Millions of older people face shrinking Social Security checks next year, the first time in a generation that payments would not rise. The trustees who oversee Social Security are projecting there won’t be a cost of living adjustment (COLA) for the next two years. That hasn’t happened since automatic increases were adopted in 1975.

By law, Social Security benefits cannot go down. Nevertheless, monthly payments would drop for millions of people in the Medicare prescription drug program because the premiums, which often are deducted from Social Security payments, are scheduled to go up slightly.

Read it all I see this one made the front page of yesterday’s local paper.

Part psychoanalyst, part detective, Dr. O’Mahony had to listen to the cues and decide what to do next.

Most doctors do not excel at delivering bad news, decades of studies show, if only because it goes against their training to save lives, not end them. But Dr. O’Mahony, who works at Montefiore Medical Center in the Bronx, belongs to a class of doctors, known as palliative care specialists, who have made death their life’s work. They study how to deliver bad news, and they do it again and again. They know secrets like who, as a rule, takes it better. They know who is more likely to suffer silently, and when is the best time to suggest a do-not-resuscitate order.

Palliative care has become a recognized subspecialty, with fellowships, hospital departments and medical school courses aimed at managing patients’ last months. It has also become a focus of attacks on plans to overhaul the nation’s medical system, with false but persistent rumors that the government will set up “death panels” to decide who deserves treatment. Many physicians dismiss these complaints as an absurd caricature of what palliative medicine is all about.

Still, as an aging population wrangles with how to gracefully face the certainty of death, the moral and economic questions presented by palliative care are unavoidable: How much do we want, and need, to know about the inevitable? Is the withholding of heroic treatment a blessing, a rationing of medical care or a step toward euthanasia?

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White House officials and Democrats in Congress say the fears of older Americans about possible rationing of health care are based on myths and falsehoods. But Medicare beneficiaries and insurance counselors say the concerns are not entirely irrational.

Bills now in Congress would squeeze savings out of Medicare, a lifeline for the elderly, on the assumption that doctors and hospitals can be more efficient.

President Obama has sold health care legislation to Congress and the country as a way to slow the growth of federal health spending, no less than as a way to regulate the insurance market and cover the uninsured.

Mr. Obama has also said Medicare and private insurers could improve care and save money by following advice from a new federal panel of medical experts on “what treatments work best.”

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…a discussion about the prospect of rationing in a public health system is not only permissible but unavoidable. Every nation that has promised comprehensive, low-cost health coverage for all citizens has faced a similar dilemma. Eventually it is not enough to increase public spending or to reduce waste. More direct forms of cost control become an overwhelming priority. And because health expenditures are weighted toward the end of life, the rationing of health care often concerns older people most directly.

Keith Hennessey, former director of the National Economic Council, puts the dilemma simply: “Resources are constrained, and so someone has to make the cost-benefit decision, either by creating a rule or making decisions on a case-by-case basis. Many of those decisions are now made by insurers and employers. The House and Senate bills would move some of those decisions into the government. Changing the locus of the decision does not relax the resource constraint. It just changes who has power and control.”

Because no one likes to ration directly, nations such as Britain and Germany employ “comparative effectiveness research” to lend an air of science to the process of cost constraint. Are “quality-adjusted life years” worth the public expense of a new drug or technology?

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With so much evidence of wasteful and even harmful treatment, shouldn’t we instantly cut some of the money spent on exorbitant intensive-care medicine for dying, elderly people and redirect it to pediatricians and obstetricians offering preventive care for children and mothers? Sadly, we are very far from this goal. A cynic would argue that this can’t happen because children can’t vote (even if their parents can), whereas members of AARP and the American Medical Association not only vote but can also hire lobbyists to keep the money flowing.

One thing’s for sure: Our health care system has failed. Generational spending wars loom on the horizon. Rationing of health care is imminent. But given the political inertia, we could soon find ourselves in a triage situation in which there is no time or money to create medical-review boards to ponder cost-containment issues or rationing schemes. We’ll be forced to implement quick-and-dirty rules based on something simple, sensible and easily verifiable. Like age. As in: No federal funds to be spent on intensive-care medicine for anyone over 85.

