Author Archives: Judith Graham

Judith Graham

About Judith Graham

Judith Graham (@judith_graham), a Colorado-based freelancer, is AHCJ’s topic leader on aging, and as such curates related material at healthjournalism.org. She welcomes questions and suggestions on aging issue resources and tip sheets at judith@healthjournalism.org.

Aging adults face universal issues of access to care, poverty, discrimination

The aging of the population is a global trend, and one that will affect developing countries even more than the United States and Europe.

Judith GrahamJudith Graham (@judith_graham), has served as AHCJ’s topic leader on aging for more than a year. She has been vital to our goal of building the best resources for journalists on this topic. We thank her for her service and look forward to following her and continuing to learn from her.

If you are interested in being the new topic leader on aging, read more about the position and how to apply.

I wrote about this for The New York TimesNew Old Age blog, using as a hook the publication of a major report on the topic from the United Nations Population Fund.

That study is worth reading if only to understand how the issues we’ve been talking about on AHCJ’s aging website are playing out across the world.

It changes your perspective as a reporter when you realize this beat isn’t limited to what’s going on in your city or your state: It concerns an amazing, unprecedented development – the lengthening of the human lifespan – occurring everywhere on this planet.

Here, we’ve been discussing key problems that older people face, such as ageism, age discrimination and elder abuse. When the U.N. Population Fund asked an international sample of 1,150 adults age 60 and above about their experiences, this is what they said:

  • 67 percent said they believed age discrimination affects older people
  • 37 percent said they had experienced age discrimination personally in the last year
  • 43 percent said they were afraid of personal violence
  • 49 percent said they were treated with respect. Flip this around and it means more than half indicate not being treated with respect.

That last statistic brings a knot to my throat.

We’ve also talked here about what can happen when older people lose jobs, see their nest eggs shrink, delay retirement, and struggle with insufficient incomes. The fact of the matter is that poverty isn’t good for any older person’s well being or health, whether she lives in the United States or Bangladesh.

This is what people 60 and older said when asked about this topic for the UN survey:

  • 66 percent wanted to work for money, if only they had the opportunity
  • 33 percent said they had paid employment in the last month
  • 53 percent found it hard or very difficult to pay for basic services
  • 47 percent said they found themselves “always” or “very often” worried about problems with money
Core Topics
Health Reform
Aging
Oral Health
Other Topics

Hardship. That’s what characterizes the life of too many older people across the world.

Adding to that is a substantial burden of poor health and disability that I mention in my New York Times’ piece but that’s worth repeating here. Again, from the UN survey:

  • 44 percent of adults age 60 and older say their health status is fair
  • 22 percent say their health status is bad or very bad
  • 34 percent say it’s difficult or very difficult to access health care when they need it
  • 16 percent say they are very often or always lonely

You’ve probably heard it said, as I have, that how we treat the most vulnerable among us – children, the severely disabled and the elderly – is a measure of who we are, both individually and as a society.

The perceptions of aging documented in the United Nations survey pose a challenge. Is this good enough, the way we’re treating the oldest among us? Can we hold our heads high and feel that we have done all we should?

Personally, when I write about these issues I hope to contribute, in some small measure, to sparking these kinds of questions in peoples’ minds as well as thoughtful policy exchanges.

It’s been a pleasure serving as editor of the aging site this past year. As some of you may know, I’m stepping down as editor to pursue other endeavors. Good luck to all of you.

Related

AHCJ seeks its next topic leader on aging; learn more

Cost of long-term care merits coverage, discussion

With the baby boomers aging into Medicare and heading into years when physical decline and disability gradually become more common, one thing seems certain: Long-term care will inevitably become a much more important topic of national discussion in the years ahead.

Judith GrahamJudith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society.

If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.

Two recent articles underscore the point. One is by Stuart Butler, director of the Center for Policy Innovations at the Heritage Foundation, a Washington, D.C.-based think tank. The other is by William Galston, a senior fellow in the governance studies program at the Brookings Institution, another think tank in the nation’s capital.

Both argue that a long-term care crisis is at hand and will only grow in scope as the baby boomers swell the ranks of older people who need assistance with household tasks (bill paying, shopping, cleaning), personal care (bathing, dressing, toileting) and custodial care.

“The growing cost of long-term care (LTC) is fast becoming a problem we can no longer ignore,” Butler writes. Continue reading

Low interest rates affect seniors’ ability to pay medical expenses

A lot is written about people who don’t save enough for retirement. But what about older adults who saved diligently, only to find the value of their nest eggs depleted in this low-interest rate environment?

Judith GrahamJudith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society.

If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.

