Seniors: help for financial decisions

Noting that most retirees have acquired significant assets as well as debts, and that cognitive decline afflicts older adults, the Center for Retirement Research at Boston College in a recent brief discusses four policy responses to help seniors make effective financial decisions. The paper lists them from least to most paternalistic:

• Disclosure. "Legislation to strengthen disclosure requirements has recently been introduced in many different domains....However, we are skeptical that improved disclosure will be effective in improving financial choices."
• Financial "Driving Licenses." "...require that individuals pass a 'license' test before being allowed to make nontrivial financial decisions, such as opting out of 'safe harbor' investment products. Such proposals would need to overcome several logistical problems."
• Mandatory Advance Directives. "...require older adults to put in place a financial advance directive before reaching a certain age so that the management of their assets could be transferred to a third party in the event of their incapacity."
• Regulatory Approval. "Instead of primarily targeting individual investors, regulations could instead target the financial products themselves."

What Is the Age of Reason? July 2010
      Brief (pdf, 8pp/249kB)
      Introduction

Green houses

The Robert Wood Johnson Foundation (RWJF) is investing $15 million over five years to support Green Houses, home-like alternatives to traditional, institutional nursing homes, according to a June 24 Wall Street Journal (WSJ) article. RWJF is working with the founder of the Green House movement, physician Bill Thomas, a Harvard Medical School graduate, who became "distressed" by his experience working in a nursing home. Green Houses are designed for seven to ten seniors, each with his or her own room, who dine together every night.

Green Houses Growing in Numbers Across the States, 6.24.08. See link to the WSJ article that includes a video.

Recent GAO reports

Recent reports from the Government Accountability Office (GAO):

WORKFORCE DEVELOPMENT: Community Colleges and One-Stop Centers Collaborate to Meet 21st Century Workforce Needs, GAO-08-547 (pdf, 46pp/620kB), May 15, 2008

The Workforce Investment Act of 1998 (WIA) created the one-stop system that requires states to unify federally funded employment and training programs. Since community colleges play a key role in providing career and technical training, they are also important in the one-stop system. GAO examined how community colleges meet workforce training needs, how they integrate with the one-stop system, what conditions affect these efforts, and actions of the Departments of Labor and Education to encourage linkages between community colleges and the workforce system. GAO visited 20 community colleges in 6 states--Iowa, Michigan, New Jersey, North Carolina, Oregon, and Washington.


MEDICAL DEVICES: FDA Faces Challenges in Conducting Inspections of Foreign Manufacturing Establishments, GAO-08-780T (pdf, 26pp/336kB), May 14, 2008

In the Food and Drug Administration's (FDA's) oversight of medical devices sold in the U.S., it inspects establishments that manufacture these devices, including foreign establishments which are the subject of this report. The Medical Device User Fee and Modernization Act of 2002 (MDUFMA) required FDA to establish third-party inspection programs, and FDA created two--the Accredited Persons Inspection Program and the Pilot Multi-Purpose Audit Program (PMAP). As of May 8, 2008, two foreign establishments had been inspected. GAO concluded that this small number of inspections "raises questions about the practicality and effectiveness of these program to quickly help FDA increase the number of foreign establishments inspected."


OFFSHORE MARINE AQUACULTURE: Multiple Administrative and Environmental Issues Need to Be Addressed in Establishing a U.S. Regulatory Framework, GAO-08-594 (pdf, 58pp/1MB), May 9, 2008

The U.S. aquaculture industry is currently limited to nearshore waters or onshore (ponds and tanks) that are governed by individual states. To increase production, there is growing interest in offshore aquaculture, raising fish and shellfish in the open ocean (3 to 200 miles from U.S. coastlines) which are federally regulated waters. As there is presently no comprehensive regulatory framework to cover offshore aquaculture, GAO identified four areas to consider in developing regulations: program administration, permitting and site selection, environmental management, and research. GAO visited Hawaii, Maine, and Washington for this report.


NURSING HOMES: Federal Monitoring Surveys Demonstrate Continued Understatement of Serious Care Problems and CMS Oversight Weaknesses, GAO-08-517 (pdf, 57pp/1.87MB), May 9, 2008

Oversight of nursing homes is shared by the Centers for Medicare and Medicaid Services (CMS) and the states. CMS defines standards nursing homes must meet to participate in Medicare and Medicaid programs and contracts with state surveyors to assess compliance. GAO found "substantial" missed deficiencies in state surveys, the most frequent involving poor quality of care relating to nutrition, hydration, and pressure sores. GAO recommended actions for CMS to take to effectively track understatement of deficiencies and to oversee regional office implementation of the survey program.

