Friday, August 29, 2008

"New Old Age Blog" per New York Times

On July 2, 2008, the New York Times added another entry to its index of sixty-five sponsored blogs -- one entitled The New Old Age Blog, written by Jane Gross. Her first posting was entitled "The Beginning of Something New" (07/02/08).

After one month in publication, a NYT Press Release, dated August 11, 2008, entitled " Introduces 'The New Old Age' Blog and Reader Forum on Caring for Aging Relatives in the Twenty-First Century," described the new blog based on posting made:

The new blog, written by Jane Gross, offers advice from professionals, personal stories and vital information as the first of the nation’s 77 million baby boomers reach 60 and must consider elder care options for their parents.

The New Old Age further examines the financial and emotional strain of caregiving, the complexities of Medicare and Medicaid, the struggles of career and the challenges of role reversal that are of critical relevance as adults over 80 are now recognized as the fastest-growing segment of the population.

Ms. Gross shares her own experience of looking after her late mother, and shapes an open-forum discussion where readers may respond online.

The posts introduce tips on everything from how-to organize a medication list and daily regimen, to hot-button issues such as when and how to confiscate car keys or manage the uncharted emotional landscape ahead; to topics unique to 21st century seniors, from negotiating the confounding and ever-changing terms of medical coverage to fears of being marginalized in a nursing home.
* * *
The Press Release noted other aspects of the New Old Age Blog, which include:
  • Q and A opportunities with a roster of guest specialists.
  • Content from the Times Health Guide, a comprehensive source for information on over 3,000 diseases, conditions, tests, injuries and surgeries.

  • Senior Housing Locator tool, powered by SNAP for Seniors, giving readers the capability to search for senior housing such as nursing homes, assisted living, independent living, hospices, home care and retirement homes across the country.

  • Resources on aging and caregiving with information, tools and links to organizations around the Web.

  • Articles from the Times’s archive and a list of other health-related Times articles.

Due to its sponsor and the reputation of its author, this new blog was noticed immediately by other bloggers and by organizations involved in aging issues:
My Internet searches report that, since its inception, this new blog has been cited often, too.

No wonder.
The writing is crisp; the attitude, humble; the graphics, verdant; the detail, extensive; and the topics, relevant. Her posts, which occur every few days, read & present like slick magazine articles.

The NYT reported that, during the first month of publication, more than 2,700 comments were posted by readers, who expanded Jane's points, shared personal stories, and offered additional resources. Jane replied to many of these comments.

The New Old Age Blog educates, ponders, and comforts. Jane Gross and her publishing company are creating a wonderful resource online; and I recommend it.

Thursday, August 28, 2008

New Online Senior Housing Locator

On July 21, 2008, the National Association of Area Agencies on Aging (n4a) introduced a new "online navigational tool to help older adults search for senior housing, no matter where they live." The resource was described in n4a's Press Release, entitled "National Association of Area Agencies on Aging rolls out nationwide senior housing resource during annual meeting in Nashville."

Powered by SNAPforSeniors®, the Senior Housing Locator makes objective, nationwide information available 24-hours a day, seven days a week through the convenience of the Internet.

Consumers and professionals alike will now have access to the n4a Senior Housing Locator through a link on

The tool allows users to search a database of more than 60,000 senior housing listings, including all licensed senior housing in the nation.

Member Area Agencies on Aging (AAAs) and Title VI Native American Aging Programs will be invited to add a link to the tool or use a version co-branded for their own website.* * *
The Press Release explained how the Senior Housing Locator is similar to the existing Real Estate Multi-Listing Service maintained by Realtors®, but is targeted towards the specific needs of senior citizens as residents, and Aging Agencies as facilitators searching for appropriate facilities.

It is a free service "developed by SNAPforSeniors, representing another example of cooperative relationships among the aging network and private sector organizations." It is devoid of advertising, however, which suggests a more trustworthy service.

The Senior Housing Locator is similar to the real estate industry’s Multiple Listing Service, and functions much like a traditional search engine.

Users can search a database of assisted living communities, nursing homes, residential care facilities, continuing care retirement communities and a growing list of independent living communities, all at the click of a mouse.

Many listings provide information about care services, lifestyle amenities, payment options and more, with some including photo galleries and virtual tours. * * *

Eve Stern, RN, MS, president of SNAPforSeniors, [said] * * * “[T]he fact that all licensed communities are included eliminates the bias that referral services and advertising-based listing services exhibit.”
The varieties of licenced housing available to senior citizens in the various states make searching confusing, and the new search resource attempts to sort out the facility types:
There are 247 different senior housing license types in the United States. According to SNAPforSeniors, the inconsistency from state-to-state is a common source of confusion when it comes to finding housing in another area.

To help remedy this, the n4a Senior Housing Locator provides definitions for all 247 license types. Medicare certified facility listings also include a link directly to that facility’s quality report on Nursing Home Compare.* * *
About a week later, the new senior housing online search resource was promoted in a Press Release entitled "Society of Certified Senior Advisors introduces comprehensive online resource to clients in need of senior housing" (07/29/08) issued by the Society of Certified Senior Advisors®, of Denver, CO, the world’s largest membership organization educating and certifying professionals who serve seniors.

