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Aspects of Aging

Long Term Health Care

PBS Newshour
June 2014 - (Frequently updated)
A wide-ranging series of articles about long-term care, including how the aging population will affect the health care system, costs, Medicare and Medicaid, long term care insurance policies, finding in-home care workers as well as facilities, how to care for aging parents from a distance, easing the burden, and much more. 

New York Times
April 1, 2015

Speak the words “dementia” and “nursing home,” and you’ve exposed two great fears among people in developed countries, where living until 80 or 90 is increasingly common. Despite efforts to keep frail elders in their own homes, increasing numbers of people with dementia are likely to spend time in a nursing home.  There is widespread fear about nursing home care, which in many cases is warranted. However, there are national efforts to change nursing home culture, and many facilities have made strides in creating homelike environments and adopting care practices that are driven by residents’ and families’ preferences. We need to examine what works in the best nursing homes and apply their methods to all facilities.


The Social Security Maze and Other Mysteries (Book review)
New York Times
March 13, 2015

“PBS NewsHour” correspondent Paul Solman wrote the guide to Social Security “Get What’s Yours,” Social Security is the biggest source of retirement income for many Americans, and even if you’ve made more money than average during your career, that just means that the book’s tricks and tips will be ever more relevant. After all, the more you’ve made, the more you have at stake when it comes to filing for benefits in just the right way at precisely the right moment. Given that there are 2,728 core rules and thousands more supplements to them according to the authors, it pays, literally, to seek out a guide.  An updated edition of the book was published in 2016.

New York Times
February 22, 2016
In a case against a New York nursing home for wrongful death, the surviving son of a patient has been unable to  sue in court. A clause in the nursing home's contract stipulated that any dispute for elder abuse required private arbitration, i.e., no judge, no jury, and proceeding hidden from public scrutiny, thus obscuring patterns of wrongdoing. UPDATED: The Right to Sue Restored (New York Times, September 30, 2016). As of November 28, 2016, nursing homes may no longer require binding arbitration.

New York Times
August 20, 2016
With the support of private equity money, InnovAge aims to aggressively expand a little-known Medicare program that will pay to keep older and disabled Americans out ofnursing homes. The goal of the program, known as PACE, or the Program of All-Inclusive Care for the Elderly, is to help frail, older Americans live longer and more happily in their own homes, by providing comprehensive medical care and intensive social support. It also promises to save Medicare and Medicaid millions of dollars by keeping those people out of nursing homes.

Why Do We Teach CPR, But Not Caregiving?
Next Avenue/Forbes
February 10, 2017

In teaching medical students about caregiving,start by teaching them to identify the caregiver, recording his or her health status and the impact caregiving is having on it, then instructing that person in methods to support and maintain their own health. 

Adelante Development Center, Inc.

Website of a nonprofit group that provides support services for the disabled as well as for veterans and the elderly in New Mexico. Explore the site for information.

Who Will Care for Us - The Aging, Childless and Single Population?
Huffington Post
July 29, 2017

Studies show that between 66 and 70% of us will need long term care. The majority of them depend on family caregivers - spouses or adult children. But what about those who don't have that option? This article provides some guidance for planning ahead.

Serious Nursing Home Abuse Often Not Reported to Police, Federal Investigators Find
August 28, 2017

Despite laws requiring it, about 1/4 of abuse cases are not reported by nursing homes. An Inspector General's report says that the Centers for Medicare and Medicaid Services needs to do a better job of linking hospital and emergency room admissions to possible abuse in nursing homes.

Making the Move to Assisted Living
HomeCity Real Estate

web site with advice and links to help decide if and when it's time to move into an assisted living facility, as well as descriptions about the different types of care and facilities to consider.

Five Tips for Choosing a Reliable Nursing Home
New York Times
September 14, 2017

You want to be sure that the nursing home you choose for yourself or for a loved one is going to be comfortable and safe. Take your time, look at government reports, visit at different times...... This is not a decision to be made in a rush or without considering all the information you can gather.

$26M TorC Facility Raises Bar for Elder Veteran Care
Albuquerque Journal
October 21, 2017

A new home for elderly veterans has just opened, with more home-like rooms and state of the art facilities. 

Care Suffers as More Nursing Homes Feed Money into Corporate Webs
New York Times
January 2, 2018

It's incredibly hard to track, but an increasing number of for-profit nursing homes are parts of larger businesses which contract within the network for building leases, custodial and management services, and other operations, all owned by the same company or individuals. Many are funneling money to these "contractors" at the expense of staffing and patient care.

