Seniors Paying $7,125 a Month to be Neglected? What Happened When Wall Street Got Involved in Assisted Living

ProPublica / By A.C. Thompson, Jonathan Jones

Seniors Paying $7,125 a Month to be Neglected? What Happened When Wall Street Got Involved in Assisted Living

 

 

The horrors of some assisted living facilities. 

 

 

 

 

 

 

January 22, 2014  |  

 

The following story is original to ProPublica. This is part 1 and part 2 of a series on assisted living facilities. 

Joan Boice needed help. Lots of it. Her physician had tallied the damage: Alzheimer’s disease, high blood pressure, osteoporosis, pain from a compression fracture of the spine. For Joan, an 81-year-old former schoolteacher, simply getting from her couch to the bathroom required the aid of a walker or wheelchair.

The Alzheimer’s, of course, was the worst. The disease had gradually left Joan unable to dress, eat or bathe without assistance. It had destroyed much of the complex cerebral circuitry necessary for forming words. It was stealing her voice.

Joan’s family was forced to do the kind of hard reckoning that so many American families must do these days. It was clear that Joan could no longer live at home. Her husband, Myron, simply didn’t have the stamina to provide the constant care and supervision she needed. And moving in with any of their three children wasn’t an option.

These were the circumstances that eventually led the Boice family to Emeritus at Emerald Hills, a sprawling, three-story assisted living facility off Highway 49 in Auburn, Calif. The handsome 110-bed complex was painted in shades of deep green and cream, reflecting its location on the western fringe of the craggy, coniferous Sierra Nevada mountain range. It was owned by the Emeritus Corp., a Seattle-based chain that was on its way to becoming the nation’s largest assisted living company, with some 500 facilities stretching across 45 states.
Emeritus at Emerald Hills promised state-of-the art care for Joan’s advancing dementia. Specially trained members of the staff would create an individual plan for Joan based on her life history. They would monitor her health, engage her in an array of physically and mentally stimulating activities, and pass out her 11 prescription medications, which included morphine (for pain) and the anti-psychotic drug Seroquel (given in hopes of curbing some of the symptoms of her Alzheimer’s). She would live in the “memory care” unit, a space designed specifically to keep people with Alzheimer’s and other forms of dementia safe.
At Emerald Hills, the setting was more like an apartment complex than a traditional nursing home. It didn’t feel cold or clinical or sterile. Myron could move in as well, renting his own apartment on the other side of the building; after more than 50 years of marriage, the couple could remain together.

Sure, the place was expensive — the couple would be paying $7,125 per month — but it seemed ideal.

During a tour, a salesperson gave Myron and his two sons, Eric and Mark, a brochure. “Just because she’s confused at times,” the brochure reassured them, “doesn’t mean she has to lose her independence.”

Here are a few things the brochure didn’t mention:

Just months earlier, Emeritus supervisors had audited the facility’s process for handling medications. It had been found wanting in almost every important regard. And, in truth, those “specially trained” staffers hadn’t actually been trained to care for people with Alzheimer’s and other forms of dementia, a violation of California law.

The facility relied on a single nurse to track the health of its scores of residents, and the few licensed medical professionals who worked there tended not to last long. During the three years prior to Joan’s arrival, Emerald Hills had cycled through three nurses and was now employing its fourth. At least one of those nurses was alarmed by what she saw, telling top Emeritus executives — in writing — that Emerald Hills suffered from “a huge shortage of staff” and was mired in“total dysfunction.”

During some stretches, the facility went months without a full-time nurse on the payroll.

The paucity of workers led to neglect, according to a nurse who oversaw the facility before resigning in disgust. Calls for help went unanswered. Residents suffering from incontinence were left soaking in their own urine. One woman, addled by dementia, was allowed to urinate in the same spot in the hallway of the memory care wing over and over and over.

The brochure also made no mention of the company’s problems at its other facilities. State inspectors for years had cited Emeritus facilities across California, faulting them for failing to employ enough staff members or adequately train them, as well as for other basic shortcomings.
Emeritus officials have described any shortcomings as isolated, and insist that any problems that arise are promptly addressed. They cite the company’s growing popularity as evidence of consumer satisfaction. They say that 90 percent of people who take up residence in assisted living facilities across the country report being pleased with the experience.

Certainly, the Boice family, unaware of the true troubles at Emerald Hills, was set to be reassured.

“We were all impressed,” recalled Eric Boice, Joan’s son. “The first impression we had was very positive.”

And so on Sept. 12, 2008, Joan Boice moved into Room 101 at Emerald Hills. She would be sharing the room with another elderly woman. After a succession of tough years, it was a day of great optimism.
Measuring the dimensions of his mother’s new apartment, Eric Boice sought to recreate the feel of her bedroom back home. He arranged the furniture just as it had been. He hung her favorite pictures in the same spots on the wall. On her dresser, he set out her mirror and jewelry box and hairbrush.
Joan, 5-foot-2 and shrinking, had short snow-and-steel hair and wintry gray-blue eyes. Eric looked into those eyes that day at Emerald Hills. He thinks he might have seen a flicker of fear. Or maybe it was just confusion, his mom still uncertain where, exactly, she was.

A Reform Movement Winds Up on Wall Street

The Emeritus Corp., the assisted living corporation now entrusted with Joan’s life, sat atop an exploding industry.

Two decades earlier, Keren Brown Wilson had opened the nation’s first licensed assisted living facility in Canby, Ore., a small town outside of Portland. Wilson was inspired by tragedy: A massive stroke had paralyzed her mother at the age of 55, forcing her into a nursing home, where she was miserable, spending the bulk of her days confined to a hospital bed.

Wilson aimed to create an alternative to nursing homes. She envisioned comfortable, apartment building-style facilities that would allow sick and fragile seniors to maintain as much personal autonomy as possible.

“I wanted a place where people could lock the door,” Wilson explained. “I wanted a place where they could bring their belongings. I wanted a place where they could go to bed when they wanted to. I wanted a place where they could eat what they wanted.”

These “assisted living” facilities would offer housing, meals and care to people who could no longer live on their own but didn’t need intensive, around-the-clock medical attention. The people living in these places would be called “residents” — not patients.


It took Wilson nine years to persuade Oregon legislators to rewrite the state’s laws, a crucial step toward establishing this new type of facility. After that, states across the country began adopting the “Oregon model.”

But what began as a reform movement quickly morphed into a lucrative industry. One of the early entrants was Emeritus, which got into the assisted living business in 1993, opening a single facility in Renton, Wash. The company’s leader, Daniel Baty, had his eyes on something much grander: He was, he declared, aiming to create a nationwide chain of assisted living facilities.
Two years later, Baty took the corporation public, selling shares of Emeritus on the American Stock Exchange, and piling up the cash necessary to vastly enlarge the company’s footprint. Many of Emeritus’s competitors followed the same path.

The company’s rapid growth was, at least in part, a reflection of two significant developments. Americans were living longer, with the number of those in the 65-plus age bracket ballooning further every year. And this growing population of older Americans was willing to spend serious money, often willing to drain their bank accounts completely to preserve some semblance of independence and dignity — in short, something of their former lives.