I’m not talking here about stocks that take a tumble, slicing into their value. I’m talking about the interest rates that older people earn on money put away in bonds, money market funds, or certificates of deposit – and that they count on to supplement Social Security payments in their retirement years.

When these interest rates are at historically low levels, as they are now, people who counted on earning 5 percent to 7 percent annually from their savings can find themselves instead earning instead 1 percent to 2 percent. That can make a real difference in the affordability of their retirement plans and their ability to handle expenses such as payments for housing, food, prescription medications or out-of-pocket medical expenses.

For a really good examination of the issue, look at this story in the Minneapolis Star Tribune by Jennifer Bjorhus. It’s full of detailed analysis and personal stories that illustrate this problem which, it’s safe to say, is playing out with seniors in every community across the United States. Continue reading

New and noteworthy tidbits on the aging beat

Alzheimer’s

Jennifer Robison of the Las Vegas Review-Journal takes an in-depth look at the financial impact of Alzheimer’s on families and programs that might help them bear the expense.

The bottom line: Costs associated with Alzheimer’s, whether for assisted living (which is not covered by Medicare) or in-home assistance (often not covered, also) or respite care (sometimes covered, depending on the state and program), are an enormous, often catastrophic, burden for families.

LGBT aging

Judith GrahamJudith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society.

If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.

Jen Christensen of CNN examines the aging of a LGBT (lesbian gay bisexual, transgender) generation that came courageously out of the closet and led the fight for civil rights.

The bottom line: Historically, LGBT have isolated themselves as they’ve aged, re-entering the closet, as it were. Retirement options are slowly improving for this group, due in part to new federal policies.

Medicare

There’s been lots of debate recently over the pros and cons of raising the age of eligibility for Medicare to 67 from 65. Sarah Kliff’s analysis in The Washington Post is a useful addition to a long list of stories on this topic.

The bottom line: The issue has been studied and there’s data out there for journalists to turn to in reporting on this topic. Analysis needs to be fact-based and sophisticated.

End-of-life

A clash between doctors and a family over end-of-life care will come before the Supreme Court of Canada in the next several weeks. In this story, CBC News writes about the painful details of a very difficult case that raises questions of medical futility, religion, and ethics.

The bottom line: The line between what constitutes “killing” and what constitutes “letting die” is not at all clear in some circumstances. Continue reading

Webcast explores aging adults’ contributions, widening disparities, creating ‘synthetic families’

You don’t often hear about how much older adults contribute to society. That’s a shame.

It allows the aging of American to be portrayed as a story of dependency: the reliance of the old upon the young. Instead, the truth is that the generations are inter-dependent, each benefiting the other.

Toni Antonucci
Antonucci

S. Jay Olshansky
Olshansky

Julie M. Zissimopoulos
Zissimopoulos

This was one of the themes articulated during AHCJ’s recent webcast with three members of the MacArthur Network on an Aging Society, a group of prominent academics exploring the opportunities as well as the challenges associated Americans’ increased life spans.

Julie Zissimopoulos, associate director of the Schaeffer Center for Health Policy and Economics at the University of Southern California, described a framework for understanding how much support older adults get and how much they give in turn. (Resources and PowerPoint presentations from the webcast are available here.)

In the “here’s what they get” column, she put government health programs such as Medicare and Medicaid, Social Security, benefits from the department of Veterans Affairs, food stamps, programs supported through the Older Americans Act, and informal caregiving, largely from children and spouses, among other smaller items.

Total that up and it comes to $916 billion in public expenditures for older Americans in 2010.

In the “here’s what they give” column, Zissimopoulos included income taxes (federal and state), payroll taxes and property taxes that older adults pay, gifts and inheritances that they pass on to family and friends, the informal care they provide to spouses, elderly parents and children, and the many hours they spend volunteering, among other items.

Total that up and it comes to $646 billion in contributions by older Americans, also in 2010.

The difference, $316 billion, is a lot of money but by no means the enormous, out-of-proportion give-away portrayed by some. And the reality is all of society shares an interest in controlling health care costs, the largest item in the “debit” column for older adults.

Another theme of the web chat revolved around one of the greatest achievements of the 20th century – the extension of the human life span by more than 30 years, largely because of improvements in public health as well as advances in science and medicine. Continue reading

Focus on Medicaid as budget debates escalate

Don’t forget about Medicaid as the budget debate occupies center stage in Washington.

Howard Gleckman reminds us why this is so important in a chock-full-of-data blog post at Forbes. I give Gleckman a boatload of credit. He’s one of the few reporters who consistently writes about vulnerable older people – a population that gets far too little attention.

Judith GrahamJudith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society.

If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.

Among the key points in his post: Two-thirds of Medicaid budgets are spent on frail older people and young people with disabilities. One-third of budgets, about $120 billion in total, goes to long-term care.

