Category Archives: Older People

SPOTLIGHT: Aging States

Source: Capitol Ideas, November/December 2016

Articles include:
Facing a wave of aging baby boomers, many states are trying to make it easier for seniors to stay in their homes—as many prefer—instead of moving into more costly nursing homes. With high stakes for state budgets, many states are undertaking long-term planning to pay for long-term care.

What is the best state for retirement? It’s a popular question among baby boomers, who increasingly seek more livable communities that will allow them to age in place. How are states responding? Drawing from an AARP scorecard on state long-term services and supports, here’s a look at top states for retirement and aging.

For many seniors, staying active in their golden years depends on staying mobile. But in many states and communities, transportation systems haven’t been developed with seniors or individuals with disabilities in mind. That’s changing as states are taking steps to improve transportation mobility for older adults.

Elder financial abuse costs older Americans $2.9 billion per year, but the harm to seniors caused by fraud often extends far beyond the checkbook. Oregon Attorney General Ellen Rosenblum shares key steps her state has taken to strengthen elder abuse prevention and response.

When state leaders discuss the fiscal challenges of an aging population, the focus is often on costs for senior services. However, as CSG Senior Fellows Katherine Barrett and Richard Greene point out, declining tax revenues are also a concern.

It Pays to Talk

Source: National Academy of Social Insurance, November 2016

From the summary:
Deciding when to take Social Security benefits is one of the most important financial decisions your parents will make. This infographic outlines thre things they should keep in mind to make smart claiming decisions. Depending on your parent’s financial situation, it may pay to wait, but definitely pays to talk.

The infographic is part of a toolkit of resources designed to educate workers approaching retirement, and their families and friends, about their options for taking Social Security benefits, and about why it can pay to wait.
it pays to talk to your parents about social security

Recoupment of Pension Overpayments: Equitable Liens and Meaningful Reform after Montanile

Source: Maria O’Brien Hylton, Jeanne Medeiros, Boston University School of Law, Public Law Research Paper No. 16-33, August 29, 2016

From the abstract:
This short paper reviews the current state of the law governing recoupment actions for defined benefit ERISA plans and focuses in particular on actions against retirees who are without fault for the overpayment. The paper argues that the current practices of many plans which focus on recovering overpayments without taking the consequences to the retiree into account are not required by either ERISA or the IRS. The practices which include ceasing all pension payments, huge cuts in payout amounts and unlimited reach back even in cases where the plan fiduciary has clearly breached its duty to participants, cause tremendous harm to participants who are invariably elderly and often disabled and/or living on a small, fixed income. The authors call for a limited reach back period of no more than three years and for a new requirement that plans obtain insurance in order to provide protection to both participants and plans when overpayment errors are discovered.

Does Socioeconomic Status Lead People to Retire Too Soon?

Source: Alicia H. Munnell, Anthony Webb and Anqi Chen, Center for Retirement Research at Boston College, IB#16-14, August 2016

The brief’s key findings are:
• The ability to stay on the job long enough for a secure retirement may vary by socioeconomic status (SES).
• Using education for SES, the analysis calculates a retirement gap – the difference between how long households plan to work and how long they need to work.
• Not surprisingly, retirement gaps are both more common and larger among households in the bottom education quartile compared to those in higher quartiles.
• Even after controlling for demographic/financial characteristics and pre-retirement shocks, the bottom-quartile households still have much larger gaps.
• Thus, premature retirement by low-SES households is a big problem. However, relatively poor health and job prospects may make it harder for them to work longer.

Protecting the Vulnerable or Ripe for Reform? State Income Tax Breaks for the Elderly—Then and Now

Source: Ben Brewer, Karen Smith Conway, Jonathan C. Rork, Public Finance Review, Published online before print September 9, 2016
(subscription required)

From the abstract:
State governments have a long history of providing income tax relief to their elderly constituents. Our research investigates the current distributional and revenue effects of these tax breaks, as well as the economic status of the elderly, and explores how these measures have changed since 1990. Using data from the 1990 Integrated Public Use Microdata Series and the 2013 American Community Survey, combined with the TAXSIM calculator, we calculate current state income tax liabilities and revenues and simulate the effects of removing all age-related tax breaks. Our analyses reveal that the economic well-being of the elderly has grown substantially relative to the nonelderly and that state tax breaks primarily benefit the middle- and upper-income elderly. Revenue costs of these tax breaks have also grown substantially, and their modest and mixed effects on income equality, measured by changes in the Gini, cast doubt on equity as a justification.

