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February 2009 Archives

February 2, 2009

Monkhouse Monday

Looting the state pension fund (AHV) in Switzerland

The Swiss AHV (pension for old age) was founded 60 years ago. Every salary has a percentage deducted which goes into the funds. With the ever aging population this fund needs to be secured by other means as an ever decreasing workforce supports an ever increasing old generation, this is nothing new. However, in 1998 a study was conducted on how to achieve this (Wechsler/Savioz 1998). One of the striking points was that different organizations such as the Red Cross, publicly funded home care organizations (Spitex), Pro-Senectute (an organization to provide information and consultancy in old age) and a few senior-run-organizations received 65 million Swiss Francs in 1986, 205 millions in 1996 and over 300 millions in 2008. This is an exponential growth with no justification, so the authors.

This needs to be stopped, so the study, these organizations provide a wide variety of services, but they do not have to prove their impact and efficiency. It is not the job of an old age pension fund to subsidize them. Or as a politically engaged 83-year old person puts it: „Stop looting our pension funds“.

Posted by Dr. Bill Thomas on February 2, 2009 8:08 AM |Permalink |Comments (0)

Facts Are Stubborn Things: Social Security Edition

Media Matters calls David Gregory out for misinforming his viewers about Social Security.

During the February 1 edition of NBC's Meet the Press, host David Gregory falsely asserted that "Social Security is about to go -- pay out more than it's taking in by 2010." In fact, the 2008 Social Security trustees' report estimated that "[u]nder the intermediate assumptions, the OASDI [Old Age Survivors and Disability Insurance] cost rate is projected to increase rapidly and first exceed the income rate in 2017," not in 2010 as Gregory claimed. Moreover, as Media Matters for America has noted, the 2008 Social Security trustees' report forecasts that, in the absence of a change in the law, Social Security will be able to pay full benefits until 2041, after which it will be able to cover between 78 and 75 percent of scheduled benefits through the end of the 75-year period the report's long-range projection covered.

This is not the first time NBC has perpetuated myths about Social Security. As Media Matters documented, during the October 2, 2008, edition of NBC's Nightly News, NBC News correspondent John Yang falsely asserted: "At current rates, analysts say Social Security will run out of money by 2041." Additionally, on the September 18, 2008, edition of MSNBC Live, correspondent David Shuster stated that Social Security "will run out of money unless we make some major changes, at least in the next several years."

Self-government requires the existence of an informed public. The existence of an informed public depends upon the ability of the press to present the public with facts. Gregory's cavalier approach to the truth (he either did not know or did not care to find out the truth about Social Security) injures our democracy. This type of failure highlights the rot that pervades the for-profit news industry. Blogs and blogging represent an active effort by the citizens of our nations to respond to the damage that is being done by the traditional media's repeated failures to fulfill their duty.

I may not have the same platform that David Gregory possesses as host of NBC's "Meet the Press" but I do have more credibility than he does because I do the best I can to understand and respond to reality. I seek to be reality-based.

David Gregory should strive for a similar stance the next time he discusses the future of Social Security.

Posted by Dr. Bill Thomas on February 2, 2009 2:26 PM |Permalink |Comments (0)

February 3, 2009

Understanding Health Care Reform

When reading writers who either support or oppose major changes in our health care system it is easy to assume that we are faced with a single mighty question...

How will we reform our health care system?

Will we wind up like Canada, or Britain or France or Zimbabwe?

The issue actually consists of two densely intertwined problems.

First, there is the money problem. Who, we are asked, will pay? How much will they pay? How much will people receive in return for what they pay?

The health care financing geeks (you gotta love 'em) have their own set of buzzwords and catch phrases...

access--- A person's ability to obtain affordable medical care on a timely basis.

beneficence--- An ethical principle which, when applied to [health] care, states that each [patient] should be treated in a manner that respects his or her own goals and values.

no balance billing provision--- A provider contract clause which states that the provider agrees to accept the amount the plan pays for medical services as payment in full and not to bill plan members for additional amounts (except for co-payments, coinsurance, and deductibles).

