When You Are Old and a Burden to Your Family

Wow, that’s a cold subject! But as we get older, specialized needs, chronic boredom, and intrusion into a family home with limited space… form the tip of the aging iceberg.  For many, there is no choice but to endure. In some cultures, extended families are designed to care for the elderly who can no longer care for themselves. At the other end of aging, some wind up pushing grocery cart or struggling in homeless encampments.

In a country where you live may not be where the rest of your family resides… indeed they could be scattered to the winds… the options are vastly complex. As we watch a Republican Congress drilling down to cut social care costs in order to pay for the tax cut to our wealthiest segment, we need to be aware exactly what we are facing – either for ourselves or for the oldest in our families unable to care for themselves – as those federal programs come under a hefty budget axe.

The biggest difficulties come from disability and disease deeply negatively impacting many of our most elderly citizens. There may be mobility issues – even getting up to go to the bathroom may be beyond the ability of those most impaired – degenerative diseases maximizing their toll, or fading mental abilities, either from simple aging or, more often, the rages of dementia or Alzheimer’s. Caring for those mental issues is a huge societal cost, in pain and money.

According the Alzheimers.net, only one in four people with that disease have been diagnosed. Annually, the United States spends upwards of $236 billion caring for those suffering with that disease. Here are the current expenditures from programs covering ALZ and other forms of dementia for seniors (over 65): Medicare $113 Billion, Medicaid $41 Billion, Out of pocket $44 Billion, Other $29 Billion. That Website provides some other not-so-pleasant realities about the disease.

·         1-in-9 Americans over 65 has Alzheimer’s disease. (Alzheimer’s Association)

·         When the first wave of baby boomers reaches age 85 (in 2031), it is projected that more than 3 million people age 85 and older will have Alzheimer’s. (Alzheimer’s Association)

·         One-third of Americans over age 85 are afflicted with the illness. (Alzheimer’s Association)

·         5.3 million Americans are living with Alzheimer’s disease. (Alzheimer’s Association)

·     Unless a cure is found, more than 16 million Americans will have the disease by 2050. (Alzheimer’s Association)

·         Alzheimer’s disease is the 6th leading cause of death in America. (Centers for Disease Control)

·         1-in-3 seniors die with Alzheimer’s or another kind of dementia. (Centers for Disease Control)

·         Typical life expectancy after an Alzheimer’s diagnosis is 4-to-8 years. (Alzheimer’s Association)

·         In 2016, the 85-years-and-older population includes about 2 million people with Alzheimer’s disease, or 40% of all people with Alzheimer’s age 65 and older. (Alzheimer’s Association)

But dementia and ALZ are not the only debilitating diseases that push people into managed care facilities… for those that can afford this often-demeaning luxury. Vision and hearing loss, crippling arthritis and other mobility disabilities, and slow degenerative diseases all take their toll. So assume somehow, with a little savings and maybe some long-term care insurance, you or an elderly relative are ready to face the cost of a retirement home – not that luxurious golf resort in your own condominium with available nursing care – but a place where the residents are likely to be left by their families… burdens. AARP tells us what we can expect, cost-wise:

“Brace yourself. Most people already know nursing home care can be expensive. Although the average cost is more than $50,000 a year and climbing, it can vary widely depending on where you live. Employee health insurance does not pay for nursing home care. About a third of nursing home residents pay all of their nursing home costs from their own funds. Extended nursing home care can eat up your or your loved one's savings quickly many people exhaust their finances after just six months. A fraction of them about 5 percent buys long-term care insurance, which covers the cost of a nursing home or other extended care. Medicare, the federal health insurance program for older persons and some younger ones with disabilities, pays for short-term nursing home stays.

“So what about the rest? The greatest share of residents, about two-thirds, pay for their care with money from Medicaid, a federal and state health insurance program for people with low incomes. Medicaid picks up the cost of nursing home care once people have used almost all of their savings spouses are allowed to keep some assets including income, savings, and their home. However, Medicaid will only pay for nursing home care that is provided at a facility certified by the government.

“Eligibility for Medicaid varies by state, so if you think a loved one may need care years from now, you should gather information as soon as possible. Learning early about the requirements ensures the care comes quickly when you or your loved one need it… As more people live longer and nursing home costs rise, so too does the urgency to deal with these issues.” And then there are the massive legal issues over competency and conservatorship, matters that are very important but beyond the scope of today’s blog.