Its immediate involvement is an example of the "co-branding" offered and sought by
Through the Alliance Network Program, SNAPforSeniors licenses and private-labels its database and search tools to the websites of leading trusted sources, including the Alzheimer's Association and the Case Management Society of America. * * *
For more information about SNAPforSeniors, read its "Frequently Asked Questions" online. It is listed in Google's online "Senior Living Directories and Helps" that offers additional online resources.

Monday, August 25, 2008

A Jewish Approach to End-of-Life

On Sunday, September 14, 2008, from 9 a.m. to 3 p.m., Yeshiva University, in New York City, will conduct a seminar entitled "The Sanctity of Life: A Jewish Approach to End of Life Challenges Adult and Pediatric End of Life Challenges."

This is the purpose of the conference:

The conference will provide a unique opportunity to interact with rabbis and physicians who are leaders in this area of medical ethics.

By enriching our education, raising our awareness, and deepening our sensitivities, the YU Student Medical Ethics Society hopes to promote continued discussion, thus enhancing the community’s ability to deal with these issues in an effective manner that holds true to the highest moral standard. * * *
The conference speakers will address the medical, psychological, social, & religious (under Jewish law) issues arising in end-of-life situations:
With expert speakers representing the medical and rabbinical professions, the conference will address the wide range of medical, ethical, psychosocial and halachic (Jewish legal) issues that arise at the end of life.

The opening plenary session of the day will begin with a general introduction to the medical background and ethical issues that are pertinent to adult terminal illness.

Presented by leading physicians, ethicists, and rabbinic authorities with extensive experience, this session will explore how medicine and halacha interact in the modern hospital setting, and will highlight some of the most pressing issues that have come up in recent cases. * * *
I highlight this conference, since it studies end-of-life issues from this religion's viewpoint:
  • Pediatric end-of-life challenges
  • Adult end-of-life challenges
  • Health care proxy
  • Assisted suicide and the value of life
  • Hospice care
  • Pain management
Further event information and registration arrangements are available online here.

The need for decisions at the end-of-life, is real; and such decisions should be made with reference to the patient's beliefs. Otherwise, the decisions rely more on medical possibilities, however fruitless, and familial expectations, however hopeless.

For one physician's perspective on the need for reference to concerns other than medical diagnoses & prognoses, read "
As death draws near, patients and families face agonizing decisions [in] End-of-life care", by Dr. Patrick Neustatter, a family practitioner in North Stafford, Virginia, posted by The Free Lance-Star (Fredricksburg, VA) on August 24, 2008.

He related that "deciding whether to fight for life at all costs, or prepare for death, is a heart-wrenching decision some patients face."

It's bad enough to be dying of terminal cancer, but when your medical specialists are pulling you in opposite directions, advising conflicting treatment plans, it generates more anguish and requires the patient and the family to make some heartfelt decisions.

A patient I'll call Mr. X already went through surgery and radiation therapy for his cancer. Now, unfortunately, the biopsy of the lump that recently appeared shows recurrence.

He is in the care of an enthusiastic, dare I say gung-ho, surgeon who is urging him to have surgery. But his oncologist, together with his daughter, is asking him: "Is another five years of life, but in a nursing home with a feeding tube, really what you want?"

In cases like these, quantity is pitted against quality. Stay alive at any cost, or prepare for the inevitable sooner with less intervention? It's a decision that can put a terrible strain on the bravest patient and most devoted of families and medical staff. * * *
In concluding with his recommendation for patients to prepare, in advance, a "living will" to address medical decision-making, Dr. Neustatter referenced the need to implement the patient's wishes, not rely upon medical possibilities regardless of pain:

At church the other morning, one of the congregants told of her father-in-law just having finally died after a long illness.

She described the heartache her husband had gone through arguing with the other siblings over the whole business, and closed with the question, "Where's the Hemlock Society -- or whatever it's called now -- so my death is not like that?"

The principle of making some preparation for your death is a sound one.

With the aid of a living will, in which you can spell out what medical efforts you do or don't want taken in your final days, you may save untold heartache amongst the family members -- not to mention possibly massive savings on futile medical expenses.

The conference at Yeshiva University will address the concern that "my death is not like that" from a Jewish perspective.

Friday, August 22, 2008

LTCI Scrutinized by Feds

On July 24, 2008, the U.S. House Committee on Energy and Commerce held the second in a series of hearings on the subject "Long-Term Care Insurance: Are Consumers Protected for the Long Term?"

The hearing was preceded by issuance on July 23rd of a Press Release, entitled "
Senate, House Members Release Results of GAO Report on Long-Term Care Insurance."

The referenced report issued by the
U.S. Government Accountability Office (GAO), entitled "Long-Term Care Insurance: Oversight of Rate Setting and Claims Settlement Practices" (June, 2008; GAO No. 08-712; PDF, 41 pages), surveyed "the consumer protections states have in place for those who purchase long-term care insurance (LTCI)."

The Press Release noted the purpose of the GAO's Report:

Due to the rapid aging of America’s population, the marketplace for long-term care services is expected to expand significantly. Private LTCI has emerged as one possible way individuals can prepare for their long-term care needs later in life.

In their request to GAO, members of Congress expressed their interest in examining the frequency with which consumers are experiencing denial of benefits and exorbitant rate increases.

In light of such practices, the GAO report examined the robustness of states’ rate setting standards and the rules for settling of benefit denials. * * *
These were the essential findings of the GAO's Report on LTCI:
GAO found that rate increases for LTCI policies fluctuate widely from state to state and plan to plan. For example, one company cited in the report repeatedly raised premiums, resulting in a cumulative increase of more than 70 percent since 1991, while another company has raised premiums only once since 1975.