I am not, of course, talking about euthanasia. I’m just wondering why the nation continues incurring enormous debt to pay for bypass surgery and titanium-knee replacements for octogenarians and nonagenarians, when for just a small fraction of those costs we could provide children with preventive health care and nutrition. Eight million children have no health insurance, but their parents pay 3 percent of their salaries to Medicare to make sure that seniors get the very best money can buy in prescription drugs for everything from restless leg syndrome to erectile dysfunction, scooters and end-of-life intensive care.

Read it all from yesterday’s New York Times.

The early baby boomers may be known as the generation of sex, drugs and rock and roll. But it turns out, they’re hitting the bottle pretty hard as they age, as well. And that portends significant alcohol-related health problems ahead as those mid-lifers become seniors.

A new study finds that among men and women 50 to 64 years old, almost 1 in 4 men and 1 in 10 women is a “binge” drinker — meaning that at some point in the last 30 days, he or she has downed four (for women) or five (for men) servings of alcohol in a single two-hour sitting. Such alcohol abuse — roughly defined as the amount needed to attain a blood-alcohol level of .08 (the level at which most states consider a driver intoxicated) — frequently escapes the notice of physicians, even though it presents an escalating health risk as the drinker ages.

The study, published in the American Journal of Psychiatry, found that binge drinkers are more likely to use tobacco or illicit drugs than those who do not drink. (It also found that among women, binge drinking was more common among the employed and those using prescription drugs for nonmedical purposes; among men, it was more common among the unmarried and those with higher incomes.)

Binge drinking among this still highly mobile group is associated with an increased risk of traffic accidents and other alcohol-related injuries.

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Elizabeth caught this one in last Sunday’s New York Times Magazine. Do not just drive by the blog entry and miss it–it is simply hysterical! KSH.

Our worst fear has recently come to pass: the dementia ward of the veterans’ home where my father had been living transferred him to a psychiatric hospital. But when I met my mother there on the day they brought him over, I wasn’t really surprised to see her waving from across the hall with a big smile on her face, about to laugh. We’re a family of laughers. We laugh when we’re happy, when we’re angry and, most of all, when we’re frightened.

“That’s him,” she said, chortling and pointing to the ambulance in the bay. “He just arrived, and he’s mad as a wet hen. But the ambulance driver said he didn’t slug anyone, so that’s an improvement.”

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[LUCKY] SEVERSON: Dr. Weinberg says the decisions about the ethics of distributive justice for society as a whole are often much more difficult when the doctor is meeting with a patient one-on-one.

DR. [GLORIA] WEINBERG: The health care dollars, an inordinate amount, go to taking care of people in the last 6 months of their lives. But how do you know when those last 6 months are? You have a person who has worked all their life, paid taxes, done very well, and now they are 80, and they have a heart attack. That may be the person who lives 10 or 15 more years. Are we going to say no just because of age? That’s a very, very slippery slope.

SEVERSON: There is a huge ethical discussion about who should make these end-of-life decisions””the patient, the family, doctors, the government? Brian Keeley says some decisions are easier to make. For instance, Medicare should only reimburse for treatments and drugs that are known to work.

KEELEY: It ought to be evidence-based. If something is proven not to work, I don’t think the federal government ought to be paying for it. I don’t think anybody ought to be paying for it, except for the private patient.

SEVERSON: Dr. Weinberg says too many patients receive expensive treatments and surgery in their final years that very likely won’t prolong their life.

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The Lords last night rejected a bid to allow relatives to help terminally ill people travel abroad to die, following an impassioned plea by a severely disabled peer.

Baroness Campbell of Surbiton, who was born with the wasting disease spinal muscular atrophy, told how doctors had persuaded her her life was at an end.

She said many would come under similar pressure from loved ones if the law was relaxed.

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Often even experienced doctors are unaware that 80-year-olds are not the same as 50-year-olds. Pneumonia in a 50-year-old causes fever, cough and difficulty breathing; an 80-year-old with the same illness may have none of these symptoms, but just seem “not herself” ”” confused and unsteady, unable to get out of bed.

She may end up in a hospital, where a doctor prescribes a dose of antibiotic that would be right for a woman in her 50s, but is twice as much as an 80-year-old patient should get, and so she develops kidney failure, and grows weaker and more confused. In her confusion, she pulls the tube from her arm and the catheter from her bladder.