Assume you find an “acceptable” facility, and costs vary profoundly depending on quality and location, what is life like? A few allow residents to bring furniture from their past lives – helpful to manage the transition – while others allow small pets, a hedge against the bitter pain of loneliness, feelings of abandonment and notion of being dumped off as they wait for death. Cruel? Yes, but we have to deal with aging one way or the other.

But as that “retirement home” or “assisted living” becomes more of a “nursing home,” the issues simply multiply. From klepto-staff, ready to lift a piece of jewelry or a nice jacket from the drawers and closets of those who “probably won’t know the difference” to downright elder abuse, there are issues that if we really knew what was happening should make our collective blood boil. Sanitation lapses also take their toll. Unfortunately, a vast number of such elder facilities are dark holes where complaints are not heard – assuming somebody is around and able to make them – and if heard, often effectively left uncorrected. Investigations can take a year or two to get started, often too little and too late for the victims.

While that sanitation issue might seem minor and easily fixed, the numbers say otherwise. Easily-spread infections are often exacerbated by ineffective staff and supervision. The December 27^th Los Angeles Times explains: “A Kaiser Health News analysis of four years of federal inspection records shows 74% of nursing homes have been cited for lapses in infection control — more than for any other type of health violation. In California, health inspectors have cited all but 133 of the state’s 1,251 homes.

“Although repeat citations are common, disciplinary action such as fines is rare: Nationwide, only 1 in 75 homes found deficient in those four years has received a high-level citation that can result in a financial penalty, the analysis found… ‘The facilities are getting the message that they don’t have to do anything,’ said Michael Connors of California Advocates for Nursing Home Reform, a nonprofit in San Francisco. ‘They’re giving them low-level warnings year after year after year, and the facilities have learned to ignore them.’

“Infections, many of which are avoidable, cause a quarter of the medical injuries Medicare beneficiaries experience in nursing homes, according to a federal report. They are among the most frequent reasons residents are sent back to the hospital. By one government estimate, healthcare-associated infections may result in as many as 380,000 deaths each year.

“The spread of methicillin-resistant Staphylococcus aureus (MRSA) and other antibiotic-resistant germs has become a major public health issue. Although Medicare has begun penalizing hospitals for high rates of certain infections, there has been no similar crackdown on nursing homes.

“As average hospital stays have shortened to 4.5 days in 2012 from 7.3 days in 1980, patients who a generation ago would have fully recuperated in hospitals now frequently end their recoveries in nursing homes. Weaker and thus more susceptible to infections, some need ventilators to help breathe and some have surgical wounds that are still healing, two conditions in which infections are more likely.

“‘You’ve got this influx of vulnerable patients but the staffing models are still geared more to the traditional long-stay resident,’ said Dr. Nimalie Stone, the Centers for Disease Control and Prevention’s medical epidemiologist for long-term care. ‘[That] kind of care is so much more complicated that facilities need to consider higher staffing.’

“The Centers for Medicare & Medicaid Services (CMS), which oversees inspections, has recognized that many nursing homes need to do more to combat contagious bugs. CMS last year required long-term-care facilities to put in place better systems to prevent infections, detect outbreaks early on and limit unnecessary use of antibiotics through a stewardship program.”

Basically, managed elder care takes planning, much of it financial, but much of it involving the elderly, when they are sufficiently aware to make choices, to participate in that planning. For those with relatives in such facilities, visiting with sufficient frequency is a top priority, even for folks who have lost their memories. It combats loneliness and serves as an additional check on the quality of the care involved. All I can say, when you are choosing a home for an elder relative, put yourself in their shoes…

I’m Peter Dekom, and if you think you will be a perfect healthy elder without a need for any kind of managed care, let’s just hope you are either very wealthy or guessed right.

Inevitability

Thank, God, for the base! It has enabled the most devastating measure against the common man in America’s tax policy history. A group quite willing to accept alternative facts and vote against their own best interests, a Republican dream. The economic distortions introduced by the “tax reform” bill now being “reconciled” between both houses of Congress will endure for a long time. Corporations are already imagining spending their windfalls on increasing dividends, instituting stock buybacks, drooling over possible mergers and acquisitions, the ability to make a whole lot more money without selling a single additional product or service. Wow!