According to the report, rate stability standards, which are designed to protect consumers against sharp premium increases, have now been adopted by more than half of all states.

However, because many states have not yet adopted these standards, a vast number of consumers are still left unprotected. Additionally, because the rate standards are so new, state regulators are unsure of how successful they will be in moderating future premium increases.

GAO also reviewed claims settled by LTCI companies in ten states by evaluating consumer complaints. The report found that standards for the timely payment of consumer claims varied significantly by state, with “timely” being defined as five days in one state and 45 days in another. One state did not have a timeliness requirement at all.

GAO also noted that some states are considering implementing an external appeals process for adjudicating disputed claims. * * *

In prior blog entries, I noted the increased promotion by the federal and many state governments, including Pennsylvania, of private long-term care insurance. See: PA EE&F Law Blog postings "PA Joins "Own Your Future" LTCI Campaign" (03/28/08), and "PA to Promote Long-Term Care Insurance" (03/12/08). I expressed concerns about adequate state regulatory review and remedies for policy purchasers & claimants of LTCI coverage.

The GAO's Report acknowledges such concerns, notes varying enforcement measures presently, and recommends further scrutiny of LTCI issuers and policies, given the increasing federal and state government promotion of such private coverage:

The federal government expects that as many as 30 states will have Long-Term Care Partnership programs in place by the end of this year. These programs encourage the private purchase of LTCI and feature state-approved plans that combine private LTCI with possible add-on Medicaid coverage in policies that allow consumers to protect some portion of their accumulated financial assets.

Many state officials, as well as LTCI providers, are enthusiastically supporting rollout of these Partnership programs. As programs of this nature unfold across the country, the GAO report’s findings make it clear that consumers who are urged by state governments to purchase these plans must have access to comprehensive, accurate information about Partnership-approved plans to determine whether they are a sound and affordable choice for them. * * *
Those witnesses who offered testimony at the recent House subcommittee hearing regarding LTCI included two from Pennsylvania. Each witness provided a prepared statement or presentation, available online, as follows:

Panel I:

Panel II:
Panel III:
You can watch the hearing on your computer using Windows Media Player and a high-speed Internet connection.

Seven elected senators or representatives had requested such a Report from the GAO and urged hearings about LTCI. Some were quoted in the Press Release as expressing deep concern about LTCI after reviewing the GAO's Report.

Such investigations are not ended. At the conclusion of the GAO's Report, the principal author,
John E. Dicken Director, Health Care, made an offer for further input about it.
If you or your staffs have any questions about this report, please contact me at (202) 512-7114 or

Contact points for our Offices of Congressional Relations and Public Affairs may be found on the last page of this report. GAO staff who made major contributions to this report are listed in appendix II.
That is an invitation for participation in this envisioning process.

Wednesday, August 20, 2008

Study Gauges Elder Mistreatment

On August 19, 2008, the University of Chicago released a study about elder abuse, as described in its Press Release entitled "More than 10 percent of older Americans suffer mistreatment, University of Chicago study shows."

About 13 percent of elderly Americans are mistreated, most commonly by someone who verbally mistreats or financially takes advantage of them, according to a University of Chicago study that is the first comprehensive look at elder mistreatment in the country. * * *

Other studies have been based on small, non-representative samples of the population or on data gathered from the criminal justice system or welfare agencies such as adult protection services. They are not as comprehensive as the new study, which was made in response to a report from the National Research Council calling for scientific study of elder mistreatment. * * *
The findings of this new study were summarized in the Press Release with reference to its lead author, Professor Edward Laumann, of the University's Sociology Department:
Laumann and his research team found that
  • 9 percent of adults reported verbal mistreatment,
  • 3.5 percent reported financial mistreatment and
  • 0.2 percent reported physical mistreatment.
Physical impairment apparently plays a role in mistreatment, the study found.

"Older people with any physical vulnerability are about 13 percent more likely than those without one to report verbal mistreatment but are not more likely to report financial mistreatment," said co-author Linda Waite, the Lucy Flower Professor in Sociology at the University. * * * [Formatting added.]
As to the reporting of alleged elder abuse, the study showed that "adults in their late 50s and 60s are more likely to report verbal or financial mistreatment than those who are older."

Regarding mistreatment, respondents were asked about the past 12 months and answer three questions:
  • "Is there anyone who insults you or puts you down?" (verbal);
  • "Is there anyone who has taken your money or belongings without your OK or prevented you from getting them, even when you ask?" (financial); and
  • "Is there anyone who hits, kicks, slaps or throws things at you?" (physical).

Of the people reporting verbal mistreatment,

  • 26 percent identified their spouse or romantic partner as being responsible,
  • 15 percent said their children mistreated them verbally, while
  • the remainder said that a friend, neighbor, co-worker or boss was responsible.

Among people who reported financial mistreatment, 57 percent reported someone other than a spouse, parent or child, usually another relative, was taking advantage of them. * * * [Formatting added.]

Professor Linda Waite noted some "good news" revealed by the study:
Few older adults reported mistreatment by family members, with older adults quite insulated from physical mistreatment.

However, the authors pointed to the need for sensitivity on the part of physicians and other medical personnel to the possibility, although infrequent, of physical mistreatment of their patients. * * *
The study's findings were reported in "Elder Mistreatment in the U.S.: Prevalence Estimates from a Nationally-Representative Study" (PDF, 7 pages), published in the current issue of the Journal of Gerontology: Social Sciences (2008, Vol. 63B, No. 4, S248–S254).