Instead of re-evaluating whether the tubes are needed, her doctor then asks the nurses to tie her arms to the bed so she won’t hurt herself. This only increases her agitation and keeps her bed-bound, causing her to lose muscle and bone mass. Eventually, she recovers from the pneumonia and her mind is clearer, so she’s considered ready for discharge ”” but she is no longer the woman she was before her illness. She’s more frail, and needs help with walking, bathing and daily chores.

This shouldn’t happen. All medical students are required to have clinical experiences in pediatrics and obstetrics, even though after they graduate most will never treat a child or deliver a baby. Yet there is no requirement for any clinical training in geriatrics….

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In recent years scientists have become intensely interested in what could be called a super memory club ”” the fewer than one in 200 of us who, like Ms. Scott and Ms. Cummins, have lived past 90 without a trace of dementia. It is a group that, for the first time, is large enough to provide a glimpse into the lucid brain at the furthest reach of human life, and to help researchers tease apart what, exactly, is essential in preserving mental sharpness to the end.

“These are the most successful agers on earth, and they’re only just beginning to teach us what’s important, in their genes, in their routines, in their lives,” said Dr. Claudia Kawas, a neurologist at the University of California, Irvine. “We think, for example, that it’s very important to use your brain, to keep challenging your mind, but all mental activities may not be equal. We’re seeing some evidence that a social component may be crucial.”

Laguna Woods, a sprawling retirement community of 20,000 south of Los Angeles, is at the center of the world’s largest decades-long study of health and mental acuity in the elderly. Begun by University of Southern California researchers in 1981 and called the 90+ Study, it has included more than 14,000 people aged 65 and older, and more than 1,000 aged 90 or older.

Such studies can take years to bear fruit, and the results of this study are starting to alter the way scientists understand the aging brain.

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Instead of seeing older workers staying on the job longer as the economy has worsened, the Social Security system is reporting a major surge in early retirement claims that could have implications for the financial security of millions of baby boomers.

Since the current federal fiscal year began Oct. 1, claims have been running 25% ahead of last year, compared with the 15% increase that had been projected as the post-World War II generation reaches eligibility for early retirement, according to Stephen C. Goss, chief actuary for the Social Security Administration.

Many of the additional retirements are probably laid-off workers who are claiming Social Security early, despite reduced benefits, because they are under immediate financial pressure, Goss and other analysts believe.

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When Kathryne Smith was young, her dad told her she was going to college. But to her, college was nothing but an abstract idea — like trying to visualize something while reading a book with no illustrations.

The word found its meaning when her family moved to Pittsburgh from Philadelphia in the 1930s.

When the family passed the University of Pittsburgh someone said, ‘That’s college.’ And I said ‘Oh, that’s where my father wanted me to go.’ ”

Now, at 88, Mrs. Smith tomorrow will be the oldest student ever to graduate from the Community College of Allegheny County.

Read it all (i love the picture!).

The financial outlook for Medicare and Social Security has significantly worsened, as the bad economy and mounting job losses have pushed both programs years closer to insolvency, according to a grim report issued Tuesday by the Obama administration.

The new projection, in an annual report from the programs’ trustees, says that Medicare’s hospital insurance trust fund will be exhausted in 2017, just a year after President Obama would leave office if re-elected to a second term. Last year the trustees said they expected the fund to last until 2019.

The trustees also said that Social Security’s reserves now face depletion in 2037, four years sooner than the previous projection of 2041. The projections assume that there are no changes in current benefits, policies and tax rates.

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People have accused the baby boomers of being whiners almost since we were born. But just wait until we get to retirement age and discover that we don’t have nearly enough money to take care of our “golden years.” That’s going to be the ultimate generational bummer.

I’ve been gathering some data about what I’ll call, with the usual boomer understatement, the “retirement crisis.” My mentors have been Eugene Ludwig, the head of the consulting firm Promontory Financial Group, and his colleague Michael Foot. The numbers show a genuinely frightening gap between what people have saved for retirement and what they will need. And many of these studies don’t take into account last year’s stock market crash, which will make the problem worse.