Older people covered by Medicaid are poor and, many of them, dependent and chronically ill. About 9 million people known as “dual eligibles” are covered by Medicaid and Medicare, and this is a very vulnerable population, Gleckman observes:

According to the Kaiser Family Foundation, one-quarter of elderly who are eligible for both programs need assistance with at least three activities of daily living (such as bathing, going to the bathroom, eating, or dressing). Many are, in other words, helpless.

“Among the 1 million dual eligibles who are the most costly Medicaid patients, nearly half are aged 80 or older, three-quarters need help with 3 or more activities of daily living, three-quarters live in institutions, and one out of every six has Alzheimer’s.”

“Ninety percent are poor or near-poor. More than half have incomes of less than $10,000.”

Many politicians discussing cuts don’t really understand how Medicaid works or who it covers, Gleckman notes. You can be sure this is as true of your state legislators as it is of those in Congress. Continue reading

Life expectancy of less-educated Americans decreasing

Call it the life expectancy gap.

While Americans with higher education degrees are living longer, white men and women without high school diplomas are seeing their life expectancies shrink – by four years since 1990.

Public health professor S. Jay Olshansky, based at the University of Illinois at Chicago, wrote about this remarkable trend in Health Affairs recently (AHCJ members have free access) and Sabrina Tavernise picked up the story for The New York Times.

Judith GrahamJudith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society.

If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.

Of most interest to Tavernise is what’s underlying this development, which is not affecting either blacks or Hispanics with similarly low education levels. (That observation is worthy of further investigation. Why would whites be affected but not others in similar circumstances?)

Could it be higher levels of obesity, smoking and prescription drug use among poor educated white women? The trend toward single parenting, with all the stress that this implies? Low wage jobs that don’t offer much flexibility, another potential source of stress? The lack of health insurance?

Tavernise writes:

“There’s this enormous issue of why,” said David Cutler, an economics professor at Harvard who was an author of a 2008 paper that found modest declines in life expectancy for less educated white women from 1981 to 2000. “It’s very puzzling and we don’t have a great explanation.”

“Something is going on in the lives of disadvantaged white women that is leading to some really alarming trends,” Jennifer Karas Montez of Harvard told the New York Times.

Here are the numbers from the Health Affairs study, sponsored by the MacArthur Foundation Research Network on an Aging Society, which will be participating in an AHCJ webcast on aging trends:

White women without high school diplomas have a life expectancy of 73.5 years, compared with one of 83.9 years for women with college degrees, according to the latest estimates available. Between 1990 and 2008, life expectancies for poorly educated white women fell by five years.

White men without have school diplomas have a life expectancy of 67.5 years, compared with one of 80.4 years for men with a college degrees. Betwteen 1990 and 2008, life expectancies for poorly educated white men fell by three years.

To me, this is one of the most graphic, vivid illustrations of the growing gap between “haves” and “have nots” in America that I’ve yet seen. Continue reading

Panelists: Watch state activities for stories about seniors’ health services

What lies ahead for Medicare now that election results are in?

Two words sum up the short-term outlook:  cost cutting.

Judith GrahamJudith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society.

If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.

Down the road, a more ambitious and difficult task awaits: restructuring the program and realigning its incentives to create a lower-cost, higher quality, more sustainable health care system.

What isn’t on the horizon is a radical overhaul of Medicare along the lines that the Republicans proposed. Converting Medicare to a premium-support model isn’t going to happen, at least not any time in the foreseeable future.

Just after the election, AHCJ asked three distinguished experts – Karen Davis of the Commonwealth Fund, Joseph Antos of the American Enterprise Institute and John Rother of the National Coalition on Health Care – to weigh in on the outlook for health programs that serve seniors. Medicare held center stage during most of that web chat.

All three experts said that traditional Medicare isn’t sustainable and that a top priority should be reimbursement reforms that shift the program away from “paying for volume” to “paying for value.”

Although Medicare spending per capita has slowed, total spending will soar as tens of millions of baby boomers become eligible for the program, putting intense pressure on the federal budget, said Davis, president of the Commonwealth Fund.

Core Topics
Health Reform
Aging
Oral Health
Other Topics

With a 27 percent cut in Medicare reimbursement for physicians due to go into effect in January, the most immediate task for legislators is averting that, panelists agreed.

Next will come dealing with the “fiscal cliff” (a package of automatic tax hikes and spending cuts) that could throw the country into another recession, according to the panel. While an end-of-the-year deadline looms, that will surely be extended into next year, the panelists predicted.

“A key issue is whether Medicare and entitlement reform” will be part of these “fiscal cliff” discussions, Davis said. “Short term savings” in Medicare above and beyond those already proposed by the administration will likely be a focus, suggested Rother, president of the National Coalition on Health Care.

