Author Archives for Herb Weiss

Report: Caregivers Face Demanding Personal and Professional Challenges

Published in Pawtucket Times, October 3, 2014

Providing care to cognitively and complex chronically impaired family members can be hazardous to the health and mental wellbeing of caregivers, says a jointly issued report by the United Hospital Fund and AARP Public Policy Institute. The researchers found that the demanding personal and professional challenges lead to high levels of self-reported challenges.

According to Family Caregivers Providing Complex Chronic Care to People with Cognitive and Behavioral Health Conditions, a publication in the “Insight on the Issues” released on Aug. 19, a majority of respondents (61 percent) reported constant stress from having their feeling stress “sometimes to always,” between their caregiving responsibilities and trying to meet other work or family obligations.

Adding to the challenge, people with cognitive and behavioral conditions (collectively termed in the 13 page report “challenging behaviors”) were generally sicker than other people requiring caregiving. These persons needing care often had chronic physical health diagnoses—including cardiac disease, stroke/hypertension, musculoskeletal problems (such as arthritis or osteoporosis), and diabetes—at higher rates than those without cognitive and behavioral conditions. Further illustrating the complexity, family caregivers of people with challenging behaviors often met with resistance from the person they were trying to help. Caregivers noted that “more cooperation from their family member” would make one key medical/nursing task—managing medications—easier.

The new findings are drawn from additional analysis of data based on a December 2011 national survey of 1,677 family caregivers, 22 percent of whom were caring for someone with one or more challenging behaviors. Earlier findings were published in the groundbreaking Public Policy Institute/United Hospital Fund report Home Alone: Family Caregivers Providing Complex Chronic Care and in earlier publications in the “Insight on the Issues” series, including Employed Family Caregivers Providing Complex Chronic Care and Family Caregivers Providing Complex Chronic Care to Their Spouses.

The report concludes, “All caregivers need training and support; caregivers who are responsible for people with challenging behaviors are among those most in need of assistance.”

Focused caregiver assessments were one of six recommendations outlined in the report. The others were better integration of behavioral and physical health programs, efforts to set up respite and adult day care programs for family caregivers, training of family caregivers to better understand and respond to challenging behaviors, better training of health care providers to work more effectively with family caregivers, and revisions to most support and training materials for family caregivers to reflect care management of the whole person, rather than just the specific condition.

“Caregiving is rarely uncomplicated, “said AARP State Director Kathleen Connell. “Add these issues and the stress on the caregiver grows and can feel unceasing. We need to be mindful of the circumstances caregivers face. In the larger scheme, this points to the need a strong strategy that provides support to all caregivers.”

Susan Reinhard, AARP’s Senior Vice President for Public Policy, adds: “Take a hard look at this profile of today’s overstretched and overstressed caregiver for someone with cognitive or behavioral issues,”. “This is the face of caregiving’s future unless we improve long-term services and support for family caregivers,” she said, pointing to the expected surge in the incidence of Alzheimer’s disease and the projected drop by more than half in the ratio of potential caregivers to those likely to need care.

“Caring for a family member is hard enough when the family member is on the same page,” said co-author Carol Levine, Director of the Families and Health Care Project for United Hospital Fund. “But when that family member has a cognitive impairment, like Alzheimer’s, or a behavioral issue, such as depression—things that can interfere with daily life as well as decision-making—the burden on the caregiver is multiplied. And currently, our health care system often doesn’t provide the kind of support that can make a difference.”

Gearing Up

According to the Rhode Island Chapter of the Alzheimer’s Association, in 2013 an estimated 5 million Americans age 65 and older have Alzheimer’s disease. Unless more effective ways are identified and implemented to prevent or treat this devastating cognitive disorder, the prevalence may well triple, skyrocketing to almost 16 million people.

Meanwhile, with 24,000 Rhode Islanders afflicted with Alzheimer’s disease, every Rhode Islander is personally touched, either caring for a family member with the cognitive disorder or knowing someone who is a caregiver or patient. As indicated by the recently released AARP/United Hospital Fund report, many of these caregivers will doubly challenged by taking care of a loved one with chronic diseases who also have chronic and behavioral issues.

As reported in a previous commentary, both federal and state officials are gearing up to battle the nation’s impending Alzheimer’s epidemic.

