http://www.elderadvocacyblog.com/index.php Copyright 2010, Felicia Curran Felicia Curran en-US SPHPBLOG 0.4.8 http://www.elderadvocacyblog.com/index.php?entry=entry100112-111850 Director Stephen Walker, pictured here, has made a film for Indepedent Lens about a chorus in Northampton, Massachusetts.

Although the chorus members are in their 80s, the music they perform is anything but geriatric, unless the Clash's "London Calling" now qualifies as old folks music.(I think not). Although you're probably still skeptical, as I admit I am, you can tell just by looking at the film's poster, below, that it is something special.

Will Joe Strummer be rolling over in his grave when they perform "Should I Stay Or Should I Go?" Tune in tonight and find out. Here in the Bay Area, the program plays on KQED, Channel 9, at 9 p.m. PST. Click here to go to the Young@Heart website to watch a preview and check the time of your local listing.

Felicia Curran
www.ElderAdvocacyLaw.com
]]> Heros & Heroines http://www.elderadvocacyblog.com/index.php?entry=entry100112-111850 Felicia Curran Tue, 12 Jan 2010 19:18:50 GMT http://www.elderadvocacyblog.com/index.php?entry=entry100110-123023 Seeing Old Age As A Never-Ending Adventure profiling three adventurers, Ilse Telemanich, 90, Tom Lackey, 89, and Charles Smith, 89, pictured here.

Ilse goes hiking in South Africa, even on a sprained leg. Tom Lackey does "wing walking" -- flying over the English Channel strapped atop a single engine plane. Tom just took up the sport in the last 10 years, and has done 20 such flights. His goal for his 90th birthday this year is to be the first person of any age to wing walk across and back the English Channel. Tom,pictured wing-walking here, a self-described "adrenaline junkie," persisted with his new hobby even when members of his church saw his sport as nothing more than a "death wish." (They have since changed their minds, thankfully).

Paul Smith travels to exotic places such as the North and South Poles.

Paul, Tom, and Ilse are not alone. The percentage of elderly travelers going in for adventure travel has gone up as much as 70% in the last 6 years. In fact, Elderhostel, Inc. the travel company specializing in travel for the elderly, has changed its name to Exploritas, to keep up with the trend. One hospital in New York City has even started the nation's first medical fellowship in trauma treatment for the elderly, to deal with mishaps that the elderly may have on their adventurers.

When people hit a ripe old age, they often brag about it, and that is evidently true in the adventure travel area. Paul Smith told the Times that on his South Pole trip, "a woman got off the plane at base camp and started bragging about being 80. She was quickly put in her place. One of the fellows in our group tapped her on the shoulder and said, ‘I don’t want to prick your balloon, but there are three in our group who are older,’ ” Mr. Smith said. Ha!

I used to tell people that if old age did not agree with me, I would take up parachuting lessons, and one day not pull the string. Now I think I will have something to look forward to when I reach that point.

Wing walking may not be your thing, but individuals such as Paul Lackey remind us that, whatever your age, you can have fun and reinvent yourself by taking on new challenges and doing things you thought you would never do. Take it to the limit one more time.

To read the Times article, click here.

Felicia Curran
www.ElderAdvocacyLaw.com
]]> Heros & Heroines http://www.elderadvocacyblog.com/index.php?entry=entry100110-123023 Felicia Curran Sun, 10 Jan 2010 20:30:23 GMT http://www.elderadvocacyblog.com/index.php?entry=entry100106-172022 series of articles recently that you should read if you’re concerned about preventing osteoporosis. One of Brody's articles in particular, "Exploring a Low-Acid Diet For Bone Health" is a must read, because of studies it describes showing that eating vegetables can maintain healthy bones. Bet your doctor never told you to eat vegetables to prevent osteoporosis, did they? Read on.

Brody’s article starts off from 2 surprising facts: 1) Osteoporotic fractures are rare in Asian countries such as Japan, even though the Japanese eat almost no calcium-rich dairy products and 2) Countries such as the U.S. which consume the most dairy products have the highest rates of osteoporotic fractures. The Japanese, it turns out, have better bone health than we do, eating little dairy products. How could that be?