The Effect of Firms’ Phased Retirement Policies on the Labor Market Outcomes of Their Employees

Source: Martin Hube, Michael Lechner, Conny Wunsch, ILR Review, Vol 69 no. 5, October 2016
(subscription required)

From the abstract:
In this article, the authors assess the impact on male employees’ labor market outcomes of firms offering a special form of phased retirement. The goal of the program is to smooth the transition from work to retirement and to decrease the costs of public pension and unemployment insurance schemes by increasing the employment of elderly workers. Using a unique linked employer-employee data set, the authors examine whether male employees spend more time in employment and less time in unemployment or inactivity after the introduction of the program. Results suggest that phased retirement options offered by firms can help to reduce some of the public costs of low labor force attachment of elderly workers, mainly by reducing exits through unemployment and by increasing employment and earnings. Under relatively good labor market conditions, they may also encourage a small share of workers to exit the labor market earlier.

How Job Options Narrow for Older Workers by Socioeconomic Status

Source: Matthew S. Rutledge, Steven A. Sass, and Jorge D. Ramos-Mercado, Center for Retirement Research at Boston College, IB#16-13, August 2016

From the key findings:
The ability of older job-changers to find “suitable” employment affects both their current income and their ability to work long enough to secure an adequate retirement income. One measure of suitable employment is the range of occupations available to them. This brief, based on a recent study, assesses the extent to which occupational options narrow for workers as they age from their early-fifties to their mid-sixties and whether the pattern varies by gender or socioeconomic status, as measured by education level.1 The discussion proceeds as follows. The first section reviews the previous literature. The second section discusses the data and methodology. The third section presents findings on the narrowing of job options and the associated change in wages. The fourth section reviews changes in older workers’ access to occupations since the mid-1990s, including differences by gender and education. The final section concludes that job options decline with age, but the outlook is generally not as bad as it used to be, particularly for better-educated women. Further, once the analysis accounts for differences in job characteristics, “old-person” jobs pay no less than other jobs.

How Not to Die Hungry: Turn Your 401(k) Into a Pension

Source: Ben Steverman, Bloomberg, August 2, 2016

The golden age of retirement is coming to an end. Now it gets complicated. …. Company after company has repudiated traditional pensions, pushing younger workers into 401(k)-style retirement plans. For diligent savers, a 401(k) can accumulate a big balance, but when the time comes to start using it, things will get a lot more complicated than it was for their parents. ….

A Special Issue on Work and Employment Relations in Health Care

Source: ILR Review, Vol. 69 no. 4, August 2016
(subscription required)

From the introduction:
Editorial Essay: Introduction to a Special Issue on Work and Employment Relations in Health Care
Ariel C. Avgar, Adrienne E. Eaton, Rebecca Kolins Givan, and Adam Seth Litwin

…..This special issue of the ILR Review is designed to showcase the central role that work organization and employment relations play in shaping important outcomes such as the quality of care and organizational performance. Each of the articles included in this special issue makes an important contribution to our understanding of the large and rapidly changing health care sector. Specifically, these articles provide novel empirical evidence about the relationship between organizations, institutions, and work practices and a wide array of central outcomes across different levels of analysis. This breadth is especially important because the health care literature has largely neglected employment-related factors in explaining organizational and worker outcomes in this industry. Individually, these articles shed new light on the role that health information technologies play in affecting patient care and productivity (see Hitt and Tambe; Meyerhoefer et al.); the relationship between work practices and organizational reliability (Vogus and Iacobucci); staffing practices, processes, and outcomes (Kramer and Son; Hockenberry and Becker; Kossek et al.); health care unions’ effects on the quality of patient care (Arindrajit, Kaplan, and Thompson); and the relationship between the quality of jobs and the quality of care (Burns, Hyde, and Killet). Below, we position the articles in this special issue against the backdrop of the pressures and challenges facing the industry and the organizations operating within it. We highlight the implications that organizational responses to industry pressures have had for organizations, the patients they care for, and the employees who deliver this care……

Articles include:
Nurse Unions and Patient Outcomes
Arindrajit Dube, Ethan Kaplan, and Owen Thompson
The authors estimate the impact of nurse unions on health care quality using patient-discharge data and the universe of hospital unionization in California between 1996 and 2005. They find that hospitals with a successful union election outperform hospitals with a failed election in 12 of 13 potentially nurse-sensitive patient outcomes. Hospitals were more likely to have a unionization attempt if they were of declining quality, as measured by patient outcomes. When such differential trends are accounted for, unionized hospitals also outperform hospitals without any union election in the same 12 of 13 outcome measures. Consistent with a causal impact, the largest changes occur precisely in the year of unionization. The biggest improvements are found in the incidence of metabolic derangement, pulmonary failure, and central nervous system disorders such as depression and delusion, in which the estimated changes are between 15% and 60% of the mean incidence for those measures.