Let’s start with the basic fact that only about half of Americans have any employer-sponsored retirement plan at all. The other folks will have to depend on Social Security. For a typical boomer worker, that would mean a monthly benefit of about $2,400 at a retirement age of 66 in 2020. On that, you won’t be able to afford many Starbucks lattes.

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The effects of the current economic crisis have touched everyone. Even if you still have a good job and a paid up mortgage, chances are your monthly 401(k) statement will remind you that you’ve lost a good chunk of your savings.

Trillions of dollars have evaporated from those accounts that have become the prime source of retirement funds for a majority of American workers, affecting their psyche and their future. If you are still young enough, there’s time to rebuild and recover, but if you are in your 50s, 60s or beyond the consequences can be dire, and its drawing attention to the shortcomings of a retirement system that has jeopardized the financial security of tens of millions of people.

I caught this on the morning run. Makes the heart sad. Read or watch it all.

Kathrine Neubauer was declared dead several months ago.

She’s had nothing but trouble ever since….

Neubauer’s predicament became absurd — and expensive — when she recently went to apply for a loan at a bank she won’t name.

The bank processed her loan application, granting her the advertised interest rate. Then the loan officer discovered Neubauer was supposedly dead.

“After they found out I was deceased, they said they could get me the loan, but they’d charge me an interest rate that was 1 percent higher,” Neubauer said.

Neubauer said she’s consulted two attorneys for advice on how to get off the deceased list. Neither could help.

Somehow a good illustration of the bureaucratic absurdities of some aspects of modern life. Read it all

Just as we hunker down to survive the worldwide economic collapse, we are confronted daily with news of fellow Americans who already have lost their homes, jobs and life savings.

In one important respect, Americans today are at a greater disadvantage than those who faced the Great Depression some 70 years ago. In 1930, the vast majority of the nation’s households consisted of families led by married couples. Today, many more households consist of adult Americans who face life alone.

They include solitary men and women, single parents, the divorced, widowed and unwed partners.

An important reminder, especially for those in parish ministry in the holiday season. Read it all.

I caught this earlier this week and thought it was a really nifty story. I was unaware of this research–watch it all and see what you make of it.

When Peter Nicholson’s mother suffered a series of strokes last winter, he did something women have done for generations: he quit his job and moved into her West Hollywood home to care for her full time.

Since then, he has lost 45 pounds and developed anemia, in part because of the stress, and he is running out of money. But the hardest adjustment, Mr. Nicholson said, has been the emotional toll.

“The single toughest moment was when she said to me, ”˜And now who are you?’ ” he said. “My whole world just dropped. That was the pinnacle of despair.”

Read it all from this past Saturday’s New York Times.

Since the stock market began to fall, friends have been coming to Barbara Goldsmith to talk about their depression, loss of appetite, insomnia and cravings for hot fudge sundaes.

“People are grieving,” said Ms. Goldsmith, a semiretired psychotherapist who counsels fellow residents of the Gleneagles Country Club, a gated community here. “There was a death. Their money died.”

In communities like Gleneagles and in the homes of retirees across the country, these are days of fear and uncertainty. In theory, retired people are not supposed to invest much in the stock market; in reality, many millions of them do. With the economy in free fall and stocks down about 40 percent this year, legions of middle- and upper-middle-class people are suddenly worried about having enough to carry them through.

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Watch it all. Somehow the real heroine of this story sounds like their mother–KSH.

In the same way the wrinkles and stoop of an old gentleman can sometimes mask a feisty personality, the faded sign out front of the First Baptist Church here and its weathered exterior belie the vibrant doings within.

Pop your head inside the church’s foyer on any given day and you’ll hear 72-year-old trumpeter Frank Hart improvising Wilson Pickett’s In the Midnight Hour with a crew of other elderly musicians. Or swing around back and you’ll likely find the church’s head pastor, the Rev. James Brown, picking grapes in the organic orchard, laughing and talking with some of his congregants, in his deep, gravelly voice, about the importance of eating fresh foods to keep the mind and body strong. The church’s freshwater fish farm ”” teeming with tilapia ”” bubbles nearby. Later, some will be cooked up in a cornmeal batter for church suppers.