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As the assisted living business flourished, the federal government, which oversees nursing homes, left the regulation of the new industry to the states, which were often unprepared for this torrent of expansion and development. Many states didn’t develop comprehensive regulations for assisted living, choosing instead to simply tweak existing laws governing boarding homes.

In this suddenly booming, but haphazardly regulated industry, no company expanded more aggressively than Emeritus. By 2006, it was operating more than 200 facilities in 35 states. The corporation’s strategy included buying up smaller chains, many of them distressed and financially troubled, with plans to turn them around.

Wall Street liked the model. Market analysts touted the virtues of the company and its stock price floated skyward. One of the corporation’s appeals was that its revenues flowed largely from private bank accounts; unlike hospitals or nursing homes, Emeritus wasn’t reliant on payments from the government insurance programs Medicare or Medicaid, whose reimbursement rates can be capped. As the company noted in its 2006 annual report, nearly 90 percent of its revenues came from “private pay residents.”

In filings with the Securities and Exchange Commission and in conference calls with investors, Emeritus highlighted many things: occupancy rates; increasing revenue; a constant stream of complex real estate deals and acquisitions; the favorable demographic trends of an aging America.

“The target market for our services is generally persons 75 years and older who represent the fastest growing segments of the U.S. population,” Emeritus stated in a 2007 report filed with the SEC.

Today, the assisted living industry rivals the scale of the nursing home business, housing nearly three-quarters of a million people in more than 31,000 assisted living facilities, according to the U.S. Department of Health and Human Services.

Keren Brown Wilson, the early and earnest pioneer of assisted living, is happy that ailing seniors across the country now have the chance to spend their final years in assisted living facilities, rather than nursing homes. But in her view, the rise of assisted living corporations — with their pursuit of investment capital and their need to please shareholders — swept in “a whole new wave of people” more focused on “deals and mergers and acquisitions” than caring for the elderly.

She speaks from experience. After her modest start, Wilson went on to lead a company called Assisted Living Concepts, and took it onto the stock market. Wilson left the company in 2001, and it has encountered a raft of regulatory and financial problems over the last decade.

“I still have a lot of fervor,” said Wilson, who now runs a nonprofit foundation and teaches at Portland State University. “I believe passionately in what assisted living can do. And I’ve seen what it can do. But for some of the people, it’s just another job, or another business. It’s not a passion.”

“A Phenomenal Deal”

Joan Boice, born Joan Elizabeth Wayne, grew up in Monmouth, Ill. It was a tiny farm belt community, not far from the Iowa border. Her father, a fixture in the local agriculture trade, owned a trio of riverfront grain elevators on the Mississippi and a fleet of barges. As a teenager, she spent her summers trudging through the fields, de-tasseling corn.

In 1952, accompanied by a friend, Joan packed up a car and followed the highway as far west as it would go. Then in her early 20s, she was propelled by little more than the notion that a different life awaited her in California. In a black-and-white snapshot taken shortly after she arrived, Joan is smiling, a luxuriant sweep of dark hair framing her pale face, gray waves curling in the background. It was the first time she’d seen the Pacific.

Joan had been a teacher for two years in Illinois, and she quickly found a job at an elementary school in Hayward, a suburb of San Francisco. In certain regards, her outlook presaged the progressive social movements that were to remake the country during the next two decades. She viewed education as a “great equalizing force” that could help to remake a society far too stratified by class, race and gender.

“She was just free-spirited and confident,” Eric, her son, said.
Joan met Myron Boice through a singles group at a Presbyterian church in Berkeley. On their wedding day, Joan flouted convention by showing up in a blue dress. The Boice children came along fairly quickly: Nancee, then Mark, then Eric.

Myron Boice was a dreamer. A chronic entrepreneur. He sold tools from a van. He made plans to open restaurants. He had one idea after another. Some worked; others didn’t.

Joan’s passion for education never dissipated. Even in her late 60s, she continued to work as a substitute teacher in public schools. After retirement, she began volunteering with a childhood literacy program.

But age eventually tightened its grip, and hints of a mental decline began surfacing around 2005. Eric grew worried when she couldn’t figure out how to turn on her computer twice in the span of a few months. Then she forgot to include a key ingredient while baking a batch of Christmas cookies. The cookies were inedible.

The elderly couple was still living in the San Francisco suburbs, when, in late 2006, a doctor diagnosed Joan with Alzheimer’s. As her mind deteriorated, Myron struggled to meet her needs. The situation was worsened by the fact that none of the children lived nearby. Mark was in Ohio. Nancee was about an hour away in Santa Cruz. And Eric and his wife, Kathleen, were roughly two hours away in the foothills of the Sierra.

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“We offered my parents to come and live with us,” Eric recalled. But Myron said no. He and Joan wouldn’t move in with any of the kids. The family patriarch refused to become a burden.

A physician encouraged Joan and Myron to consider assisted living. It made sense. And so Myron sold their home in 2007 and the couple moved into a facility called The Palms, near Sacramento. The move put them approximately 40 minutes away from Eric and Kathleen.

“They were very attentive to every single thing she needed,” Kathleen Boice said of the staff at The Palms. “They actually re-taught her to eat with a fork and a knife.”

By 2008, however, Myron wanted a change. He wanted to be closer to his son and daughter-in-law and grandkids. He wanted different meals, a new environment. Myron began hunting for a new place to live, a search that led to Emeritus at Emerald Hills in Auburn.

Emeritus opened the Emerald Hills complex in 1998. It was, in many ways, a classic Emeritus facility, situated in a middle-class locale that was neither impoverished nor especially affluent. It was a sizable property, capable of housing more than 100 people.

In part because of its appetite for expansion, Emeritus was in the early stages of what proved to be a period of enormous stress. In 2007, the company had made its biggest acquisition to date, buying Summerville Senior Living Inc., a California-based chain with 81 facilities scattered across 13 states.

The purchase — which expanded Emeritus’s size by roughly one-third — helped the company make another major leap, bouncing from the low-profile American Stock Exchange into the big leagues of commerce, the New York Stock Exchange. News of the Summerville deal propelled the company’s stock to a new high. Emeritus was poised to become the nation’s No. 1 assisted living chain.

But the timing for this bold move turned out to be wretched. The real estate market was freezing up, and it would soon collapse, plunging the nation into an epochal recession. For Emeritus, the economic slowdown and then the housing crash posed direct challenges. Its services didn’t come cheap, so many people needed to sell their homes before they could afford to move into the company’s facilities. With the real estate market calcified, Emeritus’s customer pool shrank.
“Our stock price plummeted,” recalled Granger Cobb, Emeritus’s chief executive officer, who joined the company as part of the Summerville deal. The company’s occupancy rates had been trending skywards. Now they went flat.

At Emerald Hills, the economic slowdown that summer was making life tough for Melissa Gratiot, the lead sales agent.

“It was way harder to move residents in,” she remembered.