Home Care Agencies Often Wrongly Deny Medicare Help to the Chronically Ill
National Public Radio
January 17, 2018

Medicare is supposed to help pay for in home care in some cases, but large numbers of agencies refuse to acknowledge and help apply, telling patients that there is no such coverage. 

U.S. Pays Billions for "Assisted Living," But What Does It Get?
New York Times
February 3, 2018

Medicaid pays billions of dollars every year for "assisted living" care, but a recent investigation indicates that there is little state regulation of the industry, and that poor care and bad living conditions are not uncommon.

Complaints About Nursing Home Evictions Rise, and Regulators Take Note
New York Times
February 22, 2017

There are strict regulations about when a patient can be removed from a nursing home, but some homes are skirting the regulations. The primary motivation seems to be the end of Medicare payments and change to Medicaid, which pays less. 

One State's Quest to Introduce Long-Term Care Benefits
New York Times
March 9, 2018

Washington state representatives introduced legislation this year to add a new tax which would pay eligible citizens $100 per day for a year of long term care, whether in a nursing home or in their own homes. Other states are watching.

Single? No Kids? Don't Fret: How to Plan Care in Your Later Years
New York Times
March 23, 2018

Seniors in the US tend to depend on their adult children (usually daughters) to care for them. Those who don't have children need to plan ahead for other arrangements.

No Luck Finding the Right Nursing Home? Maybe Yelp Can Help
New York Times
May 11, 2018

There are several official sources of evaluative information about nursing homes, but none of them come from residents or their families. Yelp fills that gap with consumer reviews. As with all consumer reviews, of course, a large dose of salt is necessary. Don't make it your only source, but add it to the mix.

Nursing Homes in New Mexico Rank at the Bottom
Albuquerque Journal
May 21, 2018

"An analysis by the investigative journalism organization ProPublica showed that of 74 Medicare- and Medicaid-certified homes located in New Mexico, inspectors reported serious deificienies in 36 of them between 2015 and April 2018. By that measure, New Mexico is the worst in the nation for serious deficiencies on a per-nursing-home basis..."  Other reports (referenced above) have revealed a pattern of falsifying staffing and other measures, so the situation may be even worse. More concerning, the Trump administration is proposing to reduce penalties for deficiencies in care. The state has proposed changes to improve the situation for residents, but there is no funding. This article concludes by identifying four of the worst offenders.

"It's Almost Like a Ghost Town." Most Nursing Homes Overstated Staffing for Years
New York Times
July 7, 2018

Until recently, the government relied on nursing homes' self-reported staffing level information as part of their quality evaluations. A recent change requiring actual payroll reports reveals what has long been suspected - nursing homes are chronically understaffed, particularly at night and on weekends. The result can be poor care, sometimes even resulting in unnecessary medical emergencies among residents. A tool developed by the Times, based on the government data, allows users to search for staffing information about specific homes or those in a particular place. 

Kicked Out of Assisted Living: What You Can Do
September 20, 2018

Assisted living facilities are largely unregulated. Increasingly, they are evicting residents when they become "too difficult" to care for. There are steps that can be taken to avoid this. Ask lots of questions about levels of care and policies before you put down a deposit and move in. If an eviction notice is filed, get an independent assessment of the level of care that is needed and confirmation that the facility cannot provide it. File a grievance with the state's long term care office. File a complaint with the landlord-tenant courts. All of these moves will delay the necessity to move, allowing you to determine if it is necessary and to identify the best place to go.

In the Nursing Home, Empty Beds and Quiet Halls
New York Times
September 28, 2018

Fewer people are ending up in nursing homes. The trend is the result of changes in Medicare payments for rehabilitation care and in longterm care, allowing more seniors to remain at home. Nursing homes are closing or downsizing. But the best remain open and continue to have waiting lists.

Elderly Maine Considers Tax Hike to Fund Universal Home Care
PBS Newshour
November 1, 2018

Maine is the oldest state in the nation, and has a severe lack of home care providers (and many residents who can't afford to pay for care). A proposal would impose a tax on incomes above approximately $128,000 to create a public fund to increase salaries and training for care providers (increasing the availability), as well as providing payments to those providers and to relatives providing care. 

Meet Zora, the Robot Caregiver
New York Times
November 23, 2018

In a recent development, a nursing home in France, with residents diagnosed with dementia and other illnesses requiring round-the-clock care, added a robot to the care team. "Zora" is controlled by a health care provider (usually out of site), and cannot provide medical or other actual care. But Zora provides companionship. The residents have developed emotional attachments to the little robot. As the population ages and the number of care givers can't keep up, robots will, almost certainly, fill some of the gaps.