Sometimes elder abuse rises to the level of alleged criminal behavior. A trial is now underway in York County Court regarding alleged elder abuse in the form of gross neglect towards a care-dependent elder, who died. When a jury verdict would be reported in that case, I'll note it here.

Tuesday, August 19, 2008

"Working with Older Adults" Training Events

The Pennsylvania Behavioral Health & Aging Coalition announced three, free, one-day training sessions for certified peer specialists, recovery specialists, and aging & mental health professionals on the topics described in an online flyer (Word format, 1 page):

  • "Behavioral Health Issues in Older Adults" and
  • "Understanding and Accessing Medicare Services for Mental Health Consumers."
The Behavioral Health Connection is a new, innovative resource center developed by the Pennsylvania Department of Aging through its APPRISE health insurance counseling program.
This training * * * will include actual case studies to help understand issues involved in serving Baby Boomers, other older adults, and those dealing with substance use.

The training is also designed to assist professionals in utilization of Behavioral Health Connection, APPRISE, and assisting consumers having difficulty accessing treatment needs.

A basic understanding of Medicare will be provided in working with Medicare beneficiaries.
In a discussion forum sponsored by the Pennsylvania Mental Health Consumers' Association, and in an invitation posted on the PBHAC website, Lynn Patrone explained the new "Behavioral Health Connection" and its mission:
Behavioral Health Connection is a brand new program that assists ALL mental health consumers in accessing necessary treatment, especially prescription medication. The training will assist all mental health professionals working with consumers and provide access to this unique resource.

Behavioral Health Connection serves consumers of all ages. There is no cost for the training but seating is limited!
Lynn referenced the online flyer, with registration form, for the training sessions (Word format, 1 page).

The sessions will be held from 8:30 A.M.-3:00 P.M. in the western, central, and eastern sections of Pennsylvania, as follows:
  • October 9, 2008, at Mountain View Inn, 121 Village Drive, Greensburg, PA 15601
  • November 19, 2008, at Inn at Chester Springs, 815 North Pottstown Pike, Exton, PA 19341
  • December 10, 2008, at Radisson Penn-Harris, 1150 Camp Hill Bypass, Camp Hill, PA 17011
A continental breakfast and lunch will be provided to attendees. For further information, you may call 717-541-4219.

Advance registration is required. Registrations can be submitted to the attention of Lynn Patrone, at PABHAC/BHC, via fax (717-541-4217) or by email to:

Thursday, August 14, 2008

Elders and Marriage

On the occasion of my eldest son's wedding this coming Saturday, I am wondering about the view of older folks, as a group, about marriage.

The Pew Research Center posted an article on July 1, 2007, entitled "As Marriage and Parenthood Drift Apart, Public Is Concerned about Social Impact Generation Gap in Values, Behaviors" that announced and summarized the findings of a Report, entitled "As Marriage and Parenthood Drift Apart, Public is Concerned About Social Impact" (07/01/07; PDF, 91 pages).

The Report's Executive Summary lists & explains its key findings, including these points:

  • Younger adults attach far less moral stigma than do their elders to out-of-wedlock births and cohabitation without marriage. They engage in these behaviors at rates unprecedented in U.S. history.
  • Adults of all ages consider unwed parenting to be a big problem for society.
  • Even though a decreasing percentage of the adult population is married, most unmarried adults say they want to marry.
  • Married adults are more satisfied with their lives than are unmarried adults.
  • Children may be perceived as less central to marriage, but they are as important as ever to their parents. As a source of adult happiness and fulfillment, children occupy a pedestal matched only by spouses and situated well above that of jobs, career, friends, hobbies and other relatives.
  • With marriage exerting less influence over how adults organize their lives and bear their children, cohabitation is filling some of the vacuum.
  • Americans by lopsided margins endorse the mom-and-dad home as the best setting in which to raise children. But by equally lopsided margins, they believe that if married parents are very unhappy with one another, divorce is the best option, both for them and for their children.
Were individual views different due to the age of survey respondents?
[T]he Pew survey finds that older adults – who came of age prior to the social and cultural upheavals of the 1960s – are more conservative than younger and middle-aged adults in their views on virtually all of these matters of marriage and parenting.

Thus, some of the overall change in public opinion is the result of what scholars call "generational replacement." That is, as older generations die off and are replaced by younger generations, public opinion shifts to reflect the attitudes of the age cohorts that now make up the bulk of the adult population.

Even among the younger generations (ages 18 to 64), however, our survey finds substantial differences in attitudes that fall along the fault lines of religion and ideology rather than age.* * *

For those senior citizens contemplating a second (or more) marriage, consider the advice given by Ashlea Ebeling in her extensive article "The Second Match" (11/12/07), posted by Forbes magazine.

She asks, "Should you remarry or just shack up?" Then she answers, "Consult your financial adviser and lawyer, as well as your conscience."

In 2006, 1.8 million Americans aged 50 and above lived in heterosexual "unmarried-partner households," a 50% increase from 2000, figures Bowling Green State University demographer Susan Brown.