The morbidly obsessed can go here for thousands more examples of this kind of language.

The second major question concerns quality. These reformers are primarily concerned with the care that is actually being delivered. They want to know if that care is any good. Does it create outcomes that are better, or worse, for the people receiving that care. America spends, per capita, more for its health care than any other nation on earth and yet the outcomes created by this (very expensive) system are middling at best. America does not have, as is so often claimed, "the best health care on Earth." Instead, we have the most expensive health care system on earth.

Real health care reform requires tackling the financing and the quality questions simultaneously.

So, as we hear more about the issue of health care reform, take note if the politician or expert you are listening too seems most concerned about quality or finance -- a few of the best will be concerned about both issues.

One last note for now. We will also be hearing people claim that we will "be like" some other country. This is not true. Whatever kind of health care reform we wind up with (and I am hoping for the best) it will be distinctly American because it will evolve out of the current system.

This is the concept of "path dependence."

Posted by Dr. Bill Thomas on February 3, 2009 9:11 AM |Permalink |Comments (2)

February 4, 2009

My Pick for Health and Human Services

If I was the President of the United States and it was my job to pick the best possible candidate to run the sprawling Department of Health and Human Services, I would choose...

I have watched Kansas Governor Kathleen Sebelius work diligently and effectively to improve the quality of the services provided to seniors in her state. She has also opened the door to innovation. She is a powerful communicator and an extremely effective administrator. Also, she has done all of this as a Democratic Governor in one of the few remaining "red" states.

Read more about her here.

If you agree with me, let President Obama know what you think here.

Posted by Dr. Bill Thomas on February 4, 2009 1:04 PM |Permalink |Comments (0)

February 6, 2009

Power Up Friday

Reporting from Mission Beach, San Diego:

Dateline February 4th, Walnut Creek CA: Residents of Rossmoor retirement village have voted to hire sharpshooters to kill a couple of dozen acorn woodpeckers, because they are disturbed by the hammering noises.

They apparently tried to shoo the birds in other ways, including playing recordings of birds being killed by predators (and this is LESS disturbing???).

The California Audubon Society has been looking for more humane solutions, such as building granaries and softwood posts with holes, but the neighborhood association has voted them down and hired the sharpshooter. The society says they can no longer work with them, and are "incredibly disappointed".

Just a reminder that the wisdom that comes with age is not a foregone conclusion. If this approach were applied to all environmental noise, we'd be killing snowplow drivers, construction workers and people with loud radios too!

Posted by Dr. Bill Thomas on February 6, 2009 10:51 AM |Permalink |Comments (0)

Blanchard WinsDays

Eating Good - How Can We Do it Better, Together?

So, when is the last time you ate in an elementary school cafeteria? How about a congregate meal site with older adults? How was the food and atmosphere? Was it wholesome, delicious, piping hot and artfully arranged to inspire your appetite? Or was it questionably nutritious, lukewarm and plopped on a Styrofoam plate and served at long rows of crowded tables? Hmmmm, I thought so.slop is slop, and so is most institutional food.

Here is the real kicker: in Denver last year we had 300 people on the Meals on Wheels waiting list at a time we were throwing out conservatively ten times that amount in school lunches. So as Director of the Denver Office on Aging I wanted to partner with Denver Public Schools to box up those extra school lunches and have older kids deliver them to homebound elders in the neighborhoods of the schools. While admittedly not the best cuisine, it seemed better than going hungry.

Of course, we couldn't do that. Why? Federal nutritional guidelines that allow our kids to eat fried, processed chickenetts, canned fruit and vegetables, and white bread, do not meet the nutritional guidelines for older adults - they need something nutritionally different, well, like pulled BBQ pork, potato salad and baked beans with white rolls.