As Brody explains it, it has to do with the fact that the large amounts of meat we typically eat in the United Staes actually deplete the calcium reserves in our bones. She explains that our bones are the “storage tank" for calcium compounds that regulate the acid-[alkaline] balance of the blood. When the blood becomes even slightly too acid, alkaline calcium compounds are leached from our bones to reduce the acidity of the blood. Some foods speed up the leaching process because they metabolize in the stomach to acid by-products in the blood. Other types of foods metabolize to alkaline by-products, which protect bone health. Thus if we eat too much acid-forming foods, and not enough alkaline-forming foods, our body will withdraw calcium from our bones to restore the correct acid-alkaline balance in our blood.

Acid-forming foods include meat, fish, eggs, and most legumes (beans and peas, except lentils, which are alkaline-forming). Sugar, coffee, alcohol, and most grains are also acid-forming. Alkaline-forming foods include virtually all vegetables and fruits, many nuts and seeds.

With a few exceptions, such as hard-cheeses, most dairy foods “are metabolized to compounds that are essentially neutral” even though they contain calcium. Because dairy-eating countries such as the United States tend to eat lots of meat also, experts have concluded that countries that consume the most dairy products have higher rates of osteoporotic fractures because they also consume the most meat, poultry, and fish, which are calcium-depleting.

What about calcium supplements? Should you take them? Brody cites a review of scientific literature published in the Journal of Clinical Endocrinology and Metabolism, which says that most clinical trials show that milk, dairy foods and calcium supplements do not prevent fractures.

Bottom line: Replacing some of your meat and even fish with fruits and vegetables may be more effective than taking calcium supplements. Aim for at least 9 servings of fruit and vegetables a day. Before discontinuing calcium supplements, talk to your doctor (and bring a copy of Brody’s article -- many doctors will be unfamiliar with the low-acid diet but it will make sense to them if they read about it).

Brody has done 2 other articles about osteoporosis -"As Bones Age, Who's At Risk for Fracture" (on how to tell whether you’re at risk for osteoporosis) and http://www.nytimes.com/2010/01/05/health/05brod.html ]"Options for Bone Loss, But No Magic Pill[/url](a review of osteoporosis medications).

To read the Brody article on eating vegetables to prevent osteoporosis, http://www.nytimes.com/2009/11/24/health/24brod.html]click here.[/url]
To read the Brody article on “As Bones Age ...”,click here.
To read the Brody article on “Options for Bone Loss ..." http://www.nytimes.com/2010/01/05/health/05brod.html ]click here.[/url]

Felicia Curran
www.ElderAdvocacyLaw.com]]> Medical Issues http://www.elderadvocacyblog.com/index.php?entry=entry100106-172022 Felicia Curran Thu, 07 Jan 2010 01:20:22 GMT http://www.elderadvocacyblog.com/index.php?entry=entry091020-175450

"SB 781 (Leno): The RCFE Eviction Protection Act This law will add requirements to eviction notices that will require the facility to inform residents of their rights when faced with an eviction and will require the facility to provide a list of resources available to identify alternative housing and care options.

AB 392 (Feuer/Jones): Restoring Long Term Care Ombudsman Funding_

AB 392 appropriates $1.6 million from the federal citation penalty account to the local ombudsman programs on a one-time basis. It helps replace part of the $3.8 million in funds for these programs cut by Governor Schwarzenegger in 2008. Co-sponsored by numerous other groups. AB 392 was signed by the Governor on August 6, 2009 and took effect immediately.

AB 407 (Beall): CCRC Closure Protections This law will impose requirements on a Continuing Care Retirement Community (CCRC) provider faced with a permanent closure to ensure residents have adequate time to find new housing and to ensure that residents receive adequate compensation should they be required to move. Co-sponsor: California Continuing Care Residents Association (CALCRA).

