The Growing Incidence of Alzheimer’s

Published in Pawtucket Times on April 26, 2016

While Congress and states are nation grappling with how to put the brakes to one of the largest public health crises in recent times, the escalating Alzheimer’s disease (AD) epidemic, the Chicago-based Alzheimer’s Association releases its annual snap shot detailing statistics on the impact of Alzheimer’s and dementia on caregivers and health care costs..

According to the 2016 Alzheimer’s disease Facts and Figures, released on March 30, 2016, this year nearly 16 million Alzheimer’s caregivers will provide 18 billion hours of unpaid care to 5.4 million afflicted with this devastating disorder. That care had an estimated value of $221.3 billion, says the report.

But that’s not all, this recently released report notes that two out of three people believe that Medicare will help them over costly nursing facility costs. Sorry it won’t. AD also has a direct impact on a caregiver’s pocketbook, too, the researchers found. More than one-third of those surveyed say they were forced by caregiving duties to reduce their hours at work or just quit their job entirely. As a result of these actions their income dropped by $15,000 compared to the previous year. Eleven percent of caregivers were forced to cut back on spending for their children’s education in order to provide support.

The 79 page Alzheimer’s Association report notes that both physical, emotional and financial support required by a person with AD may ultimately deprive family and friend care givers basic necessities, such as food, transportation and medical care. The Facts and Figures report reveals that these caregivers were 28 percent more likely to eat less or go hungry while contributing care to someone with AD, and one-fifth even sacrificed their own medical care by cutting back on doctor visits. Overall, nearly half of the caregivers say they cut back on their own expenses to afford dementia-related care for their family member or friend.

“The devastating emotional and physical effects of caring for a person with Alzheimer’s disease has been well-studied,” said Beth Kallmyer, MSW, Vice President of Constituent Services for the Alzheimer’s Association. “However, this new report shows, for the first time, the enormous personal financial sacrifices that millions of care contributors must make every day. These sacrifices jeopardize the financial security of individuals and families, as well as their access to basic needs and health care.”

This year’s Facts and Figures report found that 13 percent of family or friend caregivers sold personal belongings, such as a car, to help pay for costs related to dementia, while nearly half tapped into savings or retirement funds. On average, caregivers, many of whom do not live with the person they’re caring for, spent more than $5,000 a year of their own money to care for someone with AD; however, amounts varied with many spending tens of thousands of dollars per year.
Incidents of AD is Fast Growing

The Facts and Figures report says that out of the 5.4 million (of all ages) afflicted with AD, an estimated 5.2 million are age 65 and over. Yes, one in nine people having the cognitive disorder. Approximately 200,000, having early onset AD, are under age 65.

Also, the recently released Facts and Figures report warns that we are truly in the midst of an AD epidemic as the baby boomers grow older. By 2050, researchers say that someone in the United States will develop AD every 33 seconds. Without a medical breakthroughs to prevent or cure, the age 65 and over population with AD, the incidence is expected to nearly triple, from 5.2 million to a projected 13.8 million. Some say may be even as high as 16 million. It’s the only disease among the top 10 causes of death in America that cannot be prevented, cured or even slowed. .

Additionally, this year’s Facts and Figure report notes that AD is officially listed as the sixth-leading cause of death in this country. It is the fifth-leading cause of death for people age 65 and older. With the graying of America, AD will become a more common cause of death. At age 70, 61 percent of those with AD are expected to die before the age of 80 compared with 30 percent of people without the cognitive disorder — a rate twice as high, says the report.

The Typical Care Giver

The Facts and Figures report puts the face on a typical caregiver. Approximately two-thirds of caregivers are women, and 34 percent are age 65 or older. Forty one percent have a household income of $50,000 or less.

AD takes a devastating toll on the health of caregivers, says the Facts and Figures report. Nearly 60 percent of those taking care of loved ones with Alzheimer’s and dementia report that their emotional stress being high or very high. About 40 percent suffer from depression. One in five care givers cut back on their own physician visits because of their caregiving responsibilities. And, among caregivers, 74 percent report they are “somewhat” to “very” concerned about maintaining their own health since becoming a caregiver.

A Huge Cost on the Health Care System

The report’s researchers warn that the AD epidemic might just bankrupt the nation’s Medicare program. In 2016, total payments for health care, long-term care and hospice are estimated to be $236 billion for people with Alzheimer’s and other dementias, with just under half of the costs paid by Medicare. Nearly one in every five Medicare dollars is spent on people with Alzheimer’s and other dementias. In 2050, it will be one in every three dollars

Medicare and Medicaid are expected to cover $160 billion, or 68 percent, of the total health care and long-term care payments for people with Alzheimer’s disease and other dementias.