But there was some good news. She was close to a significant sale, this one to a couple. Gratiot worked the pitch. She talked with the family. She emailed. She gave them a tour of the facility’s memory care unit, called The Emerald City. She told the family she’d received approval from higher ups to offer the family “a phenomenal deal.”

Gratiot closed the sale. On Aug. 29, 2008, Myron and Eric signed the contract, and the family opened its wallet: A $2,500 initial move-in fee; $2,772 for Joan's first two weeks in Room 101; another $1,660 for Myron.
There had been one oversight, though. No one at Emeritus with any medical training had ever even met Joan, much less determined whether Emerald Hills could safely care for her.

Correction (7/29): An earlier version of this story stated that Emeritus at Emerald Hills had failed a company audit of its memory care unit before Joan Boice moved in. It has been corrected to say an audit found flaws in the facility’s medication handling process before Boice moved in. The memory care unit was audited while Boice was living there and failed nearly every important test.

PART 2 -- "They're Not Treating Mom Well"

When the ambulance crew arrived, about 8:20 p.m., Joan Boice was in the TV lounge, face-down on the carpet. Her head had struck the floor with some velocity; bruises were forming on her forehead and both cheeks. It appeared she’d lost her balance and fallen out of a chair.

But no one at the assisted living facility could say precisely how the accident had occurred. No one knew how long Joan had been splayed out on the floor. She had defecated and urinated on herself.

Worried that Joan might have injured her spine, the emergency medical personnel gently rolled her over and placed her on a back board. They pumped oxygen into her nostrils.

It was Sept. 22, 2008 — just 10 days after Joan had first moved into Emerald Hills.

No Emeritus employees accompanied Joan to the hospital. And even though Joan’s husband, Myron, was living in the facility, the Emeritus workers didn’t immediately alert him that Joan had fallen and hurt herself. Joan, confused, injured, and nearly mute, ended up in the local hospital by herself, surrounded by strangers.

It was supposed to have been a festive night for Joan’s son Eric and his wife, Kathleen, who lived nearby. They were throwing a birthday party for their daughter, then in elementary school. The celebration was interrupted when a doctor called from the hospital with news of Joan’s fall. As Kathleen recalled it, the physician was somewhat baffled — he didn’t understand what Joan was doing in the emergency room without a family member, and he was having trouble deducing the extent of her injuries because she couldn’t communicate.

California law requires assisted living companies to conduct a “pre-admission appraisal” of prospective residents, to ensure they are appropriate candidates for assisted living.

But Emerald Hills took Joan in without performing an appraisal. It wasn’t for lack of time. The Boices had signed the contract to live at Emerald Hills more than two weeks before Joan moved in.

Joan, then, had taken up residence in the memory care unit at Emerald Hills. The unit — referred to as a “neighborhood” by the company — is a collection of abouta dozen small apartments on either side of a central hallway. At each end of the hallway are heavy doors equipped with alarms, which sound when anyone enters or leaves. The alarm system is meant to prevent residents from simply walking off.

On the day Joan moved into Room 101 in the unit, a company nurse named Margaret “Peggy” Stevenson briefly looked her over. The nurse realized that Joan needed to be monitored closely to keep her from falling — she wrote it down in her cursory assessment — but facility records show she didn’t craft any kind of detailed plan for her care and supervision.

Stevenson, asked years later about Joan, said she could recall nothing about her or her stay at Emerald Hills.

Kathleen had immediate suspicions about Joan’s fall. The family, she said, had warned the facility not to leave Joan sitting in a chair without supervision because she was liable to try to stand up, lose her balance, and topple to the floor. Joan had fallen several times during an earlier stay in an assisted living facility near Sacramento, but the staff had developed a specific plan to address the issue.

Despite the warning, Kathleen said that when she visited Emerald Hills during Joan’s first days there she often found her mother-in-law sitting in a chair alone.
The recent track record at Emerald Hills featured a host of falls similar to Joan’s, and ambulances were often called to take the injured off to the hospital. Falls are a particular hazard for the elderly, and assisted living facilities like Emerald Hills are required to report them to state regulators.

Internal company records documented 112 falls at Emerald Hills in 2008. Some residents fell repeatedly.

Consider the case of one Emerald Hills resident, 83-year-old Dorothy “Dottie” Bullock.

On April 5, 2008, an Emeritus employee discovered Bullock “on the floor in a semi-seated position” in the memory care unit, according to a state report. She “was unable to tell” the worker what had happened to her. The incident was described as a fall in state records. Emerald Hills sent her to the hospital.
On April 7, Bullock, back at Emerald Hills, fell again, according to the handwritten log of her personal attendant, who was hired by Bullock’s husband to give her extra help.

On April 8, Bullock, complaining of pain, was hauled by ambulance back to the hospital. Doctors concluded that she’d fractured her pelvis, but soon returned her to Emerald Hills. She fell again on April 12.

Bullock would fall again months later, for the final time.

Emeritus records show Bullock tumbled in front of her apartment and was found on the carpet with her aluminum walker beneath her. Blood spilled from her nose and a “bump” developed on her forehead, according to the company documents. The impact broke a vertebra in Bullock’s neck and crushed her nasal bones and sinus structures, hospital records show. A CT scan revealed possible fractures of both eye-sockets and the base of the skull.
Dottie Bullock died in the emergency room.

While Emeritus recorded the fatality in its internal logs, the company did not report her death to state regulators, a violation of California law. The state requires assisted living facilities to file reports on all deaths, even those believed to be from natural causes, so that it can look into suspicious or troubling incidents.

Emeritus said it lacked information about Bullock’s death and thus could not say why it had occurred.

Bullock’s personal attendant, Julie Covich, says Bullock was not supervised properly.

“I think there was neglect,” said Covich, who usually visited Emerald Hills once or twice a week to help out Bullock. “I would go in there and never see a caregiver.”

“It was hard to find anyone that was running the place,” she said. “It was crazy.”

“Heads on the Beds”

In early 2008, the year Joan Boice entered Emerald Hills, Emeritus rolled out a new business campaign. The company dubbed it the “No Barriers to Sales” effort.

The concept was straightforward: Move as many people as possible into Emeritus facilities. Wall Street was looking closely at the company’s quarterly occupancy numbers and a few percentage points could propel the stock price upward or send it tumbling down.

With the housing market foundering, Emeritus needed to step up its sales efforts.
In case there was any confusion about just how seriously the company took this new campaign, a company vice president sent a blast email to facility directors across California. In the body of the email, the vice president got right to it:“SALES and your commitment to sales is your highest priority right now.” Facility directors, the message concluded, would be “held responsible for census and occupancy growth.”

Emeritus employees across the country realized they were entering a new era.
“There was a different sense of urgency. The tone was different,” said a former Emeritus manager who ran a facility at the time. “The message from above was put as many people as possible in the beds and make as much money as possible. That’s what they said. Verbatim. Honestly.”

According to Lisa Paglia, a regional executive in California at the time, Budgie Amparo, the company’s top official for quality control, was openly critical when a Northern California facility declined to admit someone who did not have a doctor’s evaluation.