Much of that growth is due to the baby boomers passing 50. But it also reflects the problems of blending finances later in life. Ninety percent of older heterosexual live-ins are widowed, separated or divorced. * * *
She suggests considering these aspects of the decision, which are explored in detail:

  • Estate Planning

  • Alimony and Palimony

  • Social Security

  • Survivors' Annuities

  • College Financial Aid

  • Nursing Home Costs
  • Income Taxes
  • Real Estate

In a shorter article posted by ElderCare Answers, entitled "Is It Better to Remarry or Just Live Together?", similar points are raised, including:
  • Estate Planning

  • Long-Term Care

  • The Family Home

  • Social Security

  • Alimony

  • Survivor's Annuities

  • College Financial Aid
When couples are young, such factors are far from mind, and love alone might be the singular motivation. But for some older Americans contemplating remarriage, the question might be asked: "What's love got to do with it?"

In answering that question, I suggest that you first consult your conscience, and then "[c]onsult your financial adviser and lawyer."

Consider, also, the results of the survey (noted in the graph above) concerning "what makes a marriage work?"

Tuesday, August 12, 2008

Personal Health Records Promoted, Pt. II

The U.S. Government and specialized technology vendors are not the only ones interested in creating personal health care records for consumers. Technology giants are too.

As evidenced in yesterday's PA EE&F Law Blog posting "Personal Health Records Promoted, Pt. I", the government's efforts, through the U. S. Department of Health and Human Services, to institute uniform health information technology, have been accelerating from beginnings in this decade, until now. For example, see: "HHS Awards Contracts to Develop Nationwide Health Information Network" (11/10/05), and "HHS awards $22.5M in contracts to health info exchanges" (10/20/07).

In 2008, major technology vendors expanded the market, seeking involvement with your personal health records.

On February 18, 2008, Reuters reported "Google unveils personal medical record service":

Google Inc. has unveiled a plan to help U.S. patients gain control of their medical records and is working with doctors' groups, pharmacies and labs to help them securely share sensitive health data. Google said it has signed deals with hospitals and companies including medical tester Quest Diagnostics Inc, health insurer Aetna Inc, Walgreens and Walmart Stores Inc pharmacies.

The password-protected Web service stores health records on Google computers, with a medical services directory that lets users import doctors' records, drug history and test results.
Google aims to foster sharing of information between these services, but keep control in patients' hands, allowing them to schedule appointments or refill prescriptions, for example. * * *
Google Health is described on its website, and also in a blog posting "Google Health, a first look" (02/28/08) by Marissa Mayer, who noted:
Google Health aims to solve an urgent need that dovetails with our overall mission of organizing patient information and making it accessible and useful.

Through our health offering, our users will be empowered to collect, store, and manage their own medical records online. * * *
Microsoft Corporation, with its HealthVault service introduced in 2007 and significantly upgraded in 2008, also focuses on personal health records.
Microsoft® HealthVault™ is designed to put you in control of your health information.

A free HealthVault account helps you collect, store and share information with family members and gives you a choice of applications and devices to help manage your fitness, diet and health.
However, according to "Microsoft HealthVault is nothing like Google Health" (02/26/08) by Dana Blankenhorn, posted on ZDNet, "Microsoft HealthVault is a platform for sharing medical data [and] Google Health could, if it chose, become a HealthVault application."

For examples of organizations working with Microsoft on compatible services, see: Press Release, "New Microsoft HealthVault Applications and Devices Unveiled" (06/10/08), which announced "[m]ore than 40 new HealthVault-enabled applications and devices introduced to improve patient-doctor data sharing, fitness, wellness and family health management."

For the past two decades, small software vendors advocated entry of personal health records into your personal computer or personal digital assistant, and offered stand-alone products.
See: "Choosing Family Health Records Software".

Such private databases did not present the significant issues arising due to transportable, shared, but private, medical records, as expansively reviewed in "Biomedical Informatics: Social Issues" posted by the University of Arizona:
Biomedical Informatics have evolved through time and have always carried with them social, privacy, and security issues.

The notion of privacy is not a new concept and is the core of the patient-physican relationship. Ethics and biopiracy have become hot topics especially since IT has given users more tools and flexibility to work-around the system.

Other considerations such as costs, affordability, and accessibility to biomedical informatics applications must be examined. Web 2.0 technologies are favoring the use of online communities for support group purposes.

Despite all the advances biomedical informatics are experiencing, consumers and patients are still concerned with the privacy of their biomedical data; those that are most concerned are minorities or patients with terminal illnesses. * * *
Nevertheless, another technological revolution, powered by economics and politics, is underway. I think it likely that, in ten years, the way we access our personal health records will more resemble online banking, than the present papers in a medical chart.

Monday, August 11, 2008

Personal Health Records Promoted, Pt. I

On August 10, 2008, The Hill posted an article entitled "Medicare expands online health records programs" by Jeffrey Young, who reported that "[t]he Bush administration is not waiting on Congress to pass legislation that increases access to online personal health records."

Beginning in January, the administration will expand access to online records in Arizona and Utah as part of an ongoing effort to encourage greater use of health information technology.

The records will contain up to two years of information from Medicare’s records. Patients will be able to add to their records and share them with physicians, pharmacists and other healthcare providers. * * *
Changing the operation of the Medicare system is crucial to its continued viability. In an article entitled "Making Medicare sustainable" delivered on February 5, 2008, as posted on The Hill as a budgetary message, Mike Leavitt, the Secretary of the U.S. Department of Health & Human Services, warned:
This week the president’s budget for 2009 was submitted. The Medicare portion of this budget should be viewed as a stark warning. Medicare, on its current course, is 11 years from going broke. * * *

The president’s budget on Medicare warns in a different way. It illuminates with specificity the hard decision policymakers — no matter their party — will face every year until we change the current system. * * *

But to keep our national commitment to seniors, we must do more to change how Medicare is managed.
* * *
Implementation of an electronic medical records system was identified by Secretary Leavitt as one of the "cornerstones" of a competitive, efficient, reconfigured Medicare system.