Seeing a huge rise in AD over the last two years, federal and state officials are gearing up to strategize a battle to fight the impending epidemic.

A Call to Action

Yes, the AD epidemic is here, right in Rhode Island. Everyone is personally touched by either caring for a family member with the cognitive disorder or knows someone who is a caregiver or afflicted.

Following the efforts of Congress to create a national strategic plan to address the rapidly escalating AD crisis and to coordinate resources across federal agencies, the Rhode Island General Assembly passed a joint resolution enacted into law to direct the Lt. Governor’s Long Term Care Coordinating Council (LTCCC) to be the vehicle to develop a state plan to address this growing public health crisis in the Ocean State. Ultimately, for over a year former Lt. Governor Elizabeth Roberts along with LTCCC members, former Division of Elderly Affairs Director Catherine Taylor, the state Chapter of the Alzheimer’s Association, universities and health care organizations with the public input gleaned from 8 listening events hammered out the 122 page battle plan with over 30 pages of recommendations.

In 2016, Lt. Governor Daniel J. McKee has picked up the ball and convened a meeting of the Executive Board on Alzheimer’s Disease and Related Disorders, consisting of researchers, advocates, clinicians and caregivers, to begin efforts to implement recommendations from the State’s Alzheimer’s Plan. The group will determine which recommendations are outdated.

With a rising population of Rhode Islander’s with AD, state policy makers must act swiftly and lose no more time in addressing this terrible disease and public health issue.

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Earth: The Gray(ing) Planet

Published in Woonsocket Call on April 17, 2016

Last month, a National Institute of Health funded U.S. Census Bureau report was released announcing that the world’s older population is growing dramatically at an unprecedented rate. According to the newly released federal report, “An Aging World: 2015,” 8.5 percent of people worldwide (617 million) are aged 65 and over. This percentage is projected to jump to nearly 17 percent of the world’s population by 2050 (1.6 billion).

The new 165 page report, released on March 28, 2016, was commissioned by the National Institute on Aging (NIA), part of the National Institutes of Health, and produced by the U.S. Census Bureau.

“Older people are a rapidly growing proportion of the world’s population,” said NIA Director Richard J. Hodes, M.D. “People are living longer, but that does not necessarily mean that they are living healthier. The increase in our aging population presents many opportunities and also several public health challenges that we need to prepare for. NIA has partnered with Census to provide the best possible data so that we can better understand the course and implications of population aging.”

“An Aging World: 2015” is chock full of information about life expectancy, gender balance, health, mortality, disability, health care systems, labor force participation and retirement, pensions and poverty among older people around the world.

“We are seeing population aging in every country in every part of the world,” said John Haaga, Ph.D., acting director of NIA’s Division of Behavioral and Social Research. “Many countries in Europe and Asia are further along in the process, or moving more rapidly, than we are in the United States. Since population aging affects so many aspects of public life—acute and long-term health care needs; pensions, work and retirement; transportation; housing—there is a lot of potential for learning from each other’s experience.”

A Look at Some of the Details

The report noted that America’s 65-and-over population is projected to nearly double over the next three decades, from 48 million to 88 million by 2050. By 2050, global life expectancy at birth is projected to increase by almost eight years, climbing from 68.6 years in 2015 to 76.2 years in 2050.

In addition, the global population of the “oldest old”—people aged 80 and older—is expected to more than triple between 2015 and 2050, growing from 126.5 million to 446.6 million. The oldest old population in some Asian and Latin American countries is predicted to quadruple by 2050.

The researchers say that the graying of the globe is not uniform, “a feature of global population aging is its uneven speed across world regions and development levels.” The older population in developed countries have been aging for decades, some for over a century. “In 2015, 1 in 6 people in the world live in a more developed country, but more than a third of the world population aged 65 and older and over half of the world population aged 85 and older live in these countries. The older population in more developed countries,” says the report.

Meanwhile, the researchers report that in the less developed world, “Asia stands out as the population giant, given both the size of its older population (617.1 million in 2015) and its current share of the world older population (more than half).” By 2050, almost two-thirds of the world’s older people will live in this continent, primarily located in the eastern and northern hemispheres. “Even countries experiencing slower aging will see a large increase in their older populations. Africa, for instance, is projected to still have a young population in 2050 (with those at older ages projected to be less than 7 percent of the total regional population), yet the projected 150.5 million older Africans would be almost quadruple the 40.6 million in 2015, notes the report. .