Such evaluations, which are designed to keep out seniors with problems that assisted living facilities aren’t equipped to handle, are required under a California law known as Title 22.

But on a conference call with roughly half a dozen California managers, Paglia said, Amparo declared that the Northern California facility should have admitted the resident.

“Our priority,” Amparo declared, according to Paglia, “is to get the heads on the beds.”

The issue arose again in October 2008 during a training session for approximately 25 facility directors and salespeople held at an Emeritus property in Tracy, Calif. During the seminar, a company vice president reiterated Amparo’s instruction to disregard California law, according to court records and interviews.

The mandate prompted something of a staff revolt.

At least one facility director spoke out at the meeting: His license to operate the facility was at stake, he said.

An employee who worked at the Tracy facility eventually alerted California regulators. The state dispatched an investigator, and state records show that the investigator met with employees who confirmed that a company official had approved the practice of admitting someone without a doctor’s report. The investigator reviewed a random sample of seven resident files, finding that two people had been moved in illegally, documents show.

Amparo, a nurse whose full title is executive vice president of quality and risk management, denies directing employees to violate the regulation. In a written statement, Emeritus said, “Neither Budgie Amparo nor any of our other officers issued a directive to violate Title 22 or any other law. Emeritus does not condone allowing residents to move in without the proper documents.”

Emeritus eventually fired Paglia, and lawyers for the company have since portrayed her as a poor worker who failed to do her job competently. Along with two other former Emeritus employees, Paglia sued the company alleging wrongful termination, and wound up settling on secret terms.

For assisted living chains such as Emeritus, there is a powerful business incentive to boost occupancy rates and to take in sicker residents, who can be charged more.

Emeritus, for its part, rejects any suggestion that a quest for profits has tainted its admission practices. But in interviews, former Emeritus executives described a corporate culture that often emphasized cash flow above all else. The accounts of the executives, who spoke independently but anonymously, were strikingly consistent.

“It was completely focused on numbers and not human lives,” said one executive, who worked for Emeritus for more than three years and oversaw dozens of facilities in Eastern states.

The company’s emphasis on sales and occupancy rates, the executive said, transformed the workforce into “a group of people who were grasping at every single lever they could pull to drive profitability.”

Emeritus operates a sophisticated, data-driven sales machine. There are occupancy goals for each facility, as well as yearly company-wide goals. The company tracks dozens of data points — including every move-in and move-out of residents — in a vast database. It posts a monthly snapshot of each facility’s sales statistics on an internal website, allowing employees to see which strategies are most successful.


Sales specialists are instructed on how to use psychology to persuade potential customers to sign on. One suggestion: Give the customer “a sense of control and choice by offering two possible options.” A 2009 Emeritus sales manual, which runs 181 pages, encourages sales people to generate publicity by hosting seminars on Alzheimer’s or organizing charity efforts in the event of a natural disaster like a “flood or earthquake.”

Emeritus motivates its workforce with a broad range of financial incentives. There are bonuses for hitting monthly occupancy goals. Bonuses for hitting yearly occupancy goals. Bonuses for boosting overall earnings. And the money doesn’t just go to sales people: The company hands out checks to maintenance workers, nurses, facility directors and other workers.

Nurses play a key role in assisted living, providing much of the hands-on care. But nurses at Emeritus facilities are also expected to be deeply involved in increasing revenue by making sales.

During more than a year of reporting, ProPublica and PBS Frontline spoke to 10 facility directors who said nurses were required to participate in weekly conference calls focusing on little but economics. Those accounts are backed by an internal Emeritus document that lays out the agenda for the weekly calls and that shows an overarching concentration on finances.

Doris Marshall was at the forefront of Emeritus’s efforts to have nurses play the dual roles of caregivers and salespeople. After receiving her nursing license in 1984, Marshall had spent many years tending to patients in the emergency department of a Southern California hospital, and she’d later gone on to help run a nursing school.

But Marshall was intrigued by the assisted living business and in March 2008 she signed on to supervise 10 Emeritus properties scattered across Northern California. Amparo, the company’s head nurse, convinced Marshall to take the job, telling her nurses “had a voice” at Emeritus.

Marshall was to oversee the well-being of roughly 800 elderly people. But her job description went well beyond that: She was to help with “marketing” and “attaining financial goals.” Her job, in the end, actually involved very little nursing.

Instead, she said, she was drawn into Emeritus’s evolving strategies aimed at upping its revenues. The company planned to bring in more seniors with Alzheimer’s and dementia because they could be charged more, she said. Her boss gave her a digital tracking tool showing how much more money Emeritus could make by admitting sicker, frailer residents.

By the fall of 2010 Marshall was worn out and disillusioned. She quit.
Emeritus’s extraordinary drive to put heads in beds — perhaps routine in, say, the hotel industry — has distorted the admissions process at some facilities, records and interviews show. Since 2007, state investigators have cited the company’s facilities more than 30 times for housing people who should have been prohibited from dwelling in assisted living facilities.

A 2010 episode at an Emeritus facility in Napa highlighted the perils of improperly admitting people. The facility rented a room to a 57-year-old woman with an eating disorder, depression, bipolar disorder and a history of suicide attempts. The woman, who was distraught over the death of her husband, taped a note to her door saying she wasn’t to be disturbed and committed suicide, overdosing on an amalgam of prescription painkillers.

The state’s investigation into the death was scathing: the woman should never have been allowed to move in; the staff had missed or ignored bulimic episodes and her obvious weight loss; no plan of care was ever developed or implemented despite the resident’s profound psychological problems.

Emeritus, asked to respond to the state’s investigation, said only that the woman had overdosed on drugs she had brought into the facility on her own, and that as a result they could not be faulted in her death.

“She Barely Even Talked to Us”

In the aftermath of her fall in September 2008, Joan returned to Emerald Hills. But the staff, inexperienced and often exhausted, worried about her.

“She couldn’t walk, she couldn’t feed herself, she barely even talked to us, and her health wasn’t that good,” recalled Jenny Hitt, a former medication technician at Emerald Hills.

But if concern was abundant at Emerald Hills, expertise was in short supply.
Alicia Parga ran Joan’s memory care unit. On some weekends, she managed the entire building — not only the wing of residents with dementia, but the rest of the three-story assisted living facility, one that could hold a total of more than 100 residents.

After Parga started on the job, it took Emeritus roughly 18 months to give her any training on Alzheimer’s and dementia. The state regulations were hardly substantial: Someone such as Parga was obligated to get six hours of training during her first four weeks on the job. But even that requirement wasn’t met.
Emeritus has insisted that Emerald Hills had properly trained personnel to care for Joan and others, and they described Parga as a woman deeply invested in tending to the residents.

But Parga, who had barely earned a high school degree, wasn’t even familiar with the seven stages of dementia. Though she was responsible for the well-being of 15 or more seriously impaired people, as well as the supervision of employees, Parga was paid less than $30,000 per year.