But, as noted in my November 29^th blog, The Deep Dark Republican Hole, America’s business leaders do not plan using this windfall on massive new hires or equipment upgrades: “Gary Cohn, the top White House economic advisor, was onstage making the Trump administration’s case that a huge cut in corporate taxes would trigger a surge of business investments.

“Then came an off-the-cuff question to business leaders listening to Cohn at the Wall Street Journal CEO Council meeting [in mid-November]: How many will increase investments if the Republican tax plan is enacted?

“TV coverage showed about three dozen executives sitting near the stage. Only three of them appeared to raise their hands. An incredulous Cohn responded: ‘Why aren’t the other hands up?’

“A video clip of that moment, which has become popular viewing in Washington, illustrates what many economists regard as a flaw in the administration’s main selling point for the Republican tax proposal: the argument that a dramatic cut in the U.S. corporate tax rate will be a boon to America’s middle class.

“The White House Council of Economic Advisers promises that the corporate tax cut, to 20% from 35%, would lead to an increase of at least $4,000 a year in average household income… But that calculation depends on an assumption that workers would get a much bigger cut of the corporate tax savings than most economic studies — including those by the Treasury Department and Congressional Budget Office — have shown.” Los Angeles Times, November 25^th. In short, Republicans have selected only numbers that show their approach will work and rejected numbers that tell the truth. Plus any cuts to individual taxes automatically expire while cuts to corporations are permanent.

“In 2015, Republicans changed the budget rules in Congress so that official scorekeepers [the Joint Committee of Taxation in addition to the non-partisan Congressional Budget Office] would be required to analyze the potential economic impact of major legislation when determining how it would affect federal revenues.

“But on Thursday, hours before they were set to vote on the largest tax cut Congress has considered in years, Senate Republicans opened an assault on that scorekeeper, the Joint Committee on Taxation, and its analysis, which showed the Senate plan would not, as lawmakers contended, pay for itself but would add $1 trillion to the federal budget deficit.

“Public statements and messaging documents obtained by The New York Times show a concerted push by Republican lawmakers to discredit a nonpartisan agency they had long praised. Party leaders circulated two pages of ‘response points’ that declared ‘the substance, timing and growth assumptions of J.C.T.’s ‘dynamic’ score are suspect.’ Among their arguments was that the joint committee was using ‘consistently wrong’ growth models to assess the effect the tax cuts would have on hiring, wages and investment.

“The Republican response points go after revenue analyses by the committee and by the Congressional Budget Office, which scores other legislation, saying their findings ‘can be off to the tune of more than $1.5 trillion over ten years.’” New York Times, December 4^th. But even for companies willing to forego paying out dividends or stock purchases, for those few willing to invest in productivity upgrades, the news is still not-so-good for those wage and salary-earners who are likely to be displaced.

Effectively, the statute would even have a disincentive for a company to hire additional people if automated equipment is available to reduce labor costs. People are expensive, suck up overhead, wages and salaries, take up real estate, and accrue fringe benefits like pensions and vacations (healthcare?), while machines produce a whole lot more for a whole lot less over the long haul. Oh, and the government will generate proportionately less tax revenue.

Think of the government’s position on all this. The taxes productive individuals pay is generally 50% higher (or more) than the proposed 20% federal corporate rate. So when companies do in fact upgrade their equipment to cut back the number of workers on payroll - which is what happens after stock buybacks, mergers and acquisitions - the federal government will receive fewer tax dollars per unit of output because the new effective corporate tax rate taxes machines at a much lower rate than individuals. More layoffs. Fewer workers. Revenues generated by machines taxed at a lower rate. It doesn’t take a rocket scientist to figure out what happens.

And the GOP, knowing that even with the most powerful gerrymandering, they are ultimately going to have to accept that the demography of the United States is rapidly moving towards more urban centers, greater diversity and a continued slide in the white, rural voters. So every judicial appointment that can hold for decades (federal judges get lifetime appointments) and the current tax legislation, which has been able to pass because the GOP Senate pulled the “nuclear option” (preventing a cloture rule that required a 60 vote minimum to bring a bill to a Senate vote; a simple majority on tax reform is all that is required), will be unamendable unless and until Democrats hold a 60 vote majority in the Senate, a majority in the House and the Presidency.