In February 2012, the U.S. Department of Health and Human Services released its draft National Plan, detailing goals to prevent or treat the devastating disease by 2025. Almost six months later, in May 2012, the Rhode Island General Assembly passed a joint resolution (The same month that the final National Plan was released.), signed by Governor Lincoln Chafee, directing the state’s Long Term Care Coordinating Council to lead an effort to create a state-wide strategy to react to Rhode Island’s growing Alzheimer’s population. Almost one year later, a 122 page document, the Rhode Island State Plan for Alzheimer’s Disease Disorders, was released to address the growing incidence in the Ocean State.

Amazingly with the November election looming, candidates for Lt. Governor may be discussing a multitude of issues, but not the Ocean State’s impending Alzheimer’s epidemic and its impact on caregivers. Nor are the candidates talking about how they would continue the work of Lt. Governor Elizabeth Roberts in implementing the Long-Term Care Coordinating Council’s efforts to fully implement the State’s Alzheimer’s plan.

With the Lt. Governor being given the responsibility of overseeing the work of the Long-term Care Coordinating Council, maybe aging policy issues like the state’s impending Alzheimer’s disease epidemic and its impact on state resources and caregivers should be thoroughly debated. It’s a no brainer.

Family Caregivers Providing Complex Chronic Care to People with Cognitive and Behavioral Health Conditions was produced with support from the John A. Hartford Foundation. The report is available at https://www.uhfnyc.org/publications/881005.

To review the Rhode Island’s Alzheimer’s plan go to http://www.ltgov.state.ri.us/alz/State%20Plan%20for%20ADRD%202013.pdf.

Herb Weiss, LRI’12, is a writer covering aging, health care and medical issues. He can be reached at hweissri@aol.com.

Pawtucket Hall of Fame Names Nesselbush As “Person of the Year”

Published in Pawtucket Times, September 27, 2014

Three City residents, Joan Crawley, former Director of the Pawtucket Leon Mathieu Senior Center, the late Kathleen Magill, a former Pawtucket City Councilor, and Miriam R. Plitt, President of the City’s Commission on Arts & Culture, will be inducted next month into the Pawtucket Hall of Fame. Philanthropist Elizabeth Higginson Weeden is this year’s historical inductee. All have made a significant impact on the City of Pawtucket.

Pawtucket dignitaries will induct this year’s Class of 2014 into the City’s most venerable institution, the Pawtucket Hall of Fame, at the upcoming 23rd annual dinner and induction ceremony. The Pawtucket Hall of Fame was founded in 1986 to commemorate the 100th anniversary of the founding of the City of Pawtucket.

Interestingly, this year there will be a new twist in the Hall of Fame in that the induction committee has created a new category of inductee: the Pawtucket Person of the Year! “We’re excited about our new “Person of the Year” Award being given this year,” says Chair Ken McGill, noting that this prestigious accolade honors a person who has made a unique and superlative accomplishment that significantly benefits the entire City.

“Senator Donna Nesselbush will receive the distinct honor of being the first person ever to receive this recognition,” said McGill, who also serves as Pawtucket’s Registrar in the Board of Canvassers. McGill added, the Pawtucket Senator successfully advocated for civil rights for all Rhode Islanders when she championed the Senate Marriage Equality bill. This historic legislative proposal was passed (along with the House companion measure) and signed into law by Governor Lincoln Chaffee.

Over the years, Nesselbush also worked to help victims of domestic violence, the homeless, the injured and the disabled. “Nesselbush’s creative leadership and tenacious hard work played a vital role in the historic passage of marriage equality, successfully ending centuries of discrimination; this made her the obvious choice by the Committee to be Pawtucket’s first “Person of the Year” said McGill.

Senate President M. Teresa Paiva Weed, notes “she has sponsored many important pieces of legislation, specifically bills to help homeowners avoid foreclosure, protect victims of crime, and to protect workers from exploitation. “I can think of no one more deserving of the recognition of being named to the Pawtucket Hall of Fame. It is my good fortune to call her a friend,” says Paiva Weed.

