March 9, 2023

Post-COVID, View of Nursing Homes Erodes

COVID has moved from a central place in our lives to a risk that, while still important to heed, has moved out of the foreground.

One thing we will not forget, however, is COVID’s toll on nursing homes and other long-term care facilities, where the virus has killed more than 200,000 older Americans and staff. The tragedy also played out in nursing homes in Canada, where the deaths received high-profile coverage in the news media, just as they did in this country.

A survey of Canadians at the end of 2020, while COVID was still raging, indicates that the pandemic caused major changes in their thinking about old age. The reaction of a majority of people in their 50s and 60s to what they saw happening was to say they intend to avoid ever spending time in a nursing home, according to a summary of the survey by Canadian researchers.

It’s not hard to understand why so many deaths left such a lasting impression. What may be more surprising is the potentially big shift in what Canadians now believe should be done to address the situation.

More than two out of three Canadians surveyed said government could increase taxes to fund more government support for someone to come into retirees’ homes and help them with daily activities such as cooking, shopping, showering, and dressing.

But home care is an expensive proposition: the cost of one month in a nursing facility in Canada would buy only about two hours of home care per day. However, about one in four individuals said they would also take more responsibility themselves for preventing a nursing home stay by saving money to pay for their future home care. …Learn More

March 3, 2022

Nursing Home Staffs’ Vax Rates by State

One in four of the more than 900,000 Americans who have died from COVID resided in nursing homes. Yet two years into the pandemic, hesitancy about protective vaccines persists in the facilities in many states.

In January, the Supreme Court upheld a regulation by the Biden administration that required all staff to be vaccinated in long-term care facilities that receive Medicare or Medicaid funding, which is pretty much all of them.

But a newly released rundown of state vaccination rates may not provide much comfort to vulnerable elderly residents and their families living in Ohio, Oklahoma, and Missouri, which rank at the bottom – only about 70 percent of nursing home staff were fully vaccinated as of Jan. 30, according to the Kaiser Family Foundation. The national average was 84 percent.

The highest vaccination rates – 99 percent of staff – were in Massachusetts, Maine, New York, and Rhode Island.

Kaiser’s vaccination rates were calculated based on the staff working in 10,600 U.S. nursing homes who’ve received two doses of the Pfizer or Moderna mRNA vaccines or one shot of Johnson & Johnson’s traditional vaccine. The rates exclude booster shots, which are not part of the federal mandate. The nationwide booster rate for staff, which Kaiser provides separately in its report, is a low 28 percent – the Hawaii, New Mexico and California rates are double that.

A partial reason for the wide range of vaccination coverage is that states have different deadlines for complying with the federal mandate – some were in January and some are in February. But numerous states, including Louisiana, Tennessee, and Virginia, have low vaccination rates because they are, despite the Supreme Court ruling, seeking other legal avenues to challenge the mandate.

The size of a state’s population of people over 65 doesn’t seem to have much bearing on vaccination rates in nursing homes. …Learn More

October 7, 2021

Headlines Sway Perception of Social Security

Each new reminder in the annual Trustees’ Report that Social Security’s trust fund will be depleted sometime in the 2030s causes a new round of angst. Some 40 percent of the workers in one poll expect to receive nothing from Social Security when they retire.

The media often play into this sense of unease with sensational headlines like “Social Security and Medicare Funds Face Insolvency” (The New York Times) or “Trust Fund to Run Dry in 2035” (Fox Business).

While these headlines do their job of attracting readers’ attention, they don’t reflect the fact that the payroll taxes paid by employers and employees will keep rolling in. If policymakers take no steps to prevent the depletion, the tax revenues will still cover about three-fourths of future retirees’ benefits, according to the 2021 Trustee’s Report released in August.

But a new study by the Center for Retirement Research shows that headlines focused on the trust fund’s potential depletion can fuel misperceptions about Social Security’s viability. In reaction to news stories with alarming headlines, some workers in an online experiment said they would alter their retirement plans.

The experiment was conducted during the June lull in the pandemic when COVID was less of a distraction. Everyone in the experiment saw the same article – except for the headline and the first sentence, which essentially repeated the headline.

The workers who read articles with headlines emphasizing the trust fund’s depletion predicted they would start their benefits about a year earlier – presumably hoping to protect them somehow by locking them in early – than those who saw the staid headline – “Social Security Faces a Long-Term Financing Shortfall.”

Two headlines in the experiment sent a more blunt message: “Social Security Fund Headed Toward Insolvency in 2034, Trustees Find” and “The Social Security Trust Fund Will Deplete its Reserves in 2034.” The people who saw a final headline, which alluded to the trust fund’s depletion – “Revenues Projected to Cover Only 75 Percent of Scheduled Social Security Benefits after 2034” – said that they, too, were more likely to start their benefits earlier.

Headlines also influenced how much workers in the experiment expect to get from Social Security when they retire. …Learn More

June 2, 2020

Home Care Reform’s Outcome a Surprise

Medicaid pays for care for six out of 10 nursing home residents.

