Dutch Consider Law to Allow Assisted Suicide for Elderly Not Sick; In Italy, Large Numbers Living Beyond 90

The Dutch government is going to draft a new proposal to allow any elderly person  to take his or her life if they no longer want to live.  The Netherlands which has been one of the most liberal countries with assisted suicide has long allowed it for those who are terminally ill.    Assisted suicide has been available in Holland since 2001 and 4% of deaths, over 5000 people every year, take advantage of the law.    The law has been expanded to allow for those with dementia and mental illness to be euthanized.

Under the new proposal which has not been finally drafted, those who are feeling their lives are “complete”  would have the ability to take their own life even if they are not sick, The intent is to provide relief from undefined suffering that may not be attributed to a terminal illness.  There would be a process for third party evaluation.   The proposal does not have an age attached to it.

No states in this country which currently allow assisted suicide have gone as far at the Netherlands.  Some advocates for it are discussing whether to extend to one year the qualification that a person have a terminal illness with six months to live.


Meanwhile, the New York Times  reported this week that in Acciaroli Italy, older people are thriving with 1 in 60 in one section of the country living into their 90s and beyond.  That is in contrast to about 1 in 163 in the United States.  The diet and lifestyle of those in this area living near in a mild climate near the sea are considered as factors as well as a strong sense of community.  Studies are being conducted about genetic characteristics and the diet of those in the area.    Researchers are examining the high use of the herb rosemary in the area which has been shown to aid brain function.  There is a low incidence of Alzheimers in the area.  A doctor at a local university said, “At 95, they have brains more like someone who is 50 and, at 50, you’re still thinking a lot about sex.”


California Voters to Decide on Drug Prices; Colorado Voters on Assisted Suicide

For more information on state ballot initiatives go to ballotpedia.org

Two states have major referendums on key issues related to end of life and drug pricing.  In California, voters will decide on whether drug prices paid by state programs will not be allowed to be higher than prices paid by the Veterans Administration (VA).   This proposition may set the record for the most money ever spent on a proposition in California with estimates of over $100 million when the campaign is over.   Despite massive spending by the pharmaceutical industry, this issue is currently ahead in the polls in the state with about 70% support.   Many community organizations and unions and others including AARP are supporting it.  An AIDS advocacy organization is the largest funder of the effort to support the proposition.

Meanwhile in Colorado, a proposal to support assisted suicide for those terminally ill is on the ballot and current polls show it has over 70% approval.  Previous votes in other states were much closer with Massachusetts defeating a similar proposal in 2012 by a margin of 51%- 49%.  Since then though, California’s  Legislature has enacted such a policy which went into effect earlier this year.   The advocacy organization, Compassion and Choices, has spent over $4.5 million supporting the measure with the Catholic Archdiocese of Denver spending over a $1 million opposing it.

The New York Times reported today that the Netherlands, where the right to die was enacted in 2001, is now proposing allowing healthy older persons to take their own lives if they think they have had a complete life.  The proposed law does not even have a minimum age so it basically would allow persons of any age to do so.  Opponents have expressed concern that it provides an opportunity for those who are depressed or have mental health issues at any age to legally take their own lives.  It basically promotes suicide.

An argument was recently made in this country that if assisted suicide is enacted and it allows an older person, a grandparent to take their life if they are terminally ill, what message does it send to a troubled younger person who may have mental health or addiction problems – perhaps it normalizes suicide at a time when the suicide rate is rising in many areas across the country.




25% of Workforce Will be 55+ in 2020; Flex-Retirement and Other Options Grow as More Seek to Keep Working

I mentioned before that I am reading Unretirement,  Chris Farrell’s extensively researched book about the Baby Boomer generation and the reality that many will continue to work, some out of necessity, and others for enjoyment.  Farrell says that many healthy “young seniors” will continue to work and some will start businesses they have always dreamed of.  He notes that there are many organizations in larger communities like Next Chapter in Kansas City that are helping this group plan the next chapter in their lives. Websites like Retired Brains help older persons find jobs and discuss options for continued employment and self-employment.

Religious organizations like the Ignatian Volunteer Corps (IVC) are located in many cities and they place older workers in human services and social justice work for a stipend and incorporate a Jesuit spiritual component and a sense of shared community.

Farrell also mentions some larger companies like Intel which are using innovative methods to lessen the “brain drain” in their companies.  With so many Baby Boomers reaching the retirement age in these companies they don’t want to lose so much of their institutional knowledge all at once, so they are offering flex-retirement.  Older workers can take  several  weeks off during the year and come back to work or they can gradually reduce their hours over a number of years as they phase into retirement.  This benefits the companies but also helps workers get a taste for being retired so they can think  and plan their next chapter.