Pawtucket Mayor Donald R. Grebien agrees with both McGill and Paiva Weed about the selection of Nesselbush. “They couldn’t have gotten it more right, he said, noting that she is “one of our city’s strongest leaders.”
Making a Difference in the Community

Nesselbush’s long list of professional and personal accomplishments caught the attention of the Pawtucket Hall of Fame Committee. The 52-year old Pawtucket resident is a founding partner of the law firm of Marasco & Nesselbush, serving the injured and disabled. As an attorney, she has represented hundreds of Social Security Disability claimants at all levels of review before the Social Security Administration, the Office of Disability Adjudication and Review, the Appeals Council, the United States District Court, and the United States Court of Appeals.

Nesselbush, a graduate of Brown University and Suffolk University School of Law, now serves as Chief Judge of the Pawtucket Municipal Court and Vice-President of the Municipal Court Judges’ Association. She is the founder and Chair of the Rhode Island Bar Association’s Social Security Disability Committee.

In the past, the two term Senator has been honored for her work by numerous organizations. Most recently, in May of 2014 she received the distinguished Ada Sawyer Award from the Rhode Island Women’s Bar Association. She has also received Appreciation Awards from Crossroads Rhode Island and the Rhode Island Coalition for the Homeless. At Brown University she received the Sarah Doyle Prize “for making a significant contribution to women on campus and in the community,” and at Suffolk she received the Leo J. Wyman Award.

Bringing Marriage Equity to the Ocean State

With all of Nesselbush’s accomplishments, the Pawtucket Hall of Fame Committee zeroed in on her successful efforts to provide all Rhode Islander’s the right to marry the person they love.

Nesselbush had observed and participated in the intensely public (and simultaneously personal) debate on marriage equality over the years. Last year’s legislative policy debate put real faces to this religiously-charged issue, she said, noting that it was personal, political and professional all at the same time in that, as a judge, she was qualified to officiate at marriages, but as a person, she was not allowed to marry the woman of her dreams.

Nesselbush mentions a significant change in the times and in social mores, noting that as the debate raged, everyone seemed to know someone who is gay, and her lobbying conversations almost always began or ended with, “yes, I know ‘so and so’ who is gay; s/he’s great and has a great partner.”

Changing Rhode Island’s law to allow gay and lesbian couples to marry took a long time, a broad coalition in support, and an openly gay Speaker of the House, says Nesselbush, referencing former House Speaker Gordon Fox. The Pawtucket Senator added, “victory has many parents, and I was indeed honored to advocate for the issue alongside many outstanding grassroots organizations, like Rhode Islanders United for Marriage, and many local church and business groups and some of the state’s top political brass.

For almost 20 years, state lawmakers had grappled with the religiously charged issue of same-sex marriage. Throughout the years, Nesselbush attended many of the legislative hearings in support of same-sex marriage, only to see bills inevitably “held for further study.” Once she became a Senator, she clearly understood that this legislative code phrase often means the legislative proposal is…dead.

In 2010, as a newly elected Senator, Nesselbush was learning the legislative procedural ropes. Knowing that she was both new and walking a tight rope, she learned the fine art of vote counting. She scrambled to count votes only to realize that marriage equality would not in that year even get out of the House. Rather, the House passed a watered down, “skim milk” (in the words of Supreme Court Justice Ruth Bader Ginsberg) version entitled Civil Unions. Nesselbush voted against the Civil Unions bill, noting that she and Rhode Island’s LGBTQ community would not accept second class status. Though she acknowledged that Civil Unions bestowed some needed rights, she wanted to “take the high road,” voting against this less than desirable and often vilified vehicle. She wanted to stand for the proposition that separate is never equal; gay and lesbian couples deserve full marriage equality.”

Although the marriage equality bill was stymied in 2010, three years later Nesselbush was in the perfect position to champion the Senate bill; she was openly gay and no longer a rookie. She was determined to honor former Senator Rhoda Perry who carried this torch in the Senate for over 15 years, changing hearts and minds but falling short of getting the bill passed. Upon Perry’s retirement, Senator Sue Sosnowski of South Kingston, a long time civil rights advocate, was next in line to sponsor the marriage equality legislation. Nesselbush notes Sosnowski’s “generosity of spirit,” as she willingly stepped aside to allow the only openly gay Senator to “take the lead.” Nesselbush gives thanks and credit to Senate Majority Whip, Maryellen Goodwin, of the City for helping to massage the Senate’s customary seniority system, allowing Nesselbush to become the lead Senate sponsor.