In short, the GOP will control U.S. values and tax policies for a very long time, even well after they are voted out of office. Their self-fulfilling balanced budget initiative, likewise, will force government to cut social services with a meat axe to pay for these unamendable tax cuts. GOP House Speaker Paul Ryan and Senate GOP Majority Leader Mitch McConnell are openly joyful in telling the world that they intend to slice and dice both Social Security and Medicare, even as they make their constituents pay increasing premiums for what is left of the eviscerated Affordable Care Act. That, along with reduced corporate regulations, is making corporate America swoon with happiness.

With the 2016 election fueled by slogans, alternative facts, and unsubstantiated claims, with tons of “dark money” paying for the dissemination of misinformation without any limitation, even without the fully-substantiated Russian meddling, it is easy to see how the Supreme Court accelerated the great unraveling of our democracy to the highest bidders. “The United States Supreme Court held (5–4) on January 21, 2010 [in Citizens United vs. Federal Election Commission] that the free speech clause of the First Amendment to the Constitution prohibits the government from restricting independent expenditures for communications by nonprofit corporations, for-profit corporations, labor unions, and other associations.” Wikipedia.

Can this be undone? If it isn’t, it is very likely that we are witnessing the end of the United States as we know it. For those angry Trump constituents left behind by modernity, their overt joy at the collapse of traditional institutions is not good news for the rest of us. They are will-armed and want their past glory back “or else.”

Even Millennials are frustrated with government: “A strong majority of millennials — 71 percent — say the Republican and Democratic parties do such a poor job of representing the American people that a third major party is needed, according to the results of a new NBC News/GenForward poll.

“Sixty-three percent of millennials disapprove of the way President Donald Trump is handling his job as president. But millennials also hold a variety of political institutions in poor regard, and 65 percent think the country is on the wrong track overall.

“Six in ten disapprove of the way Congress is handling its job, while 59 percent have an unfavorable view of the Republican Party and 42 percent have an unfavorable view of the Democratic Party. On the whole, millennials overwhelmingly do not think either party cares about people like them.” AOL.com, December 1^st. Fewer and fewer people think our government is capable of fixing what is obviously wrong. Are you one of them? What do you think can save this country from all this polarization… effectively from itself?

I’m Peter Dekom, and if the majority of a nation’s citizens have lost faith in their government and given up hope for a better future, what do you think history teaches us?

You Don’t Have to Give a Hoot if You Do Pollute

Donald Trump embraced the GOP platform of cutting back environmental regulations with a vengeance. They were “job-killers” even though the pollution of air and water were clear people killers and implementing environmental controls actually created new jobs. He vowed to pull the United States out of the Paris climate accords, again arguing that environmental controls were based on unsubstantiated science. Thus the United States became the only country in the world to reject that accord and what is well-established scientific fact – that man’s use of fossil fuel has caused and/or exacerbated the accumulation of gases in our atmosphere creation an effective greenhouse heating effect on the world’s average temperatures.

But the GOP and the Trump administration were committed to decimating the Environmental Production Agency (part of draining the swamp), and appointed a former state attorney general (R-Oklahoma), Scott Pruitt, who made a career out of suing the EPA to cut or reduce their environmental rules. His new mandate was to cut regulations and reduce the staff of the EPA in order to enable business to work unencumbered by anti-pollution rules. Here’s what’s really going on:

“[In mid-August,] the U.S. Environmental Protection Agency (EPA) announced that it would be rolling back limits on wastewater from coal plants. The limits on coal plants and other steam electric power plants are part of a 2015 Clean Water Act regulation known as the Effluent Limitation Guidelines for steam electric power plants, or the ‘ELG Rule.’ The announcement was made in a filing with the United States Court of Appeals for the Fifth Circuit, which is hearing legal challenges to the merits of the 2015 ELG rule.

“‘This is exactly what I feared when I saw the agency abandoning the polluter pays principle,’ said Betsy Southerland, former Director of the Office of Science and Technology in the EPA Office of Water, which promulgated the ELG rule in 2015. ‘They are just transferring the costs of polluted water to public and private treatment systems downstream of these plants. Now the public, not the polluter, will have to pay to clean the water. And it is much cheaper to prevent pollution than to clean it up after the fact.’

