for Mid-Minnesota Legal Aid. ‘It’s completely inconsistent with the law and the purpose of waivers.’”
Serres found that “the primary culprit . . . is a statewide shortage of caregivers, which has put group homes in a precarious position.” The lack of human resources and the state’s penchant for moving people into group homes, anyhow, has a steep price. He found, “In 2017, the state Medicaid program spent $104,000 for every group home resident, compared with $26,000 for those who live independently with supports.” Although in 2014 federal regulators “approved sweeping new rules to promote inclusion among people with disabilities who receive Medicaid benefits, Serres learned that “enforcement of the rules has been minimal, and pSublic awareness of the new protections remains low, say disability rights groups . . . Roberta Opheim, state ombudsman for mental health and developmental disabilities, [said], ‘Simply requiring providers to submit a form is not enforcement,’ she said.
Time now for a New Year’s toot with our own horn, and proudly so: The following stories are the first to hit the web and, in some case, the actually presses, from the 2019-20 Journalists in Aging Fellows Program, the JNG/GBONews collaboration with the Gerontological Society of America.
*** “What’s Behind My Mother’s Obsession with Food?” by Jaya Padmanabhan, India Currents, (Dec. 16, 2019): Her mother, Sarada, 86, immigrated to the U.S. in her 70s. She “finds equanimity performing activities and engaging in conversations that hinge around food . . . Familiar flavors act as a barometer to her moods, often alleviating the stress of adjusting to a brand-new environment and she looks at food as the one constant in her new life, which she uses to bridge the gap between her past and present. More importantly, when Sarada does not have access to familiar foods, she displays signs of acute emotional distress, appearing physically drained and listless . . . . What complicates the Indian experience is that the cuisines of the different regions are distinct, right down to the staples and vegetables. Southern Indian cuisine uses rice, tamarind and coconut gravies, which differ from the wheat breads and tomato-onion-ginger flavors of the north.”
The piece continues, “With over a decade of experience directing Stanford’s Aging Adult Services program, Rita Ghatak, a gerontologist and psychologist, is the associate director of Optimal Aging Center, and—along with her husband—is a caregiver for her father-in-law, [whose] biggest preoccupation is food, particularly food from India’s southern state of Andhra Pradesh, well-known for its tamarind and chili flavors.” But he doesn’t much like his daughter-in-law’s Bengali dishes, so different from his the regional tastes of his childhood.
She continues, “With the steady pipeline of older immigrants arriving and aging in the United States—in 2010, more than one in eight adults, 65 years and older, were foreign-born, according to the Population Reference Bureau—it’s critical to have conversations on what drives the emotional health of immigrant seniors, since emotional health affects physical health, and both these have economic costs associated with them.”
The article also looks at other cultures, such as for Korean American Chang Song Lim, 86, who lives alone in Boston. “Lim came to America in 1989 and his first job was as a factory assembler in Springfield. Within a year, the factory closed down and he was laid off. With his limited English skills, Lim has had to work many odd jobs, including dishwashing and cleaning. She writes, “Once he retired, Lim signed up for the government assisted meal service program. He had to choose from American, Russian, Italian and Chinese offerings. Figuring that Asian food was the closest to his Korean palate, Lim opted for Chinese. ‘It’s a different taste, a different style,’ he told me. His body was not used to this type of food, Lim explained, adding that it was causing a serious problem for him. ‘I’m very skinny right now and I’m indirectly killing myself. I just want kimchi,’ he said, the stress clearly audible in his voice.”
She adds, “And even among the foreign born, the older Asian population is growing definitively. Dr. Vyjeyanthi S. Periyakoil wrote in the Journal of the American Geriatrics Society (May 2019) that the older Asian American population is ‘projected to quadruple from 2 million in 2014 to 8.5 million in 2060. This ethnogeriatric imperative underscores the great and growing need for healthcare services that account for the cultural beliefs and behaviors of older persons.’”
* Jaya Padmanabhan is also a weekly columnist for the San Francisco Examiner. See her Nov. 28 story, “When Older Residents Can’t Make Ends Meet,” subhead: “In less than 10 years I will be part of the elderly population.” She quotes UCLA professor Steven P. Wallace, “The number of people, 65 and older, will double in America by 2040. The 2010 Census estimated that there were 40.2 million elderly in America, which is projected to grow to 81.2 million by 2040. Significantly, the fastest growth is among elders of color.” In 2015, half of those 65-plus spent more than one-third of their monthly income on rent and 23 percent experience a severe—over 50 percent—rent burden. Policies like Supplemental Security Income, Social Security payments and Medicare were put in place to shield individuals from facing huge financial outlays in the twilight years of their lives.
However, according to Amber Willink, a researcher from the Johns Hopkins Bloomberg School of Public Health, “one in five Medicare beneficiaries is under-insured,” and “beneficiaries are exposed to high out-of-pocket costs and premiums.”