Consistent with the movement by HHS to encourage use of electronic medical records, on October 30, 2007, WebMD Health News had reported, in "Doctors Urged to Get Electronic Records" by Todd Zwillich, that Medicare would offer incentives to persuade doctors to use electronic medical record systems.
Federal officials said Wednesday they would soon launch a program aimed at convincing reluctant doctors to buy electronic medical records systems for their offices.

Officials gave few details of the plan, saying it would not get going until late winter or early spring. But it will involve doctors getting cash bonuses from Medicare for buying electronic health records systems and then reporting quality improvements to the government.
* * *

Many doctors are also reluctant to buy systems before industry and government groups have settled on a single standard for how the programs operate and communicate with each other. * * *
This incentive program was introduced in June, 2008. See: "Bush Plan Offers Bonuses to Medicare Doctors Who Use Electronic Records" (06/10/08) by Alex Wayne, posted on CQ Today.

One of the twelve regions included in the new program is Pittsburgh, Pennsylvania.
I wonder, will this region have special input into the Commonwealth's investigation into electronic medical records, as recently implemented by Governor Rendell in an Executive Order? See: EE&F Law Blog posting "PA Governor Plans Electronic Health Info Exchange" (04/21/08).

Still, author Todd Zwillich again noted on WebMD Health News, in "A Slow Switch to Electronic Health Records", that "only 4% of U.S. doctors use fully functional electronic systems."
Less than one in 20 American doctors is using fully functional electronic health records and e-prescribing systems in their offices. And researchers say that figure shows that the switch to the new technology is moving too slowly.

Many experts say that computerized health records reduce medical errors and improve doctors' ability to communicate with patients and keep up with their care.

Government agencies for years have been pushing physicians and hospitals to adopt the systems but have met resistance, especially from small and medium-sized medical practices. * * *

In its newest, state-centered, pilot programs, HHS goes beyond such private incentive programs, to advance a vision of electronically created, stored, accessed, and linked personal medical records.

In "Medicare to launch personal health record pilot in Arizona and Utah" (08/11/08), posted on Healthcare IT News, Bernie Monegain reported that the most recent initiative announced for Arizona and Utah by the Centers for Medicare & Medicaid Services, of the HHS, "is aimed at providing patients with better care while also reducing costs."

It follows a similar initiative begun in April, 2008, in South Carolina, as announced in the article "CMS launches PHR pilot for Medicare beneficiaries" (05/07/08) by Richard Pizzi, posted by Healthcare IT News.

These CMS pilot projects encourage "traditional Medicare beneficiaries to use an online Personal Health Record [PHR] to track their healthcare services and better communicate with their providers."

The [first] CMS pilot -- which will take place in South Carolina -- gives Medicare beneficiaries the ability to collect and access information about their health or healthcare services, such as medical conditions, hospitalizations, doctor visits and medications.

CMS claims that strict privacy and security safeguards will protect all beneficiary data, and affirmed that the PHRs would be under the control of patients. * * *

In those pilot program states, beneficiaries can select one of the participating personal health record vendors, and then add additional personal health information to the claims data. For example, they may be able to authorize:

  • Online links their personal electronic information, such as pharmacy data.
  • Online tools that help consumers manage their health, such as wellness programs for tracking diet and exercise, medical devices, health education information and applications to detect potential medication interactions.
  • Access by family members to their PHR data.
  • Access by other healthcare providers to their PHR data.
Tomorrow, in Part II of this posting, I will review the efforts of technology giants with household names that have ventured separately into an expanded personal health record industry.

Friday, August 08, 2008

Pennsylvania Lawyers Publish Profusely

On August 7, 2008, Professor Gerry W. Beyer noted in his posting on the Wills, Trusts & Estates Prof Blog that "Carmina Y. D'Aversa (estate tax attorney with the International Estate Tax Group of the Internal Revenue Service in Washington, D.C.) has published her book entitled Tax, Estate, and Lifetime Planning for Minors."

His introduction seemed somewhat misleading to me on two minor points, but his recognition of the book remains laudable; and it caused me to think about other Pennsylvania attorney-authors.

First, Carmina Y. D'Aversa edited the book (382 pages), as described on the American Bar Association's bookstore website (as also noted by Gerry within his posting):

Tax, Estate, and Lifetime Planning for Minors brings together the knowledge and insights of fourteen experienced practitioners and law professors, including Jon J. Gallo, Christopher P. Cline, E. Paul Van Horn, Nancy E. Shurtz, Aen Walker Webster, Naomi R. Cahn and Cynthia L. Barrett.
Second, the book was published on January 25, 2007 (copyrighted 2006) -- not recently. The ABA's bookstore website offered a one-page update for the book, as issued through May, 2007, but not since then. The book is also referenced by commercial vendors online, including Barnes & Noble, Amazon, and Best Book Buys, among others.

Those points aside, I am happy that Gerry drew our attention again to this book, one edited by a Pennsylvanian.