“Coal power plants routinely discharge large quantities of toxic heavy metals and other chemicals. Until 2015, they were operating under outdated standards last revised in 1982. Each year, the industry was discharging over 2 billion pounds of pollutants, including carcinogens and neurotoxins like arsenic, mercury and lead. According to EPA, these pollutants are causing excess cancer and neurological damage in people exposed to contaminated fish. Over 6,000 river miles are unsafe for recreational fishing, and over 10,000 miles are unsafe for subsistence fishing. These pollutants also present serious risks to wildlife and ecosystems.” Environmental Integrity Project, August 15^th.

The New York Times (December 10^th), put some numbers to the new downsized Environmental Production Agency, starting with the professed mission statement and followed by some very contradictory actions: “Scott Pruitt, the E.P.A. administrator, has said the Trump administration’s high-profile regulatory rollback does not mean a free pass for violators of environmental laws. But as the Trump administration moves from one attention-grabbing headline to the next, it has taken a significant but less-noticed turn in the enforcement of federal pollution laws… [BUT]

“During the first nine months under Mr. Pruitt’s leadership, the E.P.A. started about 1,900 cases, about one-third fewer than the number under President Barack Obama’s first E.P.A. director and about one-quarter fewer than under President George W. Bush’s over the same time period.

“In addition, the agency sought civil penalties of about $50.4 million from polluters for cases initiated under Mr. Trump. Adjusted for inflation, that is about 39 percent of what the Obama administration sought and about 70 percent of what the Bush administration sought over the same time period.

“The E.P.A., turning to one of its most powerful enforcement tools, also can force companies to retrofit their factories to cut pollution. Under Mr. Trump, those demands have dropped sharply. The agency has demanded about $1.2 billion worth of such fixes, known as injunctive relief, in cases initiated during the nine-month period, which, adjusted for inflation, is about 12 percent of what was sought under Mr. Obama and 48 percent under Mr. Bush…

“In the last two complete fiscal years of the Obama administration, the E.P.A.’s office in Chicago sent requests for testing that covered an average of 50 facilities per year, or about 4.2 each month. By comparison, after the policy changes, one such request for a single facility was made in the subsequent four-month period. There was a similar decline in the Denver regional office, according to the data.

“The enforcement slowdown has been compounded by the departure of more than 700 employees at the E.P.A. since Mr. Trump’s election, many of them via buyouts intended to reduce the agency’s size, and high-level political vacancies at the E.P.A. and the Justice Department. The agency’s top enforcement officer — Susan Bodine — was confirmed only late last week.

“Separately, Mr. Pruitt’s team has told officials and industry representatives in Missouri, North Dakota and other states that E.P.A. enforcement officers will stand down on some pollution cases, according to agency documents. The retrenchment is said to be part of a nationwide handoff of many enforcement duties to state authorities, an effort Mr. Pruitt calls cooperative federalism but critics say is an industry-friendly way to ease up on polluters.”

“Current and recently departed E.P.A. staff members said the new direction has left many employees feeling frozen in place, and demoralized, particularly in the regional offices, which have investigators who are especially knowledgeable of local pollution threats.” Some of the environmental damage is reversible, some is not and simply compounds from bad to worse to much worse for every day that polluters get a free ride from dumping on the waterways that really belong to the taxpayers of America. Air and water quality matter!!!!

I’m Peter Dekom, and giving away our environment with no costs or consequences to big business polluters is yet another form of Republican redistribution of wealth from most of us to a very few of the richest of us.

Trickleup Recession Brewing

What do you get when you force the sixth largest economy in the world - California - to pay higher taxes than most of the rest of the United States? Add New York, New Jersey, Massachusetts and other states that have higher mega-cities and the high taxes that generally required to support such urbanized centers. As deductions for state taxes and expensive mortgages (also a hallmark of big cities) fade into history under the Republican tax plan, a whole lot of residents in those states will have significantly lower discretionary income to spend. Considering that over 70% of the American economy is determined at the consumer level, slamming states with more consumers than any other states is going to take a big bite out of grassroots spending.

Perhaps it will be good to slow or stop the escalating housing costs in those states, but remember that residential real estate is also a fundamental component of non-corporate American wealth.