Catherine Hawes, a health care researcher at Texas A&M University, conducted the first national study of assisted living facilities. In her view, training is absolutely crucial. A well-educated employee can “interpret non-verbal cues” from people like Joan, intercept seniors before they wander away from the building, or keep residents from eating or drinking poisonous substances.
“You can do great care,” she said. “You just — you’ve got to know how.”
Other than the Emeritus employees working in the memory care unit at Emerald Hills, only one person saw Joan enough to know what kind of daily care she was getting: Her husband, Myron.

He was worried. And he did his best to sum up his concerns to his son Eric:
“They’re not treating Mom well.”

Jonathan Jones is a former religion reporter for MediaNews Group and is the son of a Presbyterian minister.

Work Until You’re Dead?

  Economy  

CounterPunch / By Mike Whitney

Work Until You’re Dead?

 

Millions of older Americans say they will never be able to retire. They simply don’t have the savings.

 

 

Photo Credit: Shutterstock.com/rayjunk

January 3, 2014  |  

 

 

Millions of older Americans say they will never be able to retire. They simply don’t have the savings. According to CNN, “Roughly three-quarters of Americans are living paycheck-to-paycheck, with little to no emergency savings…50% have less than a three-month cushion and 27% had no savings at all….” (“76% of Americans are living paycheck-to-paycheck“, CNN Money)

“No savings at all”?

That’s right. So retirement is out of the question. A sizable chunk of the adult population is going to punch a clock until they keel-over in the office parking lot and get hauled off in the company dumpster. And those are the lucky ones, the so called baby boomers. By the time we get to the millennials it’ll be even worse because the economy will have been ravaged by 25 or 30 years of austerity leaving the proles to scrape by on hardtack and gruel. Pensions are already being looted, Social Security is under fire, and any small stipend that supports the poor, the unemployed, or the infirm is going to be terminated. That’s why everyone is so down-in-the-mouth, because their expectations of the future are so bleak. Check this out from Business Insider:

“For millennials, the situation is even more grim. Compared to their parents at their age, the under-30 set is worth only half as much. And while this is a sobering reminder of the scale of the Great Recession’s impact on younger generations, it’s not the whole story. These households were actually falling behind even before the stock market and housing crash, researchers found.
Young people not only saw their wages stagnate or drop but also suffered a rise in fixed costs. They leave college with an average $27,000 debt load and have a harder time finding jobs that pay well, while facing more expensive health care and housing costs.

“If these generations cannot accumulate wealth, they will be less able to support themselves when unexpected emergencies arise or when they eventually retire,” the study authors said. “This financial uncertainty could reverberate throughout the economy, since entrepreneurial activity, saving, and investment tend to build on a base of confidence and growing wealth.”(“AMERICA IN DECLINE: Young People Are Much Worse Off Than Their Parents Were At That Age“, Business Insider)

An entire generation of young people have been raped and discarded by their government and all the author cares about is the impact it will have on personal consumption.

Go figure. And there’s a larger point here too, which is that Americans have always believed that their children would enjoy a higher standard of living than their own. Until now, that is. Now most people think things are going to get worse, much worse. You see it in all the surveys. Expectations have changed, the future looks darker than ever before, and people are scared. Check this out from CNN:

“Things appear to be looking up for the economy.

On Wednesday the Federal Reserve felt confident enough to begin slowly withdrawing the huge economic stimulus the central bank has been pumping into the economy.

Unemployment is the lowest in five years. Economic growth picked up recently. The housing sector — which got us into this mess in the first place — is bouncing back. Home sales, prices and construction are all on the rise.

Auto sales recently had their strongest growth since 2006. Gas prices have fallen dramatically this year, and the stock market has risen sharply.

And there’s some reason to be hopeful for next year too. The Fed announced a slightly improved outlook for unemployment in 2014.

But things aren’t always as good as they seem. For many Americans, all the good news in the larger economy isn’t translating over to everyday life. Only 24% of the public believe economic conditions are improving, while nearly four-in-ten say the nation’s economy is actually getting worse, according to a recent CNN poll.” (“Is the economy as good as it looks?“, CNN Money)

That’s right; no one is buying the “recovery” crappola any more. They all know it’s BS. And a closer look at the CNN survey tells you why.

“Looking specifically at the economy, 39% feel that the economy is still in a downturn, up six points from April. Only 24% believe that an economic recovery is under way. Thirty-six percent are in the middle – they don’t think we’re in a recovery but they believe conditions have stabilized.” (CNN Politics)

So, 3 out of 4 people think we’re either still in a severe slump or running in place.(stagnation) That’s your recovery in a nutshell. And it explains why people hate bankers, Wall Street, and Congress. It also explains why millennials have given up on Obama after finally acknowledging that the man is a bumptious blowhard who’s never lifted a finger to help the people who shoehorned his worthless keister into office. Take a look at this from Policy Mic:

“Debt-weary millennials are disillusioned with Obama’s performance with regard to the economy, the implementation of the Affordable Care Act, his handling of foreign relations”…
A new poll conducted by Harvard University’s Institute of Politics has revealed that young Americans’ support for President Barack Obama has reached the lowest point yet. According to the poll, only 41% of Americans aged 18-29 approve of Obama’s performance in office, an 11% drop since April.” (“Millennials officially hate Obama. Here’s why“, policymic)

Ahhh, so people are finally waking up to what an unprincipled phony this guy is. Good!
Unfortunately, ripping Obama won’t pay the bills, which is why so many people are making painful adjustments in their own lives to make ends meet. Aside from cutting back on trips to the doctor and setting the thermostat on “Off”, America’s plenteous graybeards are staying on the job longer than ever. Here’s a clip from an article in Forbes:

“An alarming 37% of middle class Americans believe they’ll work until they’re too sick or until they die.

Another 34% believes retirement will come at the ripe age of 80…

It’s a grim look at the state of retirement which seems to be getting worse for middle class Americans.

Wells Fargo WFC -0.09% interviewed 1,000 Americans between age 25 and 75 and with household income ranging between $25,000 and $99,000. More than half (59%) said their top day-to-day financial concern is paying the monthly bills; that’s up from 52% who said the same last year.

“We do this survey every year and for the past three years, the struggle to pay bills is a growing concern and the prospect of saving for retirement looks dim, particularly for those in their prime saving years,” Laurie Nordquist, head of Wells Fargo Institutional Retirement and Trust, says in the report.

And here’s something for leaders in Washington DC to consider: One third of those surveyed said their primary source of retirement income will come from social security. That figure gets even bigger for those who make less than $50,000–48% of those earners say social security is going to be their primary retirement income.” (“Work Until You Die? More Middle Class Americans Say They Can Never Retire“, Halah Touryalai, Forbes)

How do you like that, eh? So nearly half the people who make less than $50,000 are counting on Social Security as their “primary retirement income.” At the same time, our old buddy Obama is planning to cut Social Security to keep his criminal friends on Wall Street happy.
That means a whole lot of us are going to be stuck bussing tables at Olive Garden until they carry us out feet first.

Your doing a hechuva job, Barry!