How Do Hospital Nurse Staffing Strategies Affect Patient Satisfaction?
Jason M. Hockenberry and Edmund R. Becker
In this article, the authors evaluate the role of the nurse staffing mix on hospital patient satisfaction. Using three years (2009 to 2011) of hospital patient satisfaction data linked to data on the productive staffing hours of registered nurses (RNs), licensed vocational nurses, nurse’s aides, and contract nurses for 311 California hospitals, the authors analyze how nurse staffing levels affect 10 dimensions of patient satisfaction. The findings indicate that a higher level of RNs per bed appears to increase overall patient satisfaction. Conversely, hospitals with a higher proportion of nursing hours provided by contract nurses have significantly lower levels of patient satisfaction on scores related to overall patient satisfaction and nurses’ communication with the patient. The results have implications for RN staffing strategies and inform the broader literature on worker-skill mix and employment arrangements.

Who Cares about the Health of Health Care Professionals? An 18-Year Longitudinal Study of Working Time, Health, and Occupational Turnover
Amit Kramer and Jooyeon Son
Health care workers are employed in a complex, stressful, and sometimes hazardous work environment. Studies of the health of health care workers tend to focus on estimating the effects of short-term health outcomes on employee attitudes and performance, which are easier to observe than long-term health outcomes. Research has paid only scant attention to work characteristics that are controlled by the employer and its employees, and their relationship to employees’ long-term physical health and organizational outcomes. The authors use data from the National Longitudinal Survey of Youth (NLSY) from 1992 to 2010 to estimate the relationships among working time, long-term physical health, job satisfaction, and turnover among health care employees. Using a between- and within-person design, they estimate how within-person changes in work characteristics affect the within-person growth trajectory of body mass index (BMI) over time and the relationship between working-time changes and physical health, and occupational turnover. The study finds that health care employees who work more hours suffer from a higher level of BMI and are more likely to leave their occupation.

Health Care Information Technology, Work Organization, and Nursing Home Performance
Lorin M. Hitt and Prasanna Tambe

The Consequences of Electronic Health Record Adoption for Physician Productivity and Birth Outcomes
Chad D. Meyerhoefer, Mary E. Deily, Susan A. Sherer, Shin-Yi Chou, Lizhong Peng, Michael Sheinberg, and Donald Levick

Creating Highly Reliable Health Care: How Reliability-Enhancing Work Practices Affect Patient Safety in Hospitals
Timothy J. Vogus and Dawn Iacobucci

Filling the Holes: Work Schedulers As Job Crafters of Employment Practice in Long-Term Health Care
Ellen Ernst Kossek, Matthew M. Piszczek, Kristie L. McAlpine, Leslie B. Hammer, and Lisa Burke

How Financial Cutbacks Affect the Quality of Jobs and Care for the Elderly
Diane J. Burns, Paula J. Hyde, and Anne M. Killett

Making It Safe to Grow Old: A Financial Simulation Model for Launching MediCaring Communities for Frail Elderly Medicare Beneficiaries

Source: Antonia K. Bernhardt, Joanne Lynn, Gregory Berger, James A. Lee, Kevin Reuter, Joan Davanzo, Anne Montgomery and Allen Dobson, Milbank Quarterly, Early View, July 4, 2016
(subscription required)

From the abstract:
The Altarum Institute Center for Elder Care and Advanced Illness has developed a reform model, MediCaring Communities, to improve services for frail elderly Medicare beneficiaries through longitudinal care planning, better-coordinated and more desirable medical and social services, and local monitoring and management of a community’s quality and supply of services. This study uses financial simulation to determine whether communities could implement the model within current Medicare and Medicaid spending levels, an important consideration to enable development and broad implementation.

The financial simulation for MediCaring Communities uses 4 diverse communities chosen for adequate size, varying health care delivery systems, and ability to implement reforms and generate data rapidly: Akron, Ohio; Milwaukie, Oregon; northeastern Queens, New York; and Williamsburg, Virginia. For each community, leaders contributed baseline population and program effect estimates that reflected projections from reported research to build the model.

The simulation projected third-year savings between $269 and $537 per beneficiary per month and cumulative returns on investment between 75% and 165%.

The MediCaring Communities financial simulation demonstrates that better care at lower cost for frail elderly Medicare beneficiaries is possible within current financing levels. Long-term success of the initiative will require reinvestment of Medicare savings to bolster nonmedical supportive services in the community. Successful implementation will necessitate waiving certain regulations and developing new infrastructure in pilot communities. This financial simulation methodology will help leadership in other communities to project fiscal performance. Since the MediCaring Communities model also achieves the Centers for Medicare and Medicaid Services’ vision for care for frail elders (better care, healthier people, smarter spending) and since these reforms can proceed with limited waivers from Medicare, willing communities should explore implementation and share best practices about how to achieve fundamental service delivery changes that can meet the challenges of a much older population in the 21st century.