The Graying of the Ocean State, Too

AARP Rhode Island State Director Kathleen Connell says that statistics gleamed from a new interactive online tool, the AARP Data Explorer, detailed by blogger Wendy Fox-Grage, a senior strategic policy advisor for AARP Policy Institute, suggests that Rhode Island for some time, has had the highest per capita 85 plus population of any state. But “Data Explorer also shows that Rhode Island was surpassed in 85 plus per capita in 2015 – second now to Florida by 1/10,000th of a percentage point. Interesting, by 1260, we are projected to rank 14th.

“Nationally, from 2010 to 2060, the 85-plus population will more than triple (260 percent), the fastest growth of any age group over that time period,” she says.

Connell says, “AARP Data Explorer clearly shows that the age 65-plus population will grow much faster than younger age groups. All three older age groups (65-74, 75-84 and 85-plus) will more than double between 2010 and 2060, while the younger age groups (0-17, 18-49, 50-64) will increase only slightly.”

“The growth of the age 85-plus population will significantly outpace all other age groups, once Boomers begin turning 85 in the 2030s,” adds Connell, noting that “This phenomenon will have significant impact on every aspect of society, ranging from our health care system to the economy.”

“People age 85-plus are the group most likely to need long-term services and supports (LTSS) to help them with everyday tasks. They not only have higher rates of disability than younger people, but they are also more likely to be living alone, without a spouse or other family member to provide them with assistance,” observes Connell.

Over the years, the Rhode Island General Assembly has enacted legislative changes in the way it delivers and funds aging services and supports for older Rhode Islanders and their family caregivers, says Connell.

According to Connell, early last year, AARP Rhode Island released, “Raising Expectations 2014: A Report Card for Rhode Island Long Term Services and Supports System Performance.” The report assessed the LTSS Scorecard and recommended policy goals.

Connell says that the results revealed that Rhode Island showed strengths. With the subsequent passage of key legislative proposals that included caregiver paid family leave and the CARE Act, the state has moved in the right direction, she says, stressing that “the policy report pointed to areas for improvement that state leaders should not ignore.”

“With the reauthorization of the Older Americans Act through 2019, and continued backing from Governor Raimondo, Rhode Island seniors and caregivers are benefitting from a host of home- and community-based programs,” says Director Charles Fogarty, of Rhode Island’s Division of Elderly Affairs. “A top priority for the agency is strengthening of those services so everyone can make it in Rhode Island. We are proud to partner with hardworking older Rhode Islanders and advocates; we are constantly listening to their suggestions which are helpful in providing direction on development of effective programming and policies,” he says.

Fogarty noted that during Governor Gina Raimondo’s first two budget cycles (FY 2016 enacted and FY 2017 proposed budgets), more than $1 million in additional general revenue funding has been allocated for programs such as Meals on Wheels, senior centers and other home and community care services. Seniors can remain in their homes with a high quality of life for as long as possible through the provision of affordable and accessible home and community-based services and living options preventing or delaying institutionalization.

Connell says a the nation’s population ages, Rhode Island now has an opportunity of showing other states, with growing age 85 plus populations what it takes to care for an aging population.

Rhode Island, too, can also teach the world community a thing or two about providing programs and services to their older citizens.

Survival Story: Former Business Owner Overcomes Devastating Setbacks 

Published in Senior Digest, April 2016

If you are in pursuit of the American Dream, you probably weren’t given a roadmap that would guarantee a successful journey. Ask the average man or woman on the street today what immediate thoughts come to mind about owning your own business, and you’ll probably hear ‘being your own boss’, and ‘working your own hours’ that top the list of perceptions. But when opening your own business becomes the alternative to unemployment in your later years, as Donald, Russell, Jr. found out, it may not be what you expected or even planned. Like millions of middle-aged workers in the early 1990s, a severe economic downturn forced this Central Falls resident to make choices that ultimately would financially hit his pocketbook as he approached retirement.

Donald Russell had worked his way up from stock boy to manager at F.W. Woolworth Co., one of the areas original five-and-dime stores. During his 33 year career with this large big-box retail company, what was at the time the fourth largest retailer in the world operating over 5,000 stores, he eventually managed seven of the retail company’s stores, one located in Providence (at Westminster and Dorrance Streets), and the others in Massachusetts, Vermont and New York.