Mike Whitney lives in Washington state. He is a contributor to Hopeless: Barack Obama and the Politics of Illusion(AK Press). Hopeless is also available in a Kindle edition. He can be reached at fergiewhitney@msn.com.

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Will You Help Fix the Retirement Crisis? It Will Affect All of You, Eventually

  Economy  

AlterNet / By Don Hazen

Editorial: Will You Help Fix the Retirement Crisis? It Will Affect All of You, Eventually

Covering the retirement crisis is our top priority in 2014.

Photo Credit: Shutterstock.com/Aletia

December 27, 2013  |  

...

Unless we get serious and do something about it now, we are quickly heading for a massive retirement crisis—not just for the huge population of aging boomers, but for generations to come. It has to be fixed, but our leaders are intent on making it worse. 

Two-thirds of working Americans will not be able to maintain their standard of living when they retire, sending many into poverty or near-poverty. And none of this is our fault. Millions of boomers, Gen Xers and so on have not been able to save for the future. Pensions have disappeared. Wages have been flat. Healthcare costs have spiraled. Private plans like 401(k)s and 403(b)s haven't kept up. There have been recessions, waves of high inflation and unemployment. 

Social Security and other benefits have to be fixed and expanded. The frustrating part is that it is all easily fixable. But the political establishment from Barack Obama to the billionaire propagandist Pete Peterson to the Washington Post editorial page, are hard at work to make it worse, by cutting benefits instead of expanding them.

AlterNet has pledged to make covering the retirement crisis a top priority in 2014. 

...

To sum up the problem and the solution, here are nine key facts about the crisis to keep in mind:

1. Americans over age 65 are  projected to increase from 14 percent of the current population to about 21 percent of the population by 2035.
2. The Social Security Trust Fund had a  surplus of $2.54 trillion in it at the end of 2011, and is projected to be  solvent until 2033.
3. Though most people don't know it, Congress has cut Social Security payments by 24 percent  since 1983, via delayed cost-of-living increases and higher taxes.
4. One-third of seniors live only on SS benefits, which is an average of only $1,274 a month per retiree. For two-thirds of retirees, the Social Security benefit is  more than half of what they live on.
5. The wealth gap is skewed extraordinarily by race. For every dollar a white person has in savings, a Latino person has only 6 cents and a black person has only 5 cents.
6. Gender is a huge issue: Seven out of 10 seniors living  under 125 percent of the federal poverty line ( $14,360) are women.
7. Social Security is also the largest federal government program  helping children, with 6.5 million recipients, totaling 8 eight of every 100 children in the U.S. in 2012.
8. Many people don't realize that no Social Security taxes are paid on incomes over $117,000—so the wealth get off very easily. Slightly raising Social Security payroll taxes would  more than cover and sustain the expansion of Social Security.
9. Huge numbers of Americans support Social Security reforms, with  87 percent of the population in favor of scrapping the $117k cap and  82 percent in favor of slight Social Security tax increases.

Why do wealthy power brokers want to cut Social Security taxes which they themselves grossly underpay? That is the question at hand. There is no other issue in America where those in power are so out of sync with the voters and the people. 

A series of simple, fair-minded fixes would not just make Social Security solvent for decades, but would allow us to expand the benefits so no Americans fall into poverty as they age. That is a worthy goal for all of us, don't you think?

...

Don Hazen is the executive editor of AlterNet.

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Your Terrifying Retirement Future: Why Millions Risk Sliding Into Poverty As They Age

AlterNet / By Steven Rosenfeld

Your Terrifying Retirement Future: Why Millions Risk Sliding Into Poverty As They Age

Low wages, low or no savings, and low Social Security benefits. The future is not bright, especially for women and minorities.

 

Photo Credit: Image by Shutterstock

December 23, 2013  |   

 

 

 

(Editor’s note: This AlterNet interview is part of our expanded focus on modernizing Social Security, which, to us means increasing benefits where needed and ensuring its long-term funding. Dr. Maya Rockeymoore is a longtime advocate for racial justice. She is chair of the National Committee to Protect Social Security and Medicare and president and CEO of Global Policy Solutions. She spoke to AlterNet’s Steven Rosenfeld about how America’s retirement crisis affects communties of color and women.)

AlterNet: There’s a lot about America’s growing retirement security crisis that’s not fully appreciated by the public, especially when it comes to the harmful impacts on communities of color and women. Tell us how unless we as a country have an honest discussion about this, and expand Social Security, that tens of millions of people will literally slide into poverty as they age.

Maya Rockeymoore: There is no way we cannot have this discussion given the nation’s changing demographics. The rising majority will be primarily Asian-American, African-American and Latino-American. The fact of the matter is those people are already here. Of all the babies born today, a majority are children of color. By 2019, a majority of all children under the age of 18 will be from these racial and ethnic, quote-unquote, minority groups. And by the by 2043, the nation will be majority minority.

The benefit cuts that austerity proponents are talking about today will be fully shouldered, if they ever were to pass, by a nation that looks very different than it does today. And so when you’re talking about cutting Social Security now, most proposals are not talking about cutting it for current retirees. They’re talking about implementing changes that would affect today’s youth. You should understand that you are primarily cutting benefits for a generation of young people who the odds are stacked against them having any type of retirement security.

AlterNet: And that’s on top of what’s shaping up as a retirement crisis for baby boomers.

Maya Rockeymoore: We’re already a nation experiencing a retirement crisis. The private sector mostly does not have defined benefit pensions anymore. And 401Ks have been a failure. What many people fail to appreciate is that communities of color have less access to retirement savings vehicles on the job than do white Americans. And unfortunately, even when they do have access, they are either more likely not to take advantage of it, or more likely to take loans out of it. So what we have is a population, that by virtue of their inconsistent relationship with the labor market, which is rooted in historical inequities, are already disadvantaged when it comes to retirement security.

That insecurity is most clearly represented by the racial wealth gap. For every $1 in wealth owned by the typical white family, the typical African-American family has five cents, and the typical Latino family has six cents. And layered on top of that are the effects of the Great Recession, and the effect of the housing crisis that stripped many households of color of any wealth that they may have accumulated through real estate.        
     
AlterNet: I know those figures and trends. They’re really shocking. And because as women tend to live longer than men, they’ll be taking the largest hit.

Maya Rockeymoore: That’s another feature of the story, because when you look at women of color, they actually earn less than white women. So when you often hear about the pay gap between women and men—and that about 77 cents earned by women for every dollar that a man makes—it’s actually lower for African-American and Latino women. They get paid less. And they have less wealth. In fact, many households headed by women have negative wealth—debt. That research has actually been conducted by Mariko Chang, and I urge you to read about the lack of wealth of women of color.

So when you’re talking about retirement insecurity, it’s a triple threat for women of color, who are discriminated against in the labor market, have lower rates of pay, come from households with low to no wealth, and negative wealth in many instances, and often do not have access to private retirement benefits. And then, of course, shoulder the burden of children, and that having a wealth-depleting effect on their personal economic security. So heading into retirement, many women of color, Social Security is all they’ve got. So when you’re talking about cutting benefits, you’re talking about further eroding any kind of economic security for households that are already extremely vulnerable. And have been exploited and vulnerable over a lifetime of work.