AB 329 (Feuer): The Reverse Mortgage Elder Protection Act of 2009 This law will prohibit any person who participates in the origination of the mortgage from referring the borrower to anyone for the purchase of other financial products. The bill would require the lender to provide the prospective borrower with a list of not fewer than 10 nonprofit counseling and would require the borrower receive a suitability checklist specifying issues the borrower should discuss with a counselor before the loan application is approved.

AB 1169 (Ruskin): CCRCs. Co-sponsored with CALCRA, this law will increase transparency in financial reporting and establish limits on the transfer of CCRC funds.

AB 76 (Yamada): Life and Annuity Consumer Protection Fund
Will eliminate the sunset provision and extend the $1 fee imposed against insurers for sales of annuities and life insurance policies sold in California. Fees from the Fund are distributed to the Department of Insurance and to the District Attorney offices to provide protections for consumers of life insurance and annuity products.

AB 215 (Feuer/Smyth): Posting Nursing Home Ratings
This law would require nursing homes to post ratings issued by the federal Centers for Medicare and Medicaid Services (CMS) in a visible, public location.

AB 1457 (Davis): Nursing Home Admission Contracts - Ownership Disclosure
This law would require nursing home admission contracts to contain an attachment that discloses the name of the owner and the name and contact information of a single entity that is fully accountable for all aspects of patient care and operation at the facility and would also require written notice to residents and their representatives containing the name and contact information for a new owner when a change of ownership takes place."

Another great job by CANHR getting laws passed that protect the elderly.

CANHR says it will post a more detailed list of bills signed or vetoed on its website www.canhr.org by the end of the week.

Felicia Curran
www.ElderAdvocacyLaw.com

]]> Nursing Homes, Residential Care, Elder Abuse Laws http://www.elderadvocacyblog.com/index.php?entry=entry091020-175450 Felicia Curran Wed, 21 Oct 2009 00:54:50 GMT http://www.elderadvocacyblog.com/index.php?entry=entry091020-145156 The New York Times ran an article recently called “Invisible Immigrants, Old and Left with ‘Nobody to Talk to,’” profiling the hardships faced by the immigrant elderly – citizens of other countries, who come to the United States at age 65 or older. Elderly immigrants are America’s fastest growing segment of immigrants. In California, one in nearly three seniors is now foreign born.

Late life immigrants are a vulnerable population, at least in part due to a 1996 federal law that puts on immigrants a 5 year waiting period for Medicaid, SSI, food stamp and other “safety net” type benefits for low income individuals. In 2007, e.g. 16 percent of the immigrant elderly lived below the poverty line, compared to 12 percent for the non-immigrant elderly. Another 24 percent of the immigrant elderly are classified as “near poor.”

Poverty is only part of their problem. Elderly immigrants, according to the Times, are among the most isolated people in the United States, facing language barriers and culture shock barriers at a time in their life when they may need extra support from social service agencies or health care providers to maintain their health and independence. “They come to the U.S. anticipating a great deal of family togetherness. But American society isn’t organized in a way that responds to their cultural expectations.”

The article profiles several elderly immigrants, including Devendra Singh, pictured here, a widower from India, who moved to Fremont, California to be with his son and his family. His son decided his family needed their privacy, and Devendra is now living in a room he got off of Craigslist. He doesn’t sound like a happy camper. He told the Times, “In India there is a favorable bias towards the elderly.” But in the U.S. “people think about what is convenient and inconvenient for them.”

Devendra and other elderly immigrants are also resourceful. If they can't go back to their villages, they can still get out of the house. Devendra meets 5 days a week at a Fremont shopping mall with other elderly compatriots from India, pictured here.

The article describes the many volunteer and civic groups that have formed to try to help the elderly immigrants in the South Bay area of the bay area:

The Muslim Support Network, www.muslimsupportnetwork.org, a community group dedicated to helping senior Muslims find services to improve the quality of their life.


The Afghan Elderly Association, www.afghanelderlyassociation, an outreach group for elderly widows from Afghanistan.