Well, perhaps I should say, more accurately, a former Pennsylvanian. Her biography correctly notes that she "served as an elected member of the Council of the Pennsylvania Bar Association's Real Property, Probate and Trust Law Section." That is how I met her before she moved to Washington, D.C. around 2002 to join the Internal Revenue Service's central offices.

I communicated with her after she left Pennsylvania, as she was arranging for contributors to the book and writing the section about advanced reproductive technologies (ART).

She thought about ART in Pennsylvania before few others did. Carmina is the person who inspired me to an interest in that cutting-edge topic. I am certain that she would be pleased with our attempts to create a legal framework for advanced reproductive technologies here, now. See: EE&F Law Blog posting JSGC's Final Report on Assisted Reproductive Technologies (06/25/08), and the topic "Reproductive Technology" on this Blog.

Since its publication, the book that she conceived and edited remains unique among legal publications in addressing personal-, estate-, and tax-planning issues from the distinctive viewpoint of a
minor, someone under the legal age of majority (18 years old). It is highly-recommended as a resource.

Carmina is not the only lawyer from or in Pennsylvania who has written or edited useful books on estate and trust topics, or elder law practice.
This is only a partial list of attorney-authors and their publications that relate to the subject matter of this Blog.

Dozens, perhaps hundreds, of Pennsylvania lawyers write book-length legal materials issued by the
Pennsylvania Bar Institute (the legal education arm of the Pennsylvania Bar Association). Pennsylvania lawyers probably write most of the publications issued by George T. Bisel Co., Inc., of Philadelphia, a distinctive, family-owned legal publisher. Pennsylvania lawyers also write textbooks and contribute to legal works published by other prominent national & international publishers.

Pennsylvania is a great place to practice law, partly because such attorney-authors professionally and precisely map this Commonwealth's legal topography.

Wednesday, August 06, 2008

Caring, Responsible (Wealthy) Children

Can wealthy parents raise caring, responsible (wealthy) children?

Wealthy parents worldwide are interested in the answer, and wonder about the process.

On July 30, 2008, Arabian Business posted an article entitled "Wealthy kids to get lessons in finance" by Soren Billing, who related how "Investment bank Merrill Lynch is to teach children of its wealthiest clients how to make the most of the money they inherit, with a special focus on how to effectively invest in charities."

Every year, children of the company’s richest clients are invited to a one week course where they are taught about topics such as different asset types, discretionary asset management and wealth structuring.

“A priority for our clients is equipping their sons and daughters with the skills and responsibility to manage the wealth they will inherit,” said Amir Sadr, Head of Middle East Wealth Management. * * *

This year’s London programme will include a special day about effective charitable giving. * * *

The programme will also focus on life coaching, developing leadership skills and personal security, giving the participants, aged between 18 and 25 years old, practical advice about how to keep themselves safe when they travel or go online.
Wealthy Arab families are not alone in wishing to inculcate skills, sense, and sensitivity in their children. Recent articles evidence that wealthy Americans pursue the same ends for their offspring.

On May 12, 2008, The Wall Street Journal's "Wealth Report" published an article entitled "10 Things the Wealthy Should Leave Their Kids — Besides Money":
When it comes to understanding the dysfunctions of wealthy families, Peter White is among the wisest.

He’s spent more than 20 years counseling wealthy parents and privileged children about how to better understand the adverse effects of wealth and to search for more meaningful lives.

He’s plied his trade at his own firm, as well as at Citi Private Bank and U.S. Trust. * * *
The article lists and briefly explains Peter A. White's "Ten Elements of Care" by parents towards their children. He recommends parents' attention to:
  1. Necessaries
  2. Affection
  3. Affirmation and Support
  4. Boundaries
  5. Guidance
  6. Respect
  7. Trust
  8. Forgiveness
  9. Religion or Spirituality
  10. Letting Go
The article notes (and the readers' posted comments ratify) a key point:
The list isn’t just for rich parents. But as Peter told me, it’s helpful for wealthy parents to learn that “the first thing to be concerned with is loving children in a way that enables them to take charge of their lives as adults, so they can use wealth to enhance, not diminish, their lives.”
Clearly, there are risks involved where children are raised in wealthy circumstances. An article entitled "Psychological Costs of Material Wealth" (summarized from "The Culture of Affluence Psychological Costs of Material Wealth" by S. Luthar published 2003 in Child Development, Vol. 74, Issue 6, by The Society for Research in Child Development, Inc.) suggested that affluent teenagers might be "troubled":
Children in wealthy families are usually thought of as being happy and well-adjusted, but recent research suggests that that they can be quite troubled.

In two studies affluent, suburban teenagers reported higher levels of substance use, as well as symptoms of anxiety and depression, than did other children of the same age. Exploration of causes suggested that two factors might be implicated: excessive pressures to achieve, and isolation from parents (both literal and emotional). * * *

Studies also indicate that parents in very wealthy communities can be more emotionally vulnerable than those in the middle classes.

When adults place inordinate emphasis on material success, for example, they tend to compromise attainment of other rewards critical for their psychological well-being, such as close interpersonal relationships. At the community level, too, material affluence can inhibit the formation of supportive networks, as services – such as child- or elder-care -- tend to be bought and not shared with neighbors. * * *

Not surprisingly, advisors, institutes, and organizations seek to address clients' concerns of educating children about money management and social responsibility.