With property tax deductions capped to reflect “average” lower cost markets combined with the above-noted lower amounts of discretionary income, that housing bubble will pop. And trust me, those reductions in value and spending will rapidly spread to impact the rest of the country as well. These high tax states, which are hurt the worst by the GOP “tax reform” legislation, represent about a third of the nation’s population. What do you think reduced spending by that segment of America will do for the entire economy?

We already have it on record what CEOs of America’s largest corporations intend to do with this tax windfall. See my November 29^th blog, The Deep Dark Republican Hole, where major CEOs evidenced little interest in using that windfall to create new jobs and invest in their own companies when asked by Donald Trump’s highest economic advisors. Dividends and job-killing corporate stock purchases (mergers/acquisitions/stock buybacks) are their focus. And as I have blogged before, where capital investment is envisioned, most of that new equipment is aimed at reducing jobs through automation and artificial intelligence. Income inequality accelerates. Not many new jobs. Not much more economic flow that will make up for the tax revenues the government has given back to the rich. There are very few neutral economists who predict otherwise.

The administration’s failure to find serious traction in replacing multinational trade agreements with bully-driven bilateral treaties is beginning to push U.S. exports into second class status versus those nations willing to participate in those modern multiparty trade structures. Expect our trade imbalance to get worse.

Meanwhile, the clear ravages of climate change - from hurricane destruction in Houston, Florida and Puerto Rico to explosive wildfires and long-term droughts in California - are slowly moving from the billions of dollars of hard costs towards the trillion dollar mark. Yet, instead of trying to reverse the negative impact of greenhouse gasses that have caused or exacerbated these natural disasters, we are the only nation on earth to have rejected the Paris climate change accord and officially to have embraced a government policy that both denies mankind’s role in the process and encourages increased use of carbon-emitting fossil fuel. More money flowing out of our pockets to deal with these hard dollar costs.

As mass shootings from civilians with military assault rifles mount, as the United States adopts woefully unpopular foreign policies (such as the universally condemned move to recognize Jerusalem as Israel’s capital thus virtually guaranteeing a failure in the local peace process), immigration walls and travel bans, and as the United States is officially making travel to the United States more difficult, our local tourist destinations and the support systems are taking a rather direct financial hit. “A report by the U.S. Department of Commerce said that travel to the U.S. for the first six months of the year dropped 3.9% compared with the same period in 2016, with travel from Mexico showing the biggest drop — 9.4%.

“‘The latest government travel data is deeply concerning, not just to our industry but to anyone who cares about the economic well-being of the United States,’ said Roger Dow, president of the U.S. Travel Assn… The Commerce Department has reported that international travel to the U.S. began to surge in 2010 and then started to decline gradually in 2016.

“From February of this year through June, international travel from Mexico and overseas countries dropped sharply, ranging from 8% to 16% each month, compared with the same period in 2016. Travel from Canada to the U.S., meanwhile, has remained strong, partly making up for the loss of travel from Mexico and overseas.” Los Angeles Times, December 6^th.

Day-by-day, despite its massive economic and political power, the United State is increasingly viewed by the rest of the world in a negative light, and global decisions about the United States are based on that perception. A dangerous place, a notion gone rogue. In Germany, for example, aside from the migrant crisis, local polls place Trump’s America as the largest threat to global economic and political stability… well behind any threats posed by North Korea and Kim Jong-un. Even Britain, which has officially struggled to remain a staunch American ally, very officially reacted strongly and negatively to Trump’s retweet of U.K. right wing anti-Muslim faked propaganda. Canada’s Prime Minister flew to Beijing to enlist China in a multinational trade agreement to balance Trump’s demands on the NAFTA renegotiation.

What is going to become painfully obvious in the next couple of years, and Mr. Trump is going to have to find “others to blame” for his mistakes, is that the U.S. economy is not only unlikely to experience the explosive growth promised by the Republicans who have tripped all over themselves to rush a horribly-drafted tax bill through Congress, but we may well face a Republican-induced recession. Meanwhile, the country will have assumed a massive addition to our deficit to fund a windfall to the rich without any government investments in true economic growth: education, infrastructure and research to spur an economy for the rest of us. Oh, don’t worry, they can save money by slashing Social Security, Medicare and healthcare.

I’m Peter Dekom, and I feel really bad for the coming generations of Americans who will be saddled with a continuing reduction in their standard of living forced on them by these under-thought policies that cannot work.