So, what if we made food that met everyone's nutritional requirements, served it hot and served it to young and old alike in our school cafeterias (which of course we would seriously redecorate). And, what if we created Sustainable Gardens that grew the food right there in the school yard ---and made the gardens part of the children's education and classroom and invited the community elders to help tend those gardens?

Such innovation is beginning to take root for our children through fabulous programs like Slow Food (http://www.slowfoodusa.org/ ) and School Gardens
(http://www.schoolgardenwizard.org
but there are few, if any, equivalent programs for seniors. And why reinvent the wheel? Aging in community seeks to bridge this gap by thinking how can we make it better, by doing it together.

Posted by Dr. Bill Thomas on February 6, 2009 11:43 AM |Permalink |Comments (1)

February 8, 2009

Getting Closer!

Please let it be so...

President Obama looking at Sebelius to head HHS Posted: 05:00 AM ET

From CNN Senior White House Correspondent Ed Henry

WASHINGTON (CNN) – In a sign that she is getting a close look for Secretary of Health and Human Services, Kansas Gov. Kathleen Sebelius recently met with senior White House adviser Valerie Jarrett, according to two Obama administration officials.

Sebelius has a good personal relationship with the President and remained in the running for the vice presidential slot until near the end of the process, the officials also told CNN.

But the officials cautioned that President Obama is considering others for HHS as well. Those getting a look include Oregon Democrat Sen. Ron Wyden and Tennessee’s Democratic Gov. Phil Bredesen, according to the officials.

White House spokesman Reid Cherlin stressed to CNN that "no decision has been made." But Cherlin added the President "is moving quickly in filling this critical role."

Full story here

Posted by Dr. Bill Thomas on February 8, 2009 4:23 PM |Permalink |Comments (0)

February 9, 2009

Monkhouse Monday

The "Grande Dame“ of Swiss Acting died in her 90th Year

Anne-Marie Blanc, the grand old lady among Swiss actors died last week, her last stage performance was only four years ago. In an interview she stated that in her 66 years of working (and being a national icon) she never perceived herself as young or old: "I am an actress, trying to get better at what I’m doing all the time“.

Posted by Dr. Bill Thomas on February 9, 2009 8:09 AM |Permalink |Comments (0)

February 10, 2009

Kevin Frick writes...

in a note to me...

I heard you on the Marc Steiner show last week. Great show. I was
wondering if you collaborate with anyone here at the Johns Hopkins
Bloomberg School of Public Health. I have been working with SPH, SOM, and
SOn colleagues for several years on a project called Experience Corps that
changes the roles that we anticipate that older adults will play before
they need a nursing home.

So, I am definitely interested in changing the
life course at almost all points to facilitate better living later in
life.
I was also wondering if you have economists working directly with
you at UMBC? That is my original training. I look forward to hearing
more about your work over time.

What advice, dear readers, do you have for him?

Posted by Dr. Bill Thomas on February 10, 2009 8:45 AM |Permalink |Comments (3)

February 11, 2009

Blanchard WinsDays

Dishing Up More News on School Lunches

Last week I wrote about legislative blocks to creating sustainable school gardens and serving healthy lunches for children AND for elders living in the neighborhood. This Aging in Community strategy is greener, more efficient and more effective because it uses existing public infrastructure to address the nutritional needs of youth and elders alike, and equally important, it creates pathways to build intergenerational relationships and social capital at a very local level.

Perhaps this is not such a far-fetched idea. A reader informed me that William F. Benson, a Washington-based aging and public health consultant and former Deputy Assistant Director for the Administration on Aging during the Clinton Administration, wrote an amendment to the Older Americans Act in the 1990s that encouraged such innovation to ease the overburdened senior nutritional programs. Unfortunately, the amendment did not survive the Bush Administration.