With paid family leave , these types of phased retirement options may be the next step in worker friendly employment, though they isn’t a  need for legislation to mandate this.  Farrell argues in the book that major businesses will see that being supportive of workers throughout their lives, as parents of newborns and later as caregivers and retirees helps to maintain loyalty and morale.

Farrell says that  25% of the labor force will be workers over the age of 55, up from 19.5% in 2010.   These “mature workers” counter the perception that a massive wave of people will just retire and collect Social Security rather than still pay into the system.

Other books to explore on this topic include The Encore Career Handbook:  How to Make a Living and a Difference in the Second Half of Life by Marci Alboher and Great Jobs for Everyone 50+ : Finding Work That Keeps You Happy and Healthy And Pays the Bills by Kerry Hannon.

We are hoping to create a network of retirees interested in work and voluntarism in the Albany area so let me know if you have an interest.

Mike Burgess



New York to Lose $2.7 Billion if Millionaires’ Tax Expires in 2017; Fiscal Policy Institute Proposes Extension

If the “millionaires’ tax”  enacted by the State Legislature in 2011 is not extended next year, its expiration will result in a $2.7 billion revenue loss for the state budget.  Ironically, failure to extend it would give the richest 1% in the state a $3.7 billion windfall and those with annual incomes between $40,000 and $300,000 a tax increase adding $1 billion to the state’s coffers, according to the Fiscal Policy Institute.

Before the 2011 millionaires tax, the state’s top tax rate was flat at 6.85% for all households with annual incomes of $40,000 and higher.  With the 2011 tax changes, the rate dropped slightly to 6.45% – 6.65% for those with incomes between  $40,000 and $300,000 annually even though it was 6.85% for households between $300,000 and $2 million annually.  The rate rose to 8.82% for those with incomes above $2 million.   So, technically the tax is the $2 millionaires tax.

The major budget issue in next year’s state budget will be how to address the expiration of this tax which is automatic without action by the Legislature.  Governor Cuomo will be under tremendous pressure from the progressive wing of his party to extend the tax.   Any effort to not roll it back could have big political ramifications for him as he considers running for a third term in 2018.  The Governor has moved to the left in the past year but he has to worry about a challenge from the left , especially in light of the recent scandal in his administration that has weakened him.  The scandal has resulted in charges by federal prosecutor Preet Bharrara against two of Cuomo’s top aides as well as the heads of several businesses which were top Cuomo campaign contributors and whose leaders were charged with bribery.

The Fiscal Policy Institute is proposing a 1% Plan for Tax Fairness which would increase rates for those with annual incomes from $665,000 and above, raising their rates to 7.65 – 9.99%.  This proposal would increase state revenues by $2.2 billion according to FPI.  The state has a 2% tax cap though which means that additional revenues above the cap have to be returned to taxpayers.  FPI says state tax revenues will grow by more than 4.5%.   With Medicaid and school aid increasing by about 4%, other budget areas have been held flat or cut in recent years.  FPI is calling for the tax cap to be scrapped to accommodate higher spending for increasing needs.





$10,000/Month in Rehab? Why Patient Navigators are Needed

You can view all my blog posts at http://www.generationsofnewyork.com

Recently, I became aware of a case of an older man who has spent the last six months in a rehab facility following two surgeries he had.  One was colon surgery and he has ended up using an ostomy bag.  While in rehab he fell and broke a bone and has been using a walker. Neither of these episodes would seem to require six months of rehabilitation.   He had been living independently with his wife.  They have no children and his wife has been living alone for six months.  She doesn’t drive and has had to get rides to see him.

They are a very middle class couple who has saved their money and own their home.  They have had enough money to pay for the nursing rehab facility since Medicare’s coverage ended after 20 days, but they have been paying about $10,000 per month.

The rehab staff recently gave the patient three options for the future. One was that he could stay in rehab!  The second was for him to go to an assisted living facility and the third was to go home with twenty four hour care.  This gentleman wants to go home, not only for himself but to be with his wife who has been alone.  He also doesn’t want to have twenty four hour care with someone in their home all day and night.  He hopes to become independent again and would accept some nursing help at home for a while.

He really needed a navigator or advocate to help him because he wasn’t sure of his rights or how to assert them.  When the rehab center told him he could go home with twenty four hour care, which he didn’t want, he felt they were saying that was his only option to go home or else he would have to stay there or move to an assisted living facility.

Of course, he can go home with help whenever he wants as long as he is not in danger, which he wouldn’t be with his wife there.   He has been offered help from his local church and others who will now advocate for him.