Hospitals Stopped Readmitting So Many Medicare Patients. Did That Cost Lives?
New York Times
January 19. 2019

Starting in 2012, the ACA included a provision to penalize hospitals that readmitted too many Medicare patients. Readmissions went down, but deaths from things like pneumonia and heart failure started to go up among discharged patients. Although there is not yet a definitive link between the two, indications are that at least some hospitals and nursing homes may be refusing to readmit patients who need hospital care, in order to avoid the penalties.

Nursing Homes Are Closing Across Rural America, Scattering Residents
New York Times
March 4, 2019

Financial pressures - shrinking populations and lower Medicaid payments, in particular - are forcing the closure of nursing homes. Hardest hit are those in rural areas or independently operated homes that don't have the financial backing of a large chain. The result is that many residents are being forced to move, sometimes long distances away from family and friends.

Where There's Rarely a Doctor in the House: Assisted Living
New York Times
March 29, 2019

Assisted living facilities were designed for people who needed limited help with daily living activities. Increasingly, residents are older and sicker than the original plan. While medical care is required in nursing homes, the unregulated assisted living facility doesn't have it. Residents may end up in the emergency room as a result. Some facilities are beginning to contract for house calls to meet the need.

How Not to Grow Old in America
New York Times
August 29, 2019

Assisted living residences are sold on the concept that all aging people need is a little help and they can continue to live mostly independently. But the majority of us will need more than a little help. And if you need help walking, using the bathroom, or have dementia, assisted living is not for you. Most assisted living residents need substantially more care than they are getting. While nursing homes are regulated, assisted living is not. If it is going to be a solution for an aging population, things have to change.

Nursing Homes Are a Breeding Ground for a Fatal Fungus
New York Times
September 11 (updated Sept. 13), 2019

Nursing homes and long term stay hospitals are spreading drug resistant fungal infections between patients and into acute care hospitals. Despite clear guidelines, staff and visitors are not following protocols for caring for patients who have been identified as having the infections. They are not identifying carriers to reduce the spread of infections. Infected patients and carriers are moved in and out of nursing homes and hospitals without proper precautions being taken. Nursing homes are setting up lucrative new areas to care for patients on respirators (those most often infected) without providing adequate staffing or training. The inevitable result is more sick and dying patients.

A New Wave of Caregivers: Men
New York Times
September 18, 2019

More men are becoming caregivers than ever before. Sometimes it's necessity - they have to care for an aging parent or an ill spouse. But it's also a rapidly growing employment opportunity and men are entering the field in growing numbers. Better pay follows the men, resulting in improved working conditions for all care givers.

My Family Cared for My Sick Aunt. Who Cared for Us?
New York Times
October 25, 2019

AARP estimates that the annual economic value of unpaid care for the sick and disabled adults is $470 billion in the US, and involves nearly one in five Americans. There is no compensation for lost earnings (estimated at $300,000 per caregiver over 50), nor for the stress and physical and emotional illness related to care giving. As the population ages, these issues need to be addressed.

Would You Let a Robot Take Care of Your Mother
New York Times
December 13, 2019

Aging patients, particularly those with dementia, need more attention than nursing homes and assisted living facilities can provide. Some are turning to "robotic companions" to help fill the gaps. There are pluses and minuses.

Lax Regulations and Vulnerable Residents "A Recipe for Problems" in Eldercare Homes
February 17, 2020

"Residential care homes" or "assisted living facilities" serve a vital need for the elderly who need long term care. But they are loosely regulated and, even when significant problems are identified, seldom fined or closed down. Residents may be neglected or drugged to make things easier for overworked staff. And there is such a need for beds for the aging that states don't want to close a facility and lose the spaces. A series of investigations, however, is forcing states to deal with the problem and toughen regulation and inspection standards.

After Covid-19, Aging in America May Never Be the Same
Washington Post
April 24, 2020

The horrendous death toll in nursing homes has made obvious the weaknesses of the system, revealing lax regulation, few inspections, chronic understaffing and poor staff training. Add to this a rapidly growing population of potential residents as Baby Boomers age, and Medicare and Medicaid reimbursement rates that don't keep up with increased costs, and you have a potential disaster. Potential fixes should include paying for in-home care, but that's not enough. Real reform and planning are needed.

Do You Want to Die in an ICU?
New York Times
April 24, 2020

Because older people are more likely to have severe cases of Covid-19, they are more likely to end up in an ICU and on a ventilator. And the statistics indicate that many of them won't survive. Conversations about what kind of care you want have to take place "just in case" so the decision is clear if disaster strikes.