To reduce the program’s costs, the Affordable Care Act (ACA) encouraged states to expand the care that people over 65 can receive in their homes or through community organizations. The hope was that they would delay or – even better for them – avoid moving into a nursing home if they had easier access to medical and support services.

Many states historically did not use Medicaid funding to pay for home care. The ACA’s Balancing Incentive Payments Program required the 15 states that chose to participate in the reform, including Nevada, Texas, Florida, Illinois, and New York, to increase spending on home and community care to half of their total Medicaid budgets for long-term care. By the end of the program, the states had met their goals of more balanced spending on home care versus nursing home care.

But four years after the reform went into effect in 2011, the states’ nursing home population had not changed, compared with the states that did not expand their services, according to a University of Wisconsin study for the Retirement and Disability Research Consortium. The researchers said one possible reason the reform didn’t reduce nursing home residence was that people who were never candidates for this care were the ones taking advantage of the alternative forms of care.

The analysis did find other unintended consequences of the shift in Medicaid funds to home and community care. First, somewhat more older people moved out of a family member’s house and were able to live on their own.

Second, as more people moved into their own place, costs may have increased for a different federal program: Supplemental Security Income (SSI) for low-income people. The increase had to do with how this program calculates financial assistance. SSI’s monthly benefits are based on an individual’s income. When retirees decide to live on their own, the housing, meals and other supports the family once provided are no longer counted as income. The drop in a retiree’s income means a bigger SSI check.

On the other hand, the Medicaid reform may have financial benefits for caregiving families, the researchers said.

The greater availability of home and community care for seniors – whether they live with family or on their own – frees up time for their family members to earn more money at paying jobs. …
Learn More

April 21, 2020

Self-Employment More Prevalent Over 65

Workers of all ages are being affected by the damage COVID-19 is doing to the economy, but people who are loosely attached to the labor force may be more vulnerable.

That’s the situation for a small but growing segment of the U.S. labor market: self-employed people who are 65 and older.

When workers are in their prime, most of them are directly on an employer’s payroll. But a new study finds that self-employment begins to dominate as people work past traditional retirement ages and work as independent contractors, consultants, freelancers, or gig workers.

The detailed Gallup survey designed by the researchers shows that self-employment is more pervasive at older ages than previous data had indicated. Nearly half of all workers in their late 60s are self-employed, and that rises to more than two-thirds of workers in their late 70s. In contrast, only one-fourth of people in their late 50s are self-employed.

The Gallup survey was designed to capture self-employment more fully than the Bureau of Labor Statistics (BLS) does. That’s because the researchers asked detailed questions designed to get a more complete count of the independent contractors who may mistakenly have failed to report themselves as self-employed to the BLS.

In the study, independent contractor is the most common form of self-employment at older ages. This is mainly the province of an elite group who are able and willing to continue working several years after most people have retired. They are often professionals or former managers who said their primary motivations for being self-employed are remaining active or pursuing an interest.

But even at the oldest ages, a significant minority of independent contractors are working mainly for the money. …Learn More

October 3, 2019

The Secret to Feeling Younger

You’re as young as you feel!

This cliché is meant to be uplifting to older people. But it really just begs the question: what, exactly, is it that makes a person feel young?

Having a sense of control over the events in one’s life is the answer that emerged from a 2019 study of 60- to 90-year-olds in the Journal of Gerontology. “[B]elieving that your daily efforts can result in desired outcomes” lines up nicely with what the researchers call “a younger subjective age.”

This makes a lot of sense. Feeling in control becomes important as we age, because it counteracts our growing vulnerabilities – we can’t move as fast, hear as well, or remember as much. Wresting back some control can rejuvenate older people, instill optimism, and improve memory and even longevity, various studies have found. …Learn More

August 15, 2019

Walk? Yes! But Not 10,000 Steps a Day

A few of my friends who’ve recently retired decided to start walking more, sometimes for an hour or more a day.

Becoming sedentary seems to be a danger in retirement, when life can slow down, and medical research has documented the myriad health benefits of physical activity. To enjoy the benefits from walking – weight loss, heart health, more independence in old age, and even a longer life – medical experts and fitness gurus often recommend that people shoot for 10,000 steps per day.

But what’s the point of a goal if it’s unrealistic? A Centers for Disease Control study that gave middle-aged people a pedometer to record their activity found that “the 10,000-step recommendation for daily exercise was considered too difficult to achieve.”

Here’s new information that should take some of the pressure off: walking about half as many steps still has substantial health benefits.

I. Min Lee at Brigham and Women’s Hospital in Boston tracked 17,000 older women – average age 72 – to determine whether walking regularly would increase their life spans. It turns out that the women’s death rate declined by 40 percent when they walked just 4,400 steps a day.

Walking more than 4,400 steps is even better – but only up to a point. For every 1,000 additional steps beyond 4,400, the mortality rate declined, but the benefits stopped at around 7,500 steps per day, said the study, published in the May issue of the Journal of the American Medical Association.

More good news in the study for retirees is that it’s not necessary to walk vigorously to enjoy the health benefits. …Learn More