But everything changed in the late 1990’s, and this 117 year old company struggled to compete with the growing big discount stores. F.W. Woolworth filed for bankruptcy protection, and Russell, facing unemployment, had to quickly make major career decisions. He knew that, “at age 52, big box competitors don’t want you,” or if he was offered a position, the salary would be much lower than what he was used to. “I could not take less because I had to pay for my daughter’s college education,” he added.

Russell credits “courses he took at Boston College” for teaching him valuable lessons on how to open a small business, and with knowledge in hand, he was ready to take that leap of faith and open his own business. . Russell decided to cash out his $80,000 pension (less penalties) and combined with a loan from U.S. Small Business Administration, he would have enough capital to open a small retail business.

Getting into the Pet Business

Russell spent time researching a market niche, searching for one that would not put him in direct competition with the chain store. He discovered that the pet business was not really sought after by “big box retailers” and at that time “there were only 30,000 pet stores throughout the country. Today the number has decreased to 6,000.” Now . Russell found his niche, and in 1997 opened his business “Dr. Doolittle’s Pets & More”, a small pet store in an East Providence shopping plaza. Though situated between two large Petco stores – one in Rumford, RI and the other in North Attleboro, MA., Russell did not view the large chain stores as competition, for he knew his prices were better. In 1997 when Russell opened his store, small business accounted for about 85 percent of the nation’s economy, he states, noting that today this percentage has dropped to 70 percent.

Business was strong when Dr. Doolittle’s first opened and for over 13 years, Russell employed seven full and part time employees. However, by 2004 “the economy began to take a dive” and juggling the monthly rent, utilities and employee salaries became difficult when his cash flow slowed. Russell began to loose money.
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By 2006 his revenue had dropped 30 percent from the previous year, and neighboring big stores located in the plaza, like Ocean State Job Lot, began to close. In an effort to trim expenses, Russell was able to renegotiate his rent to a lower amount, however “losing the Stop & Shop Supermarket in the next plaza, which was a main draw to the area, “was ultimately the straw that broke the camel’s back”.

Taking from Peter to Pay Paul

Like thousands of small business owners in the Ocean State, Russell had to juggle each month to meet his expenses, which included his RI sales tax. Choosing to pay his monthly sales tax or paying his employees salary was not an easy choice to make, but he could not pay both. “I chose to pay my employees” first, with the plan to make up my [delinquent] sales tax later” he stated, noting however, that the “economy put the brakes to that”. “I could not even borrow a dime even with an excellent credit rating of 750,” added Russell. The poor economy had forced banks to cut off credit to small businesses – period.

In 2009, the Rhode Island Department of Taxation came knocking on his door, and the now 65-year-old pet store owner was forced to close his business because he was in arrears on his payment of sales taxes. While his business was his sole-source of income, the forced closing of the business put him in a ‘catch 22’ situation – blocking any attempt to rescue his business and pay off the remaining sales tax owed, which had now grown to thousands of dollars. Rather than padlock the door, the State did allow him access to the store to feed and maintain the animals until other arrangements were made.

Two weeks after his closing, Russell hammered out an agreeable payment plan with the State of RI for back taxes, but the economy never recovered, and by September, 2010 the doors closed for the final time. In a valiant effort, Russell paid off $18,500 of the $20,000 owed before he closed, but two years later to his surprise, he was blocked from registering his car because of the remaining taxes (and penalties) still owed. A dispute as to the amount of sales taxes (plus penalties and interest) paid ultimately ended with the state’s tax agency backing off and allowing him to register his vehicle.

Russell’s forced closing and ultimately his bankruptcy caught the eye of both statewide and national media. Two radio talk shows and television coverage brought the news of his closure to the public. Even the nation’s most popular Web site, “The Drudge Report,” posted articles. Amazingly, he says that over 100 pages of blog posting were also generated, too.

Making Ends Meet

Today, Russell, 72, is collecting Social Security supplemented by a part-time job delivering pizzas. He notes that beneficiaries will not receive cost of living this year. Like millions of Social Security beneficiaries, Russell feels the impact of inflation. “There is no extra money to buy groceries after paying my rent and utilities,” he says. Local food pantries provide additional food and the Pawtucket-based Blackstone Valley Community Action Program pays for some of his heating bills.

Reflecting on the lay off in his fifties that led to the opening of his small business and ultimately its closing as he reached his mid-sixties because of an ailing economy, Russell admits he did not have a strategy for getting through the tough times in his later years.