(President Obama had previously announced plans to cut projected increases in Medicare spending by $716 billion over a 10 year period. That’s now a floor for cuts that will be upcoming.) Continue reading

New and noteworthy tidbits on the aging and health care beat

The Center for Budget and Policy Priorities has published a new report that looks at Social Security’s role in keeping Americans out of poverty.  Poverty is closely linked with compromised access to medical care and lesser health status.   Regarding older adults, the Center explains:

“Almost 90 percent of people aged 65 and older receive some of their family income from Social Security.[2]   Without Social Security benefits, 43.6 percent of elderly Americans would have incomes below the official poverty line, all else being equal; with Social Security benefits, only 8.7 percent do.  These benefits lift some 14.5 million elderly Americans — including 8.7 million women — above the poverty line.

Social Security reduces elderly poverty dramatically in every state in the nation, as Figure 1 and Table 2 show.  Without Social Security, the poverty rate for those aged 65 and over would meet or exceed 40 percent in 41 states; with Social Security, it is less than 10 percent in the large majority of states.”

The Scan Foundation has published a new issue brief on who provides long-term care in the United States.  Among the findings:

  •  The vast majority of people who need long-term care – 87 percent – receive services from informal or unpaid caregivers.
  • 43.5 million Americans serve as informal caregivers to adults age 50 and older.  Two-thirds of these caregivers are female.
  • For people who require assistance with activities of daily living, the most common types are getting in and out of bed (40 percent), getting dressed (32 percent) and bathing and showering (26 percent).
  • For people who need help with so-called instrumental activities of daily living, the most common types offered by a caregiver are transportation (83 percent) and housework and grocery shopping (both at 75 percent).
  • 70 percent to 80 percent of paid long-term care services are provided by direct care workers – certified nursing assistants, personal care aides, and home health aides.

AARP and New York’s United Hospital Fund document the extent to which family caregivers deal with complex medical needs of older relatives in a new report, Home Alone:  Family Caregivers Providing Complex Chronic Care.  It’s based on an online survey of more than 1,600 family caregivers.   Important findings include:

“Almost half (46 percent) of family caregivers performed medical/nursing tasks for care recipients with multiple chronic physical and cognitive conditions.

“These tasks include managing multiple medications, helping with assistive devices for mobility, preparing food for special diets, providing wound care, using monitors, managing incontinence, and operating specialized medical equipment.

“Family caregivers reported very few home visits by health care professionals. Sixty-nine percent of the care recipients did not have any home visits by health care professionals. Of those who did have home visits, roughly seven in ten were visited by a nurse.

“Most family caregivers who provided help with five or more medical/nursing tasks believed they were helping their family member avoid institutionalization. Those who provided these tasks and reported they had training were more likely to say they were able to help their family member avoid nursing home placement.

“These significant relationships are important on both the individual and public policy levels.”

AARP’s Public Policy Institute also  has published a new issue brief that looks at the impact of family caregiving on work.  Of note:

“An estimated 61 percent of family caregivers of adults age 50 and older are currently employed either full-time (50 percent) or part-time (11 percent).”

“Forty-two percent of U.S. workers have provided care for an aging relative or friend in the past five years. About half (49 percent) of the workforce expects to be providing eldercare in the coming five years.”

“In 2011, 17 percent of workers in the United States provided eldercare,5-7 up from 13 percent in 1999.”

If you’ve seen other reports or issue briefs on aging that deserve wide circulation, drop a line below and let us know.

Seniors have special concerns in natural disasters like Sandy

It’s well known that older adults are more vulnerable in times of natural disaster. But there’s nothing like a storm the size of Sandy to drive this point home.

Judith GrahamJudith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society.

If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.

In the past week, we’ve read about New York City hospitals and nursing homes that decided to wait out the storm rather than evacuating. Sheri Fink, who won a Pulitzer Prize for her report on decisions made at Memorial Medical Center in the wake of Hurricane Katrina, got out ahead of Sandy and talked to city and state health officials as well as facility executives. Her ProPublica story is must-reading for anyone who wants to understand the thinking of officials responsible for preparing for the storm.

A take-home point: Evacuations can be extremely difficult for frail seniors living in nursing homes. Balancing the potential impact of displacing residents against the potential impact of sheltering in place during a storm isn’t easy.

I hope that reporters writing these kinds of Sandy-related stories take this into account. For another look at decisions made by city and state decisions vis a vis nursing homes, see this piece by Ben Hallman in the Huffington Post. Kudos to this reporter for going out during the storm and going to a site where nursing home residents were being sheltered. Continue reading