CAPS, Community Ambassador Program for Seniors, www.capseniors.org, a community organization that has trains “ambassador volunteers” to act as liaisons between different elderly immigrant communities and the social services that they need.


And the Tri-City Elder Coalition, www.tceconline.org, a consortium of elder service groups partnering to provide services and advocacy to the elderly of the south bay.


What can you do to help? Seek out elderly immigrant support groups in your community who need your support, and get involved in making a change.

Felicia Curran
www.ElderAdvocacyLaw.com
]]> http://www.elderadvocacyblog.com/index.php?entry=entry091020-145156 Felicia Curran Tue, 20 Oct 2009 21:51:56 GMT http://www.elderadvocacyblog.com/index.php?entry=entry090826-150803 The New York Times ran an article on Monday describing an innovative type of training for medical students thinking of specializing in geriatric medicine – spend a week or two in a nursing home. The article profiles how a medical student, Kristin Murphy, pictured here, spent two weeks at a nursing home in New York. She was given the mock diagnosis of “mild stroke that affected her right side, difficulty swallowing and chronic lung disease,“ and had to act the part. She said that the experience gave her an even greater desire to practice geriatrics.

The idea is to sensitize the medical students to the experiences of their elderly patients who are sick enough to be in a nursing home, and to make prospective geriatric doctors familiar with the types of places that their sickest patients may find themselves living. The attention that the training program is drawing to need for geriatric doctors is great, but most medical students who will agree to live in a nursing home in the first place are probably already highly sensitive, and the medical students who need sensitization the most probably won’t participate in this program to begin with.

A cardiologist doesn't need to have had a heart attack herself in order to know how to diagnose and treat heart problems. So why should a geriatrician need to know about the quality of life issues that confront residents of nursing homes?

A recent article by Jane Brody on what is special about geriatric doctors sheds some light on this issue. Jane Brody interviewed, R. Sean Morrison M.D., pictured here,
a geriatric specialist at Mount Sinai Medical Center in New York. Jane Brody asked Dr. Morrison how he would approach a new patient who is 85 years of age. Dr. Morrison said he would start with a series of questions: ''Tell me about yourself. What do you like to do? What are the things you would like to do that you cannot do anymore? What is your medical history? What medications do you currently take? What brings you here today?''

If you are elderly, Dr. Morrison explained, “You want a doctor who asks more than just about your medical conditions. . . . The doctor should ask about the effect of medical conditions on quality of life, and then should explore what improvements are possible. ‘The focus of care should be on quality of life. . . .Too often, doctors lose sight of this goal when the focus is on treating specific diseases.'’ Dr. Morrison gives the example of “ if a patient has serious arthritis and hypertension and cannot go to places without a readily accessible bathroom on the first floor because she takes a diuretic for high blood pressure, perhaps the blood pressure medication should be changed. The patient may prefer a different drug that carries a slightly greater risk of stroke if it means a better quality of life.“

So if quality of life is part of what the geriatrician needs to address, they need to educate themselves on the diminishments of quality of life that can come with old age, and nursing homes, unfortunately, will present many instances of diminished quality of life for the medical student to draw on.

The Brody article also has an excellent discussion of what questions you should make sure your parents’ doctor is asking at their doctors' appointment.

To read Jane Brody’s article, click here.

To read about Kristen Murphy's experience in the nursing home, click here.

Kudos again to Kristen Murphy and others for their efforts to walk a mile in another person's shoes.

Felicia Curran
www.ElderAdvocacyLaw.com

]]> Nursing Homes, Medical Issues http://www.elderadvocacyblog.com/index.php?entry=entry090826-150803 Felicia Curran Wed, 26 Aug 2009 22:08:03 GMT http://www.elderadvocacyblog.com/index.php?entry=entry090812-172359

That's the term that is being used by the right wing of the Republican Party (including Rush Limbaugh, Glen Beck, and Sarah Palin --who said that Americans would have to "stand in front of Obama's death panel so his bureaucrats can decide, based on a subjective judgment of their level of productivity in society, whether they are worthy of health care") to describe the provision in the healthcare reform bill that would authorize Medicare to reimburse a physician for providing counseling sessions about end-of-life directives.