How to Improve and Protect Nursing Homes from Outbreaks
New York Times
May 22, 2020

The coronavirus has exposed the chronic problems of nursing homes that have been there all along. Outbreaks of any contagious disease are spread easily in nursing homes where standard hand washing and other hygiene practices are not rigorously maintained. Shared rooms and baths and large dining rooms make isolation impossible. There are things that can be done to lessen the dangers, usually without significant added cost.

Did Mom Take Her Medicine? Keeping Eyes on Elders in Quarantine
New York Times
June 5, 2020

Whether because we can't visit them because of the virus or distance, there are a variety of technologies to help monitor seniors living alone. They can be reassuring for both the distant family and for the senior. Or they can seem intrusive. Be sensitive and careful before installing monitors.

Navigating Home Care During the Pandemic
New York Times
June 6, 2020

Having outsiders come into your home is risky. But older people may still need the care those "outsiders" provide. This article gives advice on how to balance safety and needed care.

This is Why Nursing Homes Failed So Badly
New York Times
December 31, 2020

Nursing home and assisted living residents and staff have been badly hit by COVID-19. The reason why is becoming clear, and the federal and state governments can do a lot to change that. Nursing homes are crowded. Their staff are overworked and underpaid - so much so that many work 2 or even 3 jobs to support themselves and their families, resulting in increasing risk of exposure and spreading infection. For-profit chains and venture capitol firms, which own an increasing number of these institutions, put profit over care. Government oversight has been weakened, even as infections rise. Medicare and Medicaid, which pay for the majority of residences, must tighten regulations, increase payments directly linked to care, and mandate better pay and training for staff.

High Turnover at Nursing Homes Threatens Residents' Care
New York Times
March 1, 2021 (updated March 5)

The high death toll of COVID-19 in nursing homes is well documents. Evidence is increasingly pointing at least part of the blame at high staff turnover, which exposes residents to more risk. Turnover is linked to very low pay and high stress. Nursing homes with better pay and working conditions had lower turnover and lower infection rates.

Turning Away from Nursing Homes, to What?
New York Times
April 1, 2021

After the COVID-19 pandemic resulted in a disproportionate number of illnesses and deaths in nursing homes and assisted living facilities, people are looking for alternatives for themselves or their aging relatives. But home care can be expensive and hard to find. Structural changes - including Medicare and Medicaid support for in-home care at a living wage - is critical. Support networks like Village in the Village are also important to allowing more people to "age in place."  For more, see Covid Pandemic Forces Families to Rethink Nursing Home Care (NYTimes May 6, 2021)

Residents Back Bill that Pushes for More Transparency in Life-Plan Retirement Communities
April 24, 2021

A proposed bill in New Mexico would require "Life-plan" communities to disclose more information about their finances to current and prospective residents.This is essential since residents invest a significant amount of money up front, and if the community closes they can lose that investment and find themselves without a home or money.

Long-haul Covid-19 Renews Push to Expand Palliative Care
Washington Post

May 10, 2021

Despite "numerous studies showing that palliative care results in a higher quality of life for patients, better management of their pain and symptoms and lower health-care costs as a result of fewer hospitalizations..." insurance only pays for in home palliative care for those in hospice. Advocates are pushing for a pilot program covered by Medicare. If it is successful, it would be expanded to Medicaid, and private insurers would be encouraged to offer coverage. The number of patients with long term symptoms of Covid is fueling the push.

How to Be a Caregiver
New York Times
ca June 6, 2021

In the U.S., about one in five people is providing unpaid health or other assistive care to a loved one. In this "Well Guide," experts provide advice on how to provide that care effectively.

What Robots Can - and Can't - Do for the Old and Lonely
New Yorker
May 24, 2021

Robot pets are becoming more sophisticated, and are proving useful companions for the elderly, particularly those with dementia. They aren't a replacement for human contact, but they fill a gap.

Nobody Wants to Live in a Nursing Home. Something's Got to Give
New York Times
August 1, 2021

Everyone wants to stay at home as they age. But the reality is that most of us will need extensive care at some point. The nursing home industry is challenged in many ways, including staffing and infrastructure. And they current financial system for long term care is not sustainable. What can be done?
In a related article, the author extends the discussion of the financial challenges: Getting Old is a Crisis More and More Americans Can't Afford

Who Will Take Care of America's Caregivers?
New York Times
August 12, 2021

As more Americans get older and in need of care, the people who provide that care are being stressed to the breaking point. Paid caregivers are under paid to the point where they have to work multiple full time jobs to support themselves - and yet many seniors and their families find the cost of care out of reach. Family caregivers (almost always female) sacrifice their own earnings (and retirement savings) and health to fill the gap. Many will end up in poverty as a result. 