Many times, we hear of patients not be provided enough discharge planning with services arranged before they are sent home from a hospital.  Here is a case of a person who is being given more care than he wants and the social work staff may have not been anticipating or acting on his wishes, thereby causing a great deal of unnecessary stress with the separation of the patient and his wife.    The fact that he was told one option was to stay in rehab and keep paying while his wife is home alone is a cause for concern and may be putting the financial interests of the facility to have a private pay resident ahead of the quality of life of this man and his wife.

Would he have stayed there if he had children or someone to advocate for him?  A patient navigator or advocate certainly would have been on top of the situation and worked to find a plan that was in the best interests of the patient – to go home as soon as he was able to function there.

Hospital Systems Contracting with Community Based Organizations in DSRIP

As the state’s Medicaid reform plan known as DSRIP picks up steam in its second year, health systems (PPS) are contracting with community based nonprofits as “partners” to help them in providing follow up coordinated care after discharge.  Many of the nonprofits are also involved in other projects that are priorities for Medicaid reform under DSRIP such as chronic disease management, asthma treatment or smoking cessations. Some community organizations have been assisting by administering patient activation surveys and patient coaching of Medicaid beneficiaries to urge them to get more involved in their own care.

The New York State Department of Health is actively urging health care systems to work closely with community based agencies that provide the kind of non-medical, social services that will be essential to successfully transitioning patients back into the community and preventing re-admissions.  The New York State Health Foundation, in analyzing DSRIP, noted “Community-based organizations (CBOs) are an untapped resource crucial to meeting DSRIP’s goals of reducing avoidable hospital use by 25% over 5 years. They are well positioned to address population health issues; have long-standing, trusted community relationships; and provide critical services to New York’s most vulnerable populations.”

Albany Medical Center which is running its DSRIP project in a five county area around the Capital District has decided to provide a base contract of about $7000 to a number of community organizations to have them as partners in their plan even though some of the organizations don’t have Medicaid clients but can assist in providing other support.  The nonprofits are involved in the various projects by sitting on committees and working on some of the projects which could include providing care coordination services.

Since DSRIP is a five year program running through early 2020, community based organizations will have opportunities to renew contracts or negotiate new, larger ones as DSRIP projects get underway.  Some organizations, for example, may be interested in developing community patient navigators, in the coming years since this one-on-one patient assistance is something many community organizations which already serve a client base may be able to successfully undertake.


Regardless of Election, Income Inequality Changes Landscape in Favor of Progressive Action

You can read all my posts at http://www.generationsofnewyork.com

No matter who wins the Presidential election and which party controls Congress, the rising focus on income inequality has changed the political dynamic in ways  that will continue to provide opportunities for change for workers, seniors, families and caregivers.  Of course, it will be more difficult if those who favor more tax breaks for the wealthy are in control, but it is quite clear that there will be major resistance to any such efforts to further the gap between the wealthy and the middle class and the poor.  If progressives are either in charge or have a strong position in Washington and state capitals the push for economic reform will be even greater.

This has already played out in New York as we saw earlier this year with the enactment of a minimum wage increase to $15.o0/hour in New York City and downstate counties and $12.50 in upstate regions.   The passage of paid family leave also was a landmark victory for families and caregivers.  Both of these proposals were considered to be going nowhere just a year or two ago.

Other issues are playing into the mix though.  Talk of increasing Social Security benefits particularly for those with lower incomes was never even mentioned before but now, it is in the platform of the Democratic Party.  Even though the Social Security system has financial problems and won’t be able to pay full benefits in 2034, that problem and an increase for lower income retirees could be paid for by lifting the earnings cap of $118,000.  Workers making above that no longer pay the tax when they reach that level each year in their salaries.

The high price of prescription drugs and increasing premiums and cost sharing in health care plans are opening the door for bigger discussions again about allowing Medicare to negotiate drug prices and also about expanding Medicare and allowing younger workers to buy-in.  That idea is also in the platform for the Democrats.  Insurance companies are dropping out of the Affordable Care Act and that is raising questions about whether universal health care would cut out a lot of administrative overhead and profits.  That issue is on the ballot in Colorado and controlling drug prices is on the ballot in California this November.

Then, there is the book I mentioned last week called Unretirement.  This book claims that Baby Boomers, rather than being a drain on the economy, will have many members who keep working because they want to and some because they have to.  Some will be entrepreneurs free to start their own businesses in retirement.  In other words, they will continue to be contributing to Social Security and Medicare and will be benefitting the economy.

When have we heard that idea presented?  Usually, all we hear is that older people and retirees are a burden, not an asset.  The ground is shifting because of our advocacy and messaging.  Baby Boomers are not going to allow themselves to be cast off as “burdens,” no longer able to participate and contribute.  No matter the election result, it is clear that our advocacy for workers, seniors, retirees and caregivers has a progressive agenda to pursue and to fight back against  those who want to marginalize people with ageism.

Mike Burgess