Do these right wing pundits even know what an advanced directive is? The AARP, not exactly a subversive left wing group, recommends that seniors complete advance directives so that their wishes will be known to their families and doctors in case they are unable to speak for themselves in a medical emergency. Believe me, a crisis situation in an emergency room or hospital is not the time to consider for the first time how you would feel about living on a ventilator for the rest of your life, or how you would feel about being kept alive in a vegetative state for the rest of your life, or how you would feel about any one of a number of calamities that could befall you in the event of a medical emergency. The idea that your physician would be reimbursed by Medicare to discuss the matter with you, at the time of, or in advance of any medical crisis, is a good one, and by no stretch of the imagination can it be compared to a "death squad."

In fact, it was a Republican Senator, Johnny Isakson of Georgia, who originally made the Medicare proposal that is being labelled "death panel", back in 2007 when he co-sponsored a Medicare End-of-Life Planning Act. On August 10th, Senator Isakson told the Washington Post that analogizing physician counseling for advanced directives to "death panels" is "nuts."

To see President Obama address the death panel issue directly, look at this excerpt of his August 11th town hall meeting in Portsmouth New Hampshire -- click below




To read the text of the town hall meeting click here.

To read the AARP article about advanced directives, click here.

To read the Washington Post's interview with Senator Johnny Isakson,click here.

Felicia Curran
www.ElderAdvocacyLaw.com
]]> Proposed Laws, Healthcare Insurance, Medicare http://www.elderadvocacyblog.com/index.php?entry=entry090812-172359 Felicia Curran Thu, 13 Aug 2009 00:23:59 GMT http://www.elderadvocacyblog.com/index.php?entry=entry090810-133759 "Secrecy Shields Medical Mishaps From Public View" discusses how little progress has been made since a 1999 federal study called "To Err Is Human" outlined steps the medical profession can take to cut the number of deaths by medical errors in half. It shows how the secrecy surrounding hospitals, the lack of compulsory reporting of mistakes, and the financial incentives given to hospitals, all combine to perpetuate if not encourage medical errors.

The article states that "A national investigation by Hearst Newspapers, including The Chronicle, found that the hospital industry, the federal government and most states have failed to take the effective steps outlined in the report a decade ago. Consequently, over that period, as many as 2 million Americans have died needlessly of preventable medical mistakes." The idea is that hospitals can prevent medical errors by setting up protocols, systems, and procedures that provide safety checks and balances to keep patient's safe, much the way that years ago car manufacturers began to design cars with safety features (such as ignitions that won't start unless the car is in park) that can prevent accidents from happening.

Why wouldn't a hospital want to save lives and prevent accidents by minimizing the number of mistakes they make? According the the Chronicle's report, "Hospitals can actually lose money by providing safer care. For example, when Utah's Intermountain Healthcare hospital chain improved its system for prescribing heart patients the proper medications on discharge, rehospitalizations were reduced by 900 beds a year. As a result, the hospital lost $3.5 million in revenue. 'To my hospital administrators, there was actually a certain amount of whining about this,' said Intermountain executive Dr. Brent James, another "To Err Is Human" co-author."

Medicare has recently taken the approach of denying payment to hospitals for "Never Events" -- viz.,illnesses and injuries patients pick up in the hospital that are entirely preventable if proper procedures are followed. Included in the list of Never Events are pressures ulcers or bed sores, and post-surgical infections. The idea is that if hospitals know they will not be able to bill the patient's Medicare for illnesses caused by the hospital's negligence, the hospital will stop negligent practices that cause injury.

New reporting laws, such as a 2007 California law that require hospitals to report errors to the the California Department of Public Health, and which requires the Department to investigate the error within 48 hours, also can make a difference.


A companion article, Lost, Stolen, or Never Existed profiles patients who have been the victim of medical mistakes. By reading the stories of the victims of medical mistakes you can hopefully learn something that might might protect you or your family next time you are in the hospital.