Low Wage Workers Prop Up the Nursing Home Industry. They're Quitting in Droves
Washington Post
January 22, 2022

Nursing homes depend on low wage workers to care for residents. They have suffered from under staffing for years. COVID has magnified the problem, as the workers get sick or can't handle the stress of caring for too many people who need too much care. The companies who own the homes claim they can't pay more and can't find people willing to do the work. The result can be tragic.

Biden Vows to Crack Down on Poorest-Performing Nursing Homes
Washington Post
February 28, 2022

The high rate of COVID-related deaths among nursing home residents exposed the weaknesses of government oversight of the industry. Low staffing, high turnover, and other problems lead to avoidable accidents, illnesses, and deaths. The Biden administration has vowed to improve oversight, increase inspections, and make sure that changes are made.

Many of Us Want to Age at Home. But That Option Is Fading Fast
New York Times
March 30, 2022

In order to remain at home, many aging residents need in home help with house keeping, cooking, daily activities, medications, etc. The home care workers who provide these essential services are very poorly paid, and there are fewer people willing to do the work. 

Major Report Says Nursing Home Care, Funding System Needs Overhaul
PBS NewsHour
April 6, 2022

The high death toll of COVID among nursing home residents revealed many of the systemic problems that the industry has tried to hide. A new report from the National Academies of Sciences, Engineering and Medicine looks at the issue and suggests major changes that are immediately needed to improve the health and safety of residents. Changes in staffing, building design, finances and oversight are all needed. For more, read Nursing Homes Are in Crisis. We Can't Look Away Any Longer

Can Robots Save Nursing Homes?
New York Times
April 21, 2022

Increasingly "smart" robots can help with chronic staffing problems in nursing homes, helping with meal delivery, socialization and group activities, telemedicine, medication monitoring, etc. 

How Long Will the US Continue to Disrespect Its Caregivers
New York Times
August 17, 2022

The need for caregivers for the aging and disabled population is huge and rapidly growing as the Baby Boomers get older. But the government has done nothing to meet the need. Wages for caregivers - both in-home and in nursing homes, assisted living facilities, and other institutions, are terrible (the median salary for a full time caregiver is $18,000 per year), and working conditions are difficult. Policy changes are overdue.

Seniors Are Stuck Home Alone As Health Aides Flee for Higher-Paying Jobs
Washington Post
September 25, 2022

We all want to stay in our homes as we age. But we may need help to do that. Home care aides are increasingly hard to find, with waiting lists in some areas stretching into the months and years, because the jobs are demanding but very low paying. And the demand for aides is inevitably increasing as Baby Boomers age and life expectancy increases. There are no easy fixes.

Biden Administration Creates Tougher New Penalties for Failing Nursing Homes
PBS Newshour
October 21, 2022

After the COVID epidemic revealed significant problems in nursing homes, the Centers for Medicaid and Medicare will be required to more closely nursing homes, with stiff financial penalties for those that continue to provide subpar care.

States Try Easing the Burden of Long-Term Care's High Cost
New York Times
June 16, 2023

Almost all seniors will need nursing care as they get older. The costs are extremely high, private long term care insurance is expensive and complicated, Medicare does not cover the cost, and Medicaid only pays for those who have spent down all of their resources. A handful of states are experimenting with programs to help younger people save for long term care through payroll tax programs that provide insurance when it's needed.

Nursing Homes Face Minimum Staff Rules for First Time
Washington Post
September 1, 2023

Understaffing has been a constant complaint among nursing home residents and their families, and research demonstrates that inadequate staff can have severe consequences. Proposed rules would mandate minimum hours of care and specific requirements (such as a registered nurse being present) to improve care. The nursing home industry is pushing back.

More Than Half of Older Americans Will Need Long Term Care

September 17, 2023

The cost of long term care has skyrocketed, and programs like Medicare don't help with the cost. Long term care insurance costs have also increased dramatically. Most Americans won't be able to afford the care they need. 

You Shouldn't Have to Care for Your Aging Parents on Your Own
New York Times
September 6, 2023

Not only is long term care expensive, the majority of seniors want to remain in their homes as they age and need more care. The burden falls on family members, and there is little or no support - either financial or physical - for those unpaid caregivers, who sacrifice their careers, their young families, and their own health to care for aging relatives. The problem is unique to America in the developed world.

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