“I just coped,” says Russell. The former business owner has a strong opinion on opening a small business in Rhode Island. “Never,” he says. .

AOA Reauthorization Bill Goes to President Obama for Signing

Published in Woonsocket Call on April 10, 2016

The Older American’s Act (OAA) current authorization expired in fiscal year 2011 because lawmakers were unable to reach an agreement on its reauthorization. On a bipartisan basis, Congress has finally passed the long-stalled legislation reauthorizing the OAA when the Senate passed the House-amended bill on April 7. Three weeks earlier the House had passed an amended version of S. 192, the Older Americans Act Reauthorization Act of 2016, by a unanimous voice vote. This legislative proposal amended the bill passed by the Senate on July 16, 2015. Now the passed legislation goes to President Obama, once signed it becomes law.

The very bi-partisan Senate reauthorization bill was sponsored by Chairman Lamar Alexander (TN) and Ranking Member Patty Murray (D-WA), of the Senate Committee on Health, Education, Labor and Pensions, and had 27 co-sponsors from each party.

OAA Authorization Has Lots of Positives

OAA’s latest reauthorization offers new support for modernizing multipurpose senior center, highlights the importance of addressing senior’s economic needs, permanently requires health promotion and disease prevention initiatives to be evidence-based, and promotes chronic disease self-management and fall prevention.

The law also includes: stronger elder justice and legal services provisions; needed clarity for caregiver support and Aging and Disability Resource Centers; new opportunities for intergenerational shared sites, and promotes efficient and effective use of transportation services.

Legislative inertia and a general undercurrent of opposition to any government programs by some members of Congress slowed consideration of the bill , says Dan Adcock, Director of Government Relations and Policy for the National Committee to Preserve Social Security and Medicare (NCPSSM). “You need champions to break through the ‘legislative inertia’ and OAA just did not have enough,” he says.

Senators Lamar Alexander (R-TN), Patty Murray (D-WA) and Bernie Sanders (I-VT) along with Reps. John Kline (R-MN) and Bobby Scott (D-VA) worked hard to finally get the Senate and House to pass this year’s OAA reauthorization, Adcock noted, stressing that there was no opposition to the bill when it passed the House and Senate on voice votes

While the passed OAA reauthorization bill has many positives, its chief weakness is that it does not raise the funding authorization level enough, says Adcock. “Unfortunately, the Older Americans Act has suffered under flat funding and sequestration cuts for several years and will need significant increases in appropriations to meet the critical demands of a senior population that will nearly double by 2030, warns Adcock, noting that that an increase of 12 percent a years is needed for the next several years to raising funding to an acceptable level.

“AARP urges President Obama to quickly sign this bill,” said AARP CEO Jo Ann Jenkins. “We are appreciative of the bipartisan work to get this bill passed. Reauthorizing the OAA will help the millions of vulnerable older Americans who depend on the programs and services that the OAA helps to fund.

“Reauthorizing the OAA is as important as ever to modernizing and improving the aging services network in our country. It’s passage reflects the heroic efforts of many advocates working together to educate Congress about how programs funded by the OAA support older Americans,” observed Steven R. Counsell, MD, AGSF, American Geriatrics Society President.

Adds Senator Sheldon Whitehouse (D-RI), who serves on the Senate Select Committee on Aging, “I am glad we were able to reauthorize and improve the Older Americans Act. This legislation authorizes more funding for meals and social services seniors depend on. It includes new protections against elder abuse, which I’ve been fighting to pass. And it gives residents of long-term care facilities-who often can’t communicate their wishes-a stronger advocate to speak on their behalf.”

Ratchet Up AOA Funding

For more than 50 years the Administration on Aging with its National Aging Network (State Units on Aging and Area Agencies on Aging) has provided federal funding, based on the percentage of the locality’s population 60 and older, for nutrition and supportive home and community-based services, disease prevention/health promotion services, elder rights programs, the National Family Caregiver Support Program and Native American Program.

Aging advocates will tell you that Congressional funding has not kept with the rising inflation or the increased demands of an aging society. Deep Congressional budget cuts, push by the GOP, have significantly reduced OAA’s ability to provide services to those on increased waiting lists. Being “penny-wise and pound foolish” should not be the way Congress looks at future OAA reauthorizations. NCPSSM’s Adcock will tell you that programming geared to helping seniors to age in place at home in their communities can save billions by reducing costly nursing facility and hospital stays.

Hopefully, the President is expected to sign it in a week or two. Hopefully he signs this it quickly on Monday .