We like to think that some of these decisions are deracialized, and that maybe that the policy makers who are opposing these things are not thinking in terms of race. But I think we do ourselves a great disservice when we do not consider race and ethnicity or class. Because when we ignore the impact of proposed policy changes on differently situated groups, we can often make things like poverty much worse. And that undermines and erodes our democracy and we can’t afford to do that.

AlterNet: I completely agree. I wrote a piece on the Senate Finance subcommittee’s recent hearing on Social Security. What I didn’t put in it was how a Democratic senator said, ‘My gosh! What’s a family that’s making $150,000 a year to do?’ I thought, ‘Wow, $150,000 a year is the family you’re concerned about? And this is from a Democrat?’ What do you think is needed to reframe this discussion, so the debate can be forced to talk about solutions that affect people with real needs?

Maya Rockeymoore: I think there are two things that we need to say. The first is there is an economic argument to be made. For most of the 20^th century, America did well. If we expect to do well in the 21^st century, then we can’t erode and undercut the economic prosperity of the nation. And regardless of race and ethnicity, average Americans are pretty bad off. But when you layer on the fact that we have more people coming from households with low to no wealth, becoming a majority of the population—and we expect to still be a superpower? Can we expect to still be a superpower? I would argue no. The fact of the matter is we’re all in this boat together. And if we’re committed to national economic prosperity, and the growing productivity of the nation, we need to consider how we actually produce systems that can support the productivity of workers. Social Security has proven its value and its worth for reducing poverty, and providing insurance benefits for families throughout the 20^th century. It can continue to do so for the 21^st century if policy makers remain committed to the value of social insurance.

The second thing is the democratic argument. Our democracy cannot stand with gross wealth inequality. There may come a time, if we let these trends and trajectories continue, that the institutions that were created will not be able to stand under the weight of the despair that will be created by policies that undercut the economic security of the vast majorities of Americans. But especially those who are already vulnerable. We cannot expect that our democratic institutions will be considered valid; that they will continue to be relevant when the vast majority of our population lives in squalor and poor circumstances. And so, if we care about prepetuating this great democratic experience we call the United States of America, we should care about making sure that we are producing policies that are in the best benefit for the majority of the nation—but especially those who have been vunerable traditionally.

And there’s a moral argument. And that argument is that we should and can do better than what’s being proposed. And that we are better as a nation when we pull together to move forward to define progress for the world. The fact of the matter is Social Security of one of our great pillars of progress. We created it and we had the foresight to realize that workers could come together to contribute to their own security. And we need to continue to perpetuate it, because that’s what we do as Americans. We are problem solvers and we know how to put together systems that work. And some policy makers have forgotten that.

AlterNet: There’s one more thing I wanted to ask about. One under-appreciated piece of this is how immigration reform would contribute to solving this crisis. Isn’t that right?

Maya Rockeymoore: Yes, that’s correct. First of all, immigrants already contribute a whole heck of a lot of money to Social Security. It’s through undocumented labor and using fake Social Security numbers that do not match. These individuals are paying taxes and they are paying Social Security taxes. And they are primarily Latino in origin and coming from various Latin American countries. And these are individuals who tend to have larger families. We have been talking for the past several decades about the growing imbalance between the number of workers to retirees, and the fact of the matter is we have a nationwide solution staring us straight in the face. We’ve got a population that’s already contributing and eager to contribute more to the American economy. And this is a population that certainly tends to value family. And have larger families. And if we simply recognize this population and do right by them with regards to honoring their contribution to our economy, we can go a significant want toward addressing the issue of Social Security solvency.

And, of course, the other part of that is scrapping the cap [where only the first $117,300 of income is taxed for Social Security] will get us all the way there.

AlterNet: Yes, I’m well aware of that. And as pollster Celinda Lake pointed out, most people are not even aware there’s a cap because they do not earn above six-figures.

Maya Rockeymoore: That’s right. You may have heard me use the term fiscal racism. But it’s also fiscal sexism. And how is it—and I say this tongue-in-cheek—that the policy makers coming up with these austerity proposals, who tend to be overwhelmingly male, and overwhelmingly white, would come up with policies that would just happen to stick it to women and people of color? And low-income people? These are overwhelmingly well-to-do people who think that a family making $150,000 is struggling, and they are just out of touch with the reality of how Americans are living, especially Americans who have come from traditionally disadvantaged populations.

I think that we have to drive home that there are racialized, and gendered, and class implications to the policies that they are proosing and it’s simply unacceptable. What they are proposing will actually exacerbate income inequality in this country.

AlterNet: I noticed that. I wrote a piece that talked about George W. Bush’s former policy director at the Social Security Administration spoke at a Senate hearing and said that we should have a floor—nobody gets less money than the federal poverty level—and the price for that is cutting benefits in the middle. That idea was seen as great progress as it wasn’t just cut-cut-cut. But all of this is so far from what really needs to happen.

Maya Rockeymoore: That’s the whole point. Even Democrats that take that stand are actually protecting the benefits of the privileged. They are unwilling to acknowledge that their policies are perpetuating the advantages of the 1 percent. They are unwilling to explain to the American people, that they represent, that are actually not representing them. They are actually sticking up for the big guy and sticking it to the little guy and girl… Nobody blinks because they don’t realize their own bias.

It’s like the bias of the Washington Post editorial board, who seems to care greatly that the wealthy have limited resources. Well, gee—what about the average Joe? What about the average worker who’s struggling to make ends meet? The wealthy have quite a bit of resources that can go to solving our problems. And not only that, they’re deserving of being hit up on this, because of the fact of the growth of unearned income. Those are resources that have skirted the system. Social Security taxes payrolls. Basically, they’ve found a way to get away with not paying their contribution to Social Security. That has exacerbated the Social Security solvency and finaning issue. And yet the nature of their solution is not about recouping lost wages, it’s about cutting benefits for people who have been faithfully making their contributions. It’s just backwards and it needs to stop.

Steven Rosenfeld covers democracy issues for AlterNet and is the author of "Count My Vote: A Citizen's Guide to Voting" (AlterNet Books, 2008).

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Feeding America

Hunger In America

Senior Hunger

    

Senior Hunger

The number of older adults is projected to increase over the next decade and continue to rise in the following decade. In 2040 there will be 79.7 million older adults, more than twice as many as in 2000.  Additionally, the senior population is becoming increasingly diverse.  Between 2012 and 2030, the white population of 65 and plus is projected to increase by 54% compared with 125% of older minorities. ^[i]  
These changing demographics will have profound impacts on the demand for social services, especially the need for adequate and culturally appropriate nutrition services.  Seniors may have unique nutritional needs and challenges that separate them from the rest of the population and must be considered.