To read the Chronicle's article, Click here.

The Chronicle has also set up a website that has lots of information on medical errors, www.deadbymistake.com.

Felicia Curran
www.ElderAdvocacyLaw.com]]> Federal Oversight, Medical Issues http://www.elderadvocacyblog.com/index.php?entry=entry090810-133759 Felicia Curran Mon, 10 Aug 2009 20:37:59 GMT http://www.elderadvocacyblog.com/index.php?entry=entry090802-145533
Government-run nursing homes can be held liable for neglect and abuse of their residents under a federal civil rights statute, Section 1983 of Title 42 of the United States Code, under a recent ruling by the 3rd Circuit Court of Appeal. In Grammer v. Hazel the federal appeals court for the Third Circuit (which covers Pennsylvannia, Delaware and New Jersey) held that the Federal Nursing Home Reform Act gives residents of state and county-run facilities the right to bring federal civil rights lawsuits over inadequate care.

In the Grammer v. Mercy case, the lawsuit was brought on behalf of Melviteen Daniels, a deceased resident of the John J. Kane Regional Center at Glen Hazel, in Pittsburgh. At the nursing home, Melviteen is alleged to have acquired pressure ulcers due to neglect; the pressure ulcers became infected, causing her death by septic infection.

Thanks to the lawyers (D. Aaron Rihn and Bob Daley, Robert Peirce & Associates, Pittsburgh, Pennsylvania)who brought the case on behalf of Melviteen's family, for their creative advocacy for their clients.

The ruling is especially significant for nursing home residents who live in states that do not have laws allowing civil lawsuits for elder abuse or neglect, because such residents can rely on the Grammer v. Hazel ruling to bring elder abuse lawsuits, in federal court, or in state court under federal law. To read the 3rd Circuit's decision, click here.

One open question is to what extent this ruling can be made applicable to nursing homes that are not government-operated but which receive government funds, such as Medicare and Medicaid payments (which virtually all nursing homes do). The lawsuit in Grammer was brought against a county-operated nursing home, under Title 42 U.S.C. Section 1983, which authorizes lawsuits against state-entities for violation of federally guaranteed rights. It is an open question whether a nursing home resident can sue a privately-owned nursing home directly under the Federal Nursing Home Reform Act (FNHRA), but one which the law surely lends itself to.

Felicia Curran
www.ElderAdvocacyLaw.com

]]> Federal Oversight, Lawsuits http://www.elderadvocacyblog.com/index.php?entry=entry090802-145533 Felicia Curran Sun, 02 Aug 2009 21:55:33 GMT http://www.elderadvocacyblog.com/index.php?entry=entry090729-133523 The Los Angeles Times is reporting that the new management of the California is seeking to more than triple the size of their enforcement staff, and to raise licensing fees, in order to get on top of the backlog of patient complaints against nurses, who are otherwise still practicing as the charges go uninvestigated. Congratulations again to the terrific investigative reporters at the Los Angeles Times and Propublica for bringing to light the quagmire of complaints at the BRN.

Whether the Governor and the Legislature will approve this type of staff increase is unknown, but if the cost of the staff increase is paid for by raising the licensing fees paid to the State by registered nurses, perhaps it will fly. Let's hope.

The state agencies that license nursing homes/skilled nursing facilities (the California Department of Public Health) and residential care facilities for the elderly (The Department of Social Services Community Care Licensing) are, in my opinion, even more grossly understaffed and hopelessly behind in responding to complaints on behalf of nursing home residents and the elderly living in care homes and assisted living facilities. And the idea of financing staff increases by raising licesning fees on nursing homes would be a brilliant move. Let's hope that will be next on some investigative reporters' list, because without some kind of crisis, or that type of reporting, it isn't likely to happen on its own.

To read the LA Times story, click here.

Felicia Curran
www.ElderAdvocacyLaw.com]]> http://www.elderadvocacyblog.com/index.php?entry=entry090729-133523 Felicia Curran Wed, 29 Jul 2009 20:35:23 GMT