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Watch it all.

George Dallas is 77 years old and 50 payments behind on his mortgage.

“Nobody even believes that,” the Red Top resident said. “They say, ‘Man, they should’ve taken that house years ago.’ ”

A nagging nerve problem forced Dallas to stop working before he was ready, at 71. He soon found that relying on Social Security and a pipefitter’s pension left little behind after making his $800-a-month mortgage payments.

He tried cash-advance stores but couldn’t manage the interest. He filed for bankruptcy but couldn’t keep up with the required payments.

Now seeking financial assistance at counseling centers and churches alike, he hears the same thing: There just isn’t any money.

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Decades of saving and hard work as a teacher earned Beverly Welsh what she thought would be a comfortable retirement.

She bought a townhouse in Las Vegas to be near her mother, but the longtime South Pasadena resident continued to spend time in her beloved Southern California. She spoiled her five cats. She took acting classes, landing small parts in a few low-budget films.

Then the bottom fell out of the real estate market and stocks cratered, wiping out a third of her $750,000 net worth over the last two years. Tight on cash, the 76-year-old retiree says she may seek work as a substitute teacher to supplement her dwindling investment income.

“It’s unbelievable how quickly it happened,” Welsh said. “I’m not sleeping well.”

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Among women caring for their parents, none face the rock-and-a-hard-place choices of those in the so-called sandwich generation. Now, a new analysis estimates that there are 20 million Americans ”” the vast majority of them mothers ”” who are juggling responsibilities for their own children and their aging parents at the same time.

The analysis, commissioned by two companies, Christian Companion Senior Care and Presto Services Inc., both selling services to this group, found that 53 percent of those in the sandwich generation feel forced to choose ”” at least once a week ”” between being there for their children or being there for their ailing parents. One in five say they make that painful choice every single day.

So what’s a double-duty caregiver to do? We asked that question of Jeannie Keenan, a registered nurse and vice president at My Health Care Manager in Indianapolis. The company is one of a growing number of for-profit companies that provide case managers to families caught in this thicket. It does not employ home care aides or other care providers but, rather, hooks clients up to available services through a national network of affiliates.

Ms. Keenan said that the biggest mistake adult children make in this situation is trying to segregate their dual responsibilities.

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Early last month, Jeanne Fair, 62, got her first hot meals delivered to her home in this lake town in the sparsely populated southwestern part of the state. Then after two deliveries the meals stopped because gas prices had made the delivery too expensive.

“They called and said I was outside of the delivery area,” said Mrs. Fair, who is homebound and has not been able to use her left arm since a stroke in 1997.

Faced with soaring gasoline prices, agencies around the country that provide services to the elderly say they are having to cut back on programs like Meals on Wheels, transportation assistance and home care, especially in rural areas that depend on volunteers who provide their own gas. In a recent survey by the National Association of Area Agencies on Aging, more than half said they had already cut back on programs because of gas costs, and 90 percent said they expected to make cuts in the 2009 fiscal year.

“I’ve never seen the increase in need at this level,” said Robert McFalls, chief executive of the Area Agency on Aging in Palm Beach, Fla., whose office has a waiting list of 1,500 people. Volunteers who deliver meals or drive the elderly to medical appointments have cut back their miles, Mr. McFalls said.

Read it all from the front page of today’s New York Times.

The actress Tatum O’Neal was arrested recently on charges of buying crack cocaine from a man on the street near her New York City home. She is a 44-year-old mother of three. She has spent years in and out of drug abuse treatment (which she chronicled in her 2004 memoir), and according to her publicist she will continue to “attend meetings” for drug and alcohol abuse.

Ms. O’Neal illustrates a disturbing trend among those being admitted to substance abuse treatment services: a growing percentage of older women are being treated for harder drugs.

Data from the Substance Abuse and Mental Health Services Administration revealed that the total number of admissions to treatment services from 1996 to 2005 (the last year for which detailed data are available) stayed about the same among people under 40, but jumped 52 percent among those 40 and older. Of the 40 and older group, the rise in admissions among men was 44 percent. Among women, it was 82 percent.

I confess that the 82 percent figure blew my mind. Wow. Read it all.