Emergency Food Assistance ^[ii]

• Nearly 3 million elderly persons are served by Feeding America each year.  18.6 percent of client households have at least one member who is age 65 or over, and 52 percent of these households are food insecure - an estimated 1.2 million households.
• Among all clients served by Feeding America, 8 percent were seniors age 65 or over, while 14.2 percent of adult clients interviewed at emergency feeding programs were age 65 or older.
• Among all client households with at least one senior, 10.5 percent use senior brown bag programs, 16.5 percent attend senior nutrition sites (such as senior centers that serve lunch) and 6.6 percent receive home-delivered meals or meals-on-wheels.
• 30 percent of client households with seniors indicated that they have had to choose between food and medical care and 35 percent had to choose between food and paying for heat/utilities.

Food Insecurity

• In 2012, 2.8 million (8.8%) households with seniors experienced food insecurity. 1.1 million (9.1%) households composed of seniors living alone experience food insecurity. ^[iii]
• In 2011, 4.8 million Americans over the age of 60 were food insecure. This constitutes 8.4% of all seniors. ^[iv]
• The number of food insecure seniors is projected to increase by 50% when the youngest of the Baby Boom Generation reaches age 60 in 2025. ^[v]
• Seniors are more likely to be food insecure if they : ^[vi]
• Live in a southern state
• Are younger
• Live with a grandchild
• Are African American
• Are Hispanic

For seniors, protecting oneself from food insecurity and hunger is more difficult than for the general population.  For example, a study that focused on the experience of food insecurity among the elderly population found that food insecure seniors sometimes had enough money to purchase food but did not have the resources to access or prepare food due to lack of transportation, functional limitations, or health problems. ^[vii]
 

Poverty

• In 2012, 9.1 percent of seniors (3.9 million older adults age 65 and older) lived below the poverty line. ^[viii]
• In 2011, under the Supplemental Poverty Measure, seniors make up 12.6% of people in poverty as compared with 7.8% under the official measure. ^[ix]
• In 2011, under the Supplemental Poverty Measure, medical out of pocket expenses (MOOP) increase the poverty rate among seniors (8.0% excluding MOOP, 12.6% including). ^[x]

Federal Nutrition Assistance

• Elderly households are much less likely to receive help through the Supplemental Nutrition Assistance Program (SNAP) than non-elderly households, even when expected benefits are roughly the same. ^[xi]
• Seniors require greater consideration towards their health and medical needs that can become compromised when there is not enough food to eat.  A study which examined the health and nutritional status of seniors found that food insecure seniors had significantly lower intakes of vital nutrients in their diets when compared to their food secure counterparts.  In addition, food insecure seniors were 2.33 times more likely to report fair/poor health status and had higher nutritional risk. ^[xii]

---

[i] U.S. Department of Health and Human Services, Administration on Aging.  (2012). A profile of Older Americans: 2012.

[ii] Cohen, R., J. Mabli,, F. Potter & Z. Zhao. (2010). Hunger in America 2010.  Mathematica Policy Research, Feeding America. 

[iii] Coleman-Jensen, A., Nord, M., & Singh, A. (2013). Household Food Security in the United States in 2012, Table 2. USDA ERS.

[iv] Ziliak, J.P. & Gundersen, C. (2013.) Spotlight on Food Insecurity among Senior Americans: 2011. National Foundation to End Senior Hunger (NFESH).

[v] Ziliak, J. & Gunderson, C. (2009, September). Senior Hunger in the United States: Differences across states and rural and urban areas.  University of Kentucky Center for Poverty Research Special Reports. Retrieved October 7, 2010. http://www.ukcpr.org/Publications/seniorhungerfollowup.pdf[v]

[vi] United States Department of Agriculture/Office of Analysis, Nutrition, and Evaluation.  Elderly Participation and the Minimum Benefit.  November 2002.

[vii] Wolfe WS, Frongillo EA, Valois P. (2003).  Understanding the experience of food insecurity by elders suggests ways to improve its measurement.  J. Nutr. 133:2762-2769, 2003.

[viii] DeNavas-Walt, Carmen, B.D. Proctor, J. Smith.  U.S. Census Bureau.  Income, Poverty, and Health Insurance Coverage in the United States:  2012.  September 2013.

[ix] The Research Supplemental Poverty Measure: 2011. (2012). U.S. Census Bureau.

[x] Ibid.

[xi] Ziliak, J. & Gunderson, C. (2009, September). Senior Hunger in the United States: Differences across states and rural and urban areas.  University of Kentucky Center for Poverty Research Special Reports. Retrieved October 7, 2010.

[xii] Lee JS, Frongillo, Jr. EA. (2001).  Nutritional and health consequences are associated with food insecurity among U.S. elderly persons.  J. Nutr. 131: 1503-1509, 2001

Here’s what chained-CPI really means: Up to $849 less for someone who retired in 2001

The Washington Post

WONKBLOG

Here’s what chained-CPI really means: Up to $849 less for someone who retired in 2001

 

Posted by Dylan Matthews on April 11, 2013 at 11:00 am

To hear critics tell it, President Obama’s plan to cut Social Security by adopting a new inflation measure is a major attack on the elderly. Rep. Greg Walden (R-Ore.), the head of the National Republican Congressional Committee, called it a “a shocking attack on seniors,” while Sen. Elizabeth Warren (D-Mass.) sent an e-mail to supporters declaring, “‘chained CPI’ is just a fancy way to say ‘cut benefits for seniors, the permanently disabled, and orphans.’”

Here are the facts. Chained-CPI does mean that Social Security beneficiaries will see their benefits cut. Imagine a person born in 1936 who retired in 2001, at age 65. For simplicity, let’s assume they’re eligible for the maximum benefit. Given that the cap was below $30,000 a year as recently as 1980, it’s not inconceivable that a middle or upper-middle class person with steadily increasing earnings since 1958 would be in this situation.

Their initial benefit would have been $1,538 a month, or $18,456 a year. Under existing law, they would have gotten a series of cost-of-living adjustments (COLAs). By 2013, COLAs would have increased this person’s annual benefit to $24,689.49. However, under chained CPI, it would be $23,820.19, a decrease of $869.30. That’s a 3.5 percent cut in benefits. And, of course, a 3.5 percent cut in income matters a lot more when you’re barely clearing $20,000 a year than it does when you’re making a regular middle-class salary.

There would be other complications as well. Kenneth Stewart, an economist in the Division of Consumer Prices and Price Indexes at the Bureau of Labor Statistics (BLS), is one of the guys who computes the various CPIs every month. He notes that one benefit of CPI-W and other unchained CPIs is that they are final upon issuance. That is, the numbers are never revised. Two weeks after this month ends, BLS will release the April 2013 CPI, and that will always and forever be the April 2013 CPI.

Not so for chained CPI. “The chained CPI-U is subject to revision because we don’t get the actual expenditure data until 1 or 2 years later,” he notes. For example, in 2005 we had access to final chained CPI data for 2003, and only interim data for 2004. If we were to adopt chained CPI, we’d either have to use incomplete data, or else wait until we had final data to implement COLAs, which would further compound the cuts. The former, of course, would reduce the accuracy of the measure, a feature that proponents often tout.

For that reason, critics of chained CPI have sometimes promoted the CPI-E, an experimental index meant to measure price changes within products bought