But if the Obama's new chef Sam Kass has any influence, perhaps there is hope yet. According to a recent NYT story, Obama's New Chef Skewers School Lunches,
http://well.blogs.nytimes.com/2009/01/29/new-white-house-chef-skewers-school-lunches/?em , he is vocal with his disgust in what we serve our children in the National School Lunch Program and how politics influences that choice. Something tells me he would not be too impressed with what we are serving some of our frailest community members either. Indeed, slop is slop!

Kass has been serving as executive chef for the Jane Addams Hull House in an effort to re-invent the soup kitchen by using quality produce and shunning empty calories. A vocal advocate for community gardens that produce fresh, local and organic food, Kass would likely prefer a White House Kitchen Garden. Kass founded Inevitable Table, a private chef service that prepares meals with the following in mind:

We aim to promote a healthy lifestyle that focuses on the quality and flavor of food to encourage good eating habits. This philosophy provides consistency and balance to ensure you thoroughly enjoy your food experience. We believe that people have a stake in each other's health. This link is what binds us together as families, communities and a nation. Nowhere are we more powerfully bound together than in the daily cultivation and preparation of food.

Amen to that, Chef Kass!

Here's to Good, Healthy Eating for All Ages!

Posted by Dr. Bill Thomas on February 11, 2009 10:00 AM |Permalink |Comments (1)

February 13, 2009

Power Up Friday

As the studies of drug therapy for behavioral expressions in dementia continue to appear, a groundswell of critics has also followed. As I continue to speak out, so do these allies.

Sister Imelda Maurer from San Francisco wrote me last week, dismayed about the recent "aripiprazole for agitation" study in JAMDA. Next, Carter Williams wrote me about a new study in Annals of Long Term Care on "nursing home violence", with the comment: "They need your book!"

(For the record, all of these drug studies make a distressed symptom slightly quieter than placebo, and call it a "positive" outcome. The problem is that this doesn't rule out sedation and it doesn't show increased contentment, engagement or growth. Worse still, it views these expressions purely as a "problem" to be "managed", without asking what basic needs are not being met. Plus they double your mortality.)

Let me tell you what scares me even more:

I'm scared about the way these drugs are being marketed to younger people for depression and other illnesses. "Is your antidepressant not quite doing the job? Take Abilify!"
The practice of using anti-psychotics for life-threatening depression has been expanded to using them to "amplify" therapy less severe cases.

I have a friend whose daughter was diagnosed with "oppositional disorder" and given Abilify. She has had a lot of trauma -- about a dozen operations, due to a congenital cranio-facial problem. She is only 10 years old.

We have no idea what the long range effect of these drugs will be.

Posted by Dr. Bill Thomas on February 13, 2009 8:36 AM |Permalink |Comments (0)

Disaster in Buffalo

A great loss...

A commuter plane dropped out of the sky without warning and nose-dived into a suburban Buffalo house in a fiery crash that killed all 49 people aboard and one person in the home. It was the nation's first deadly crash of a commercial airliner in 2 1/2 years.

The cause of the disaster was under investigation, but other pilots were overheard around the same time complaining of ice building up on their wings — a hazard that has caused major crashes in the past.

The twin turboprop aircraft — Continental Connection Flight 3407 from Newark, N.J. — was coming in for a landing when it went down in light snow and fog around 10:20 p.m. Thursday about five miles short of the Buffalo Niagara International Airport.

Witnesses heard the plane sputtering before it plunged squarely through the roof of the house, its tail section visible through flames shooting at least 50 feet high.

Posted by Dr. Bill Thomas on February 13, 2009 11:50 AM |Permalink |Comments (0)

February 15, 2009

ChangingAging.org Redesign -- Please Bookmark!

Attention Readers! We are launching a new design for the blog that will be hosted directly at the URL www.changingaging.org. Please navigate to www.changingaging.org and reset your bookmarks and sign up for our new RSS Feed. In the coming days we will set up an automatic redirect to the new hosting site. See you there!

Web Master

Posted by Kavan Peterson on February 15, 2009 8:00 PM |Permalink |Comments (0)