For example, the
Gallo Institute professes its two founders' belief that "The Most Important Service Financial Professionals Can Offer Clients Is Helping Them Educate Their Children About Money!"
According to a recent study [conducted by The New Retirement Mindscape, Ameriprise Financial, in conjunction with Harris Interactive, Inc., in January 2006], 61% of affluent parents with financially-dependent adult children rated “advice to help children become more financially savvy” as their top priority. And 52% of adults planning retirement share this concern as well.

Eileen and Jon Gallo have spent more than 20 years helping financial professionals and their clients navigate the complex issues of family wealth. Through their books, seminars and media appearances, the Gallos provide tools to help affluent parents raise financially intelligent children. * * *
The Gallos wrote a book, Silver Spoon Kids, as "a parent's guide to raising financially responsible children in an age of unprecedented wealth."
Drawing upon their experiences as members of the renowned NYU Family Wealth Institute, they tell you how to talk to kids about money, how to teach them to handle it responsibly, and how to instill in your kids a sense of giving to their communities.
Eileen Gallo (a psychotherapist) and Jon Gallo (an estate planning attorney), of Los Angeles, California, were interviewed as the authors of Silver Spoon Kids: How Successful Parents Raise Responsible Children by about "money, kids and the sudden discovery of being Jewish" after their book was featured in a Time magazine article.

The Inheritance Project (also known as Trio Press) seeks to smash myths that the "possession of wealth brings happiness" and that "[t]hose who inherit (money they did not earn) do not deserve their wealth." That organization offers ten "publications for heirs, wealthy parents, and professional advisors" that address "the many complex issues that surround inheritance."

More recent studies indicate that wealth is a positive factor in families, if properly handled.

On March 26, 2008,
a summary entitled "How wealth affects children's cognitive achievement" noted that "a new study published in the March/April 2008 issue of the journal Child Development found that family wealth might partly explain differences in test scores in school-age children."
The study, conducted by researchers at New York University, also found that family wealth is positively associated with parenting behavior, home environment, and children's self-esteem.
In Pennsylvania, on February 12, 2007, PNC Bank issued a Press Release about its commissioned study, released as "Growing Up Wealthy", that found "affluent teens don't fit tabloid stereotype."
PNC Wealth Management's "Growing Up Wealthy" study depicts an affluent youth culture that is privileged yet more responsible, hard working and ambitious than the perception fueled by the antics of young celebrity socialites.
On the PNC Bank website, "Growing Up Wealthy" resources are offered: a Press Release, Survey Highlights, a PowerPoint presentation, and various "sound bytes" by Bruce Bickel, Managing Director of PNC's Private Foundation Management Services.

Another resource for bringing awareness to a child about personal and social responsibility in the setting of an anticipated inheritance is the Fox Studios movie, released in February, 2007 -- The Ultimate Gift. Its website offers discussion materials. For additional background and links, see PA EE&F Law Blog posting "The Ultimate Gift" Movie (03/12/07).

Finally, parents might wish to consider another resource: a

On March 12, 2008 the
Wall Street Journal published an article entitled "Games Can Help Rich Kids Value Money" by Josee Rose, who described "a board game, a stock-market contest and donating $1,000 to charity" as "techniques financial advisers are using to help wealthy parents introduce concepts of financial and social responsibility to children of wealth."
Wealthy families frequently worry that, as money trickles down through the generations, its value is lost. The first and second generation sacrificed to accumulate their wealth, and they tend to pamper the next generation, says Glenn Kautt, president of the Monitor Group, a wealth management firm in McLean, Va. "That generation is the one that has the sense of entitlement."

Financial advisers find that sometimes the easiest way to raise the topic of the responsibilities of wealth is by playing a game.

GenSpring Family Offices LLC, which serves 600 families whose collective worth exceeds $15 billion, created a board game called "Shirtsleeves to Shirtsleeves," meant to open a discussion on family-wealth issues.

The name is based on the old proverb, "Shirtsleeves to shirtsleeves in three generations," and the game, which feels in some ways like the game Monopoly, asks the question, "How long will your money last?" * * *
The game addresses a "curse" that may be real: Marilyn Gardner described the "Midas Curse" in "The curse of vanishing wealth" originally published by The Christian Science Monitor, then posted by MSN Money:
"Almost everybody knows a family or has seen a case where the money hurt somebody in the family, or the kids or grandchildren blew it all," says [Rodney] Zeeb, an attorney and coauthor (with Perry L. Cochell) of "Beating the Midas Curse" [Heritage Institute Press, 2005,] a reference to the destructive relationships with money that splinter some families.

So widespread is the problem, that six out of 10 affluent families will lose the family fortune by the end of the second generation, Zeeb says. And nine out of 10 will have depleted the family wealth by the end of the third generation.

It's a modern-day drama summed up in an ancient Chinese adage: "Wealth never survives three generations."

Nineteenth-century Americans updated it to read, "From shirtsleeves to shirtsleeves in three generations." * * *

See also: "7 ways to raise kids who can hold onto money", by Terry Savage, posted on MSN Money, who advises: "Strengthen your child's grasp of financial matters by starting early, keeping lessons simple and setting an example."

That game, "
Shirtsleeves to Shirtsleeves", was featured in an audio article entitled "The game of wealth management" broadcast June 25, 2008, on National Public Radio's "Marketplace." You can listen to the show to determine if you (or your children) might prefer it to Monopoly.

[Graphic Source: Educational Week, here]