The Senate Judiciary Committee voted 7-4 to pass Nesselbush’s same sex marriage bill along with the House companion measure. Both measures were passed by the Senate, and by the House in concurrence, and Governor Lincoln Chaffee put his pen to paper, signing the historic measure into law on May 3, 2013.

Bowing to the powerful Catholic lobby, the General Assembly leadership put language in the House and Senate bills reiterating the constitutionally guaranteed freedom for religious institutions to set their own guidelines for marriage eligibility within their faith, stipulating that under no circumstances will clergy or others authorized to perform marriages be obligated by law to officiate at a same sex marriage.

Through Nesselebush’s leadership, Rhode Island joined its New England neighbors, becoming the 10th state in the nation to enact marriage equality. Today, a total of 19 states and the District of Columbia have enacted marriage equality, and Nesselbush “predicts that the remaining ‘house of cards’ will fall quickly as ‘marriage equality fever’ spreads through the entire nation.”

The Pawtucket Hall of Fame 23rd Annual Dinner and Induction Ceremony is scheduled for October 28, 2014 at 7:00 p.m. (pre-induction reception at 6:00 p.m.) at the Le Foyer Club, 151 Fountain Street, Pawtucket. To purchase tickets, contact Ken McGill at 401 728-0500, Ext. 283.

Herb Weiss, LRI ’12, is a Pawtucket-based freelance writer covering, aging, health care and medical issues. He is a member of the Pawtucket Hall of Fame Committee and can be reached at hweissri@aol.com.

GAO: Older Persons Hit Hard by Student Loan Debt

Published in Pawtucket Times, September 19, 2014

By Herb Weiss

In her late 20s, Janet Lee Dupree took out a $ 3,000 student loan to help finance her undergraduate degree. While acknowledging that she did not pay off the student loan when she should have, even paying thousands of dollars on this debt, today the 72-year-old, still owes a whopping $15,000 because of compound interest and penalties. The Ocala, Florida resident, in poor health, will never pay off this student loan especially because all she can afford to pay is the $50 the federal government takes out of her Social Security check each month.

Citing Dupree’s financial problems in her golden years in his opening remarks at a Senate Panel hearing in Room 562 of the Dirksen Senate Office Building, Chairman Bill Nelson (D-FL), of the Senate Special Committee on Aging, used his legislative bully pulpit to dispel the myth that student loan debt only happens to young students. “Well, as it turns out, that’s increasingly not the case,” he said.

Student Loan Debt Impacts Seniors, Too

But, last week’s Senate Aging panel hearing also put the spot light on fifty seven-year-old Rosemary Anderson, a witness who traveled from Watsonville, California, to inside Washington’s Beltway, detailing her student loan debt. Anderson remarked how she had accumulated a $126,000 loan debt (initially $64,000) to pay for her bachelor’s and master’s degree. A divorce, health problems combined with an underwater home mortgage kept her from paying anything on her student loan for eight years.

Anderson told Senate Aging panel members that with new terms to paying off her student loan debt, she expects to pay $526 a month for 24 years to settle the defaulted loan, setting her debt at age 81. The aging baby boomer will ultimately pay $87,487 more than her original student loan amount.

Like Anderson, a small but growing percentage of older Americans who are delinquent in paying off their student debts worry about their Social Security benefits garnished, drastically cutting their expected retirement income.

According to a 22 page Government Accountability Office (GAO) report, “Inability to Repay Student Loans May Affect Financial Security of a Small Percentage of Retirees,” released at the Sept. 10 Senate panel hearing, the amount that older Americans owe in outstanding federal student loans has increased six-fold, from $2.8 billion in 2005 to more than $18 billion last year. Student loan debt for all ages totals $ 1 trillion.

The GAO report noted that student loan debt reduces net worth and income, eroding the older person’s retirement security.

Nelson observed, “Large amounts of any kind of debt can put a person’s finances at risk, but I think that Ms. Dupree’s story shows that student debt has real consequences for those in or near retirement. And, the need to juggle debt on a fixed income may increase the likelihood of student loan default.”