See Nursing Home Compare

Recent GAO reports

From the Government Accountability Office (GAO):

LONG-TERM FISCAL OUTLOOK: Action Is Needed to Avoid the Possibility of a Serious Economic Disruption in the Future, GAO-08-411T (pdf, 21pp/376kB), January 29, 2008

In testimony by the Comptroller General, 3 key points:

• The federal budget is on an imprudent and unsustainable path
• Rapidly rising health care costs are our nation's number one fiscal challenge
• The window of opportunity for action is shrinking as the first baby boomers retire and begin tapping into Social Security and Medicare

STATE AND LOCAL GOVERNMENTS: Growing Fiscal Challenges Will Emerge during the Next 10 Years, GAO-08-317 (pdf, 78pp/716kB), January 22, 2008

As is true for the federal sector, the growth in health-related expenditures is the primary driver of the fiscal challenges facing the state and local government sector. In particular, two types of state and local expenditures will likely rise quickly. The first is Medicaid expenditures, and the second is expenditures by these governments for health insurance for state and local employees and retirees.

ELDERLY VOTERS: Some Improvements in Voting Accessibility from 2000 to 2004 Elections, but Gaps in Policy and Implementation Remain, GAO-08-442T (pdf, 30pp/792kB), January 31, 2008

This report covers voting accessibility by seniors and the disabled, specifically getting to polling places and being able to cast votes once they arrive. Besides impediments to wheelchair users, the forms of ballots, type size of voting instructions, and lack of ballots with audio-tape or braille ballots may affect access. GAO noted an increase in states' providing alternative voting methods such as early voting, absentee voting without medical certification, curbside voting, allowing voters to go to more accessible polling places, and taking ballots to a voter's residence. Some election officials reported that early and absentee voting added to the "cost and complexity" of elections.


BILINGUAL VOTING ASSISTANCE: Selected Jurisdictions' Strategies for Identifying Needs and Providing Assistance, GAO-08-182 (pdf, 86pp/2.8MB), January 18, 2008

This study was mandated by the "Fannie Lou Hamer, Rosa Parks, and Coretta Scott King Voting Rights Act Reauthorization and Amendments Act of 2006," P.L. 109-246 (pdf, 5pp.), section 9, regarding the implementation of section 203 of the Voting Rights Act of 1965. Section 203 is codified at 42 USC 1973b(f). GAO gathered information from 14 of the 296 jurisdictions required to provide bilingual voting assistance. It found that evaluating the effectiveness of these programs is difficult, therefore the extent to which they are helpful to language minority voters is unknown.

Elder abuse

The Hawaii Legislative Reference Bureau's new study examines states' adult protective services law, gathers data on elder and adult abusive incidence in other states, analyzes possible changes to Hawaii's laws to conform to those of other states, and estimates the predicted effects of those changes on the caseload of Hawaii's Dept. of Adult Protective Services.

A new LRB study in response to HCR 188, HD2 (Hawaii Regular Session, 2007):

A Survey of Adult Protective Services and Elder Abuse in Hawaii and Nationwide.
(2007, pdf, 65pp/1MB)

Caregiving costs

A study issued June 25 by the AARP Public Policy Institute estimates the value of unpaid caregiving by family and friends at $350 billion nationally and $1.25 billion in Hawaii. Both the Honolulu Advertiser and the Star Bulletin reported on the study.

While $350 billion is attributed to actual caregiving, the report also cites other costs:

• Out-of-pocket costs (groceries, medicines, other cash support)
• Lost wages and retirement income (adverse effects on job security, career paths, employment benefits, and Social Security and pensions)
• Lost productivity (losses to businesses include absenteeism, workday interruptions, unpaid leave, reductions in hours from full-time to part-time)
• Health effects and associated costs (caregivers putting their own health at risk is a growing public health concern)

Valuing the Invaluable: The Economic Value of Family Caregiving (Issue Brief, pdf, 12pp/528kB)

Valuing the Invaluable: A New Look at State Estimates of the Economic Value of Family Caregiving (Data Digest, pdf, 8pp/576kB)

Boomers become pre-seniors

In reporting on a study from the Brookings Institution on the demographics of the impending "senior tsunami," the New York Times focused on one of the study's findings, the effect of the aging population on the nation's suburbs. It quoted the author, William H. Frey: "Suburbs, which previously were considered youthful and family-friendly parts of America, will, as more seniors age in place, become a fast-graying part of our national landscape."

Other findings:

• Aging boomers make pre-seniors (ages 55-64) this decade's fastest-growing age group
• Pre-seniors are increasing rapidly everywhere, esp. in economically dynamic Sun Belt areas such as Las Vegas, Austin, Atlanta, and Dallas
• Seniors (ages 65+) are growing fastest in the Intermountain West and South Atlantic states
• In states where senior populations will grow fastest, "aging in place" rather than migration will drive this growth

A capsule conclusion:

Today's seniors and pre-seniors are upending traditional notions of how and where Americans spend their later years. The rise of boomer populations in suburban and Sun Belt locations will create new demand for senior-oriented housing and amenities. As older populations age in place, however--especially in the suburbs of slower-growing metropolitan areas--public policies must respond to the new stresses they will exert on health, transportation, and social-support systems.

Mapping the Growth of Older America (pdf, 28pp/1MB)