*** “A Dog’s life: New Study to Investigate Aging Process in Man’s Best Friend,” by Joanne Laucius, Ottawa Citizen (Nov. 19, 2019): “Scientists, with the backing of the U.S National Institute on Aging, have launched an ambitious project in which they want dog owners to enroll canines in a study of aging in man’s best friend, hoping it will help both dogs and humans live longer and better lives. The ‘citizen scientists’ will answer dozens of questions about their pooches over the lifetime of the animals, such as how much and how often they exercise, what they eat and how much, and their interactions with people or other pets in the household.”
*** “How These Aging Experts Decided Where They’d Live in Later Life,” by Richard Eisenberg, PBS Next Avenue (Nov. 19, 2019) and Forbes.com: “One of the most vexing questions many of us face once we hit our 60s is: Where should we live as we get older? … I mean what kind of home, and type of community, would be most suitable.” While attending the 2019nGerontological Society of America Annual Scientific Meeting, he interviewed experts such as author and gerontologist Stephen Golant, who says seniors need to be “aging in the right place.” Eisenberg cites examples of seniors in a range of situations.
*** “Elder Employment Program Struggling to Find Kentucky Businesses to Hire Workers with Upgraded Skills,” by Rhonda J. Miller, WKU Western Kentucky Public Radio (Dec. 3, 2019): Her story, the first of two parts, begins, “A federal program to keep older adults in the workforce is struggling to find more businesses in the Owensboro region willing to hire these elders after they upgrade their skills,” the Senior Community Service Employment Program (SCSEP). After 19 months of on the job training to upgrade her computer and related skills, and many rejections, Dee Padgett, 74, has been thriving in her new job as office manager at United Way of the Coalfield in Madisonville since September. SCSEP, the federal program that retrains low-income individuals age 55 and over and helps them get jobs.
*** “If Dementia Can’t Be Prevented, Can It at Least Be Detected Early?” by Katherine Ellen Foley, Quartz, (Dec. 2, 2019). She describes the Mobile Toolbox project, a research initiative at Penn State University and Northwestern University with the help of the Seattle-based nonprofit Sage Bionetworks and the U.S. National Institutes of Health. It aims to develop ways to “measure populations’ cognitive health in the least invasive way possible—by capitalizing on the time you’re already spending on your phone.”
The Penn State team is collecting smartphone snapshots on some 300 healthy adults over 70. They’ve created a mobile app that pings users four times a day to play a quick game that tests different aspects of memory. Twice a day, in the morning and in the evening, they check in again—these times, without a ping.” Foley writes, “In the era of technology . . . , it seems only logical that our smartphones could play a role in monitoring—and perhaps predicting—our cognitive health . . . . But long before M2C2 can be used to detect dementia, it’ll likely have to be validated with biological indicators that verify something in the brain has changed. At the moment, these biological indicators are also out of date—but researchers are working to improve them.” Currently access to the story is limited to members only, but reporters can go to https://tinyurl.com/u5djjgg. If that doesn’t go through, send a request for the story link to Foley.
Foley also e-mailed GBONews that for 2020, aging will be a “major focus of mine and a few other reporters here at QZ, so there should be lots of coverage.”
*** “Rural Social Worker Develops Internationally Known Anti-Frailty Program,” by Jeanne Erdmann, PBS Next Avenue (Nov. 14, 2019):
Janice Lundy knew she had to do something. As a social worker at Perry County Memorial Hospital in rural Missouri, she watched too many older residents end up in nursing homes more quickly than they should. She was also concerned about the number of medications they were taking, and didn’t want to see the progression of frailty and cognitive decline as a one-way ticket to death. But identifying patients in need wouldn’t be much help without a way to intervene . . . . ‘In a rural area, we can say that we have the Alzheimer’s Association, but it’s not like having someone to meet with residents and do case management,’ Lundy says.”
*** “Death and Dying: A Filipino American Perspective,” by Mariel Toni Jimenez, AsAm News (Nov. 13, 2019): “Death in the Philippines is one of the most important occasions in family life. For many Filipinos, a death of a relative is an opportunity to strengthen ties in the family. To pay respect and honor the relationship to the deceased, long lost relatives, friends and even relatives working abroad are reunited.
The Philippines is the home of some unique death rituals that are partly religious and mostly superstitious. The mourning and the weeping are still present, but a happy and welcoming atmosphere would usually take place to help the deceased on his journey to the afterlife. . . . Filipinos have close family ties, which extends to a great circle of relatives, usually including third cousins.” Jimenez explains that when death comes, the obligation to attend funeral services can be burdensome for relatives in the United States.
In one modern instance, though, she writes of a family in Stockton, Calif., whose Nanay, or mother, died during a vacation to the Philippines. The travel costs would have been a hardship for two of the Nanay’s daughters. “Instead, there was a live-stream in real time of the mass and internment. Times have changed with digital and electronic capabilities. Mourning someone can be done over cyber waves.”
Funding for this year’s Journalists in Aging Fellows Program was provided by The Silver Century Foundation, The Retirement Research Foundation; The Commonwealth Fund and The John A. Hartford Foundation.
The Journalists Network on Generations (JNG), founded in 1993, publishes Generations Beat Online News (GBONews.org). JNG provides information and networking opportunities for journalists covering generational issues, but not those representing services, products or lobbying agendas. Copyright 2019 JNG. For more information contact GBO Editor Paul Kleyman.
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