Although the newly released GAO report acknowledged that seniors account for a small fraction of student loan debt holders, it noted that the numbers of seniors facing student loan debt between 2004 and 2010 had quadrupled to 706,000 households. Roughly 80 percent of the student loan debt held by retirement-aged Americans was for their own education, while only 20 percent of loans were taken out went to help finance a child or dependent’s education, the report said.

Senator Sheldon Whitehouse (D-RI), who sits on the Senate Special Committee on Aging, acknowledges that student loan debt is a burden for thousands of Rhode Islanders, including a growing number of retirement-age borrowers who either took out student loans as young adults, or when they changed careers, or helped pay off a child’s education. “Student debt presents unique challenges to these older borrowers, who risk garnishment of Social Security benefits, accrual of interest, and additional penalties if they are forced to default,” says Whitehouse, stressing that pursuing an education should not result in a lifetime of debt.

Whitehouse sees the Bank on Students Emergency Loan Refinancing Act, which would allow approximately 88,000 Rhode Islanders to refinance existing student loans at the low rates that were available in 2013-2014, as a legislative fix to help those who have defaulted on paying off their student loans. “By putting money back in the pockets of Rhode Islanders we can help individual borrowers make important long-term financial decisions that will ultimately benefit the economy as a whole,” he says.

Garnishing Social Security

The GAO reports finds that student loan debt has real consequences for those in or near retirement The need to juggle debt on a fixed income may increase the likelihood of student loan default. In 2013, the U.S. Department of the Treasury garnished the Social Security retirement and survivor benefits of 33,000 people to recoup federal student loan debt. When the government garnishes a Social Security check, multiple agencies can levy fees in addition to the amount collected for the debt, making it even more challenging for seniors to pay off their loan.

Ranking Member, Susan M. Collins (R-ME) Ranking, on the Senate Panel, warned [because of a 1998 law] seniors with defaulted student loans may even see their Social Security checks slashed to see their Social Security check to $750 a month, a floor set by Congress in 1998. “This floor was not indexed for inflation, and is now far below the poverty line, adds Collins, who says she plans to introduce legislation shortly to adjust this floor for inflation and index it going forward, to make sure garnishment does not force seniors into poverty.

According to an analysis of government data detailed on the CNNMoney website, “More than 150,000 older Americans had their Social Security checks docked last year for delinquent student loans.”

Unlike other types of consumer debt, student loans can’t be discharged in bankruptcy. Besides docking Social Security, the federal government can use a variety of ways to collect delinquent student loans, specifically docking wages or taking tax refund dollars. These strategies also cutting the income of the older person.

Some Final Thoughts…

“It’s very important that we focus on the big picture and the implications in play,” said AARP Rhode Island State Director Kathleen Connell, noting that “Education debt is becoming a significant factor for younger workers in preparing for retirement, delaying the ability of people to retire and threatening a middle-class standard of living, both before and after they retire.

Connell says, “Its serious concern for some older Americans as approximately 6.9 million carry student loan debt – some dating back to their youth. But others took on new debt when they returned to school later in life and many others have co-signed for loans with their children or grandchildren to help them deal with today’s skyrocketing college costs.”

“It’s not just a matter of Federal student loan debt being garnished from Social Security payments if it has not been repaid, “ Connell added. “Outstanding federal debt also will disqualify an older borrower from eligibility for a federally- insured reverse mortgage.

“Families need to know the costs and understand the long-term burden of having to repay large amounts of student loan debt,” Connell concluded. “They also need information regarding the value of education, hiring rates for program graduates and the likely earnings they may expect.”

Finally, Sandy Baum, senior fellow with the Urban Institute, warns people to think before they borrow. “They should borrow federal loans, not private loans, she says, recommending that if their payments are more than they can afford, they should enroll in income-based repayment.

Addressing student loan debt issues identified by the GAO report, Baum suggests that Congress might ease the restrictions on discharging student loans in bankruptcy, and end garnishment of Social Security payment for student debt. Lawmakers could also strengthen income-based repayment, making sure that they don’t give huge benefits to people with graduate student debt and relatively high incomes.

Herb Weiss, LRI ’12, is a Pawtucket writer who covers aging, health care and medical issues. He can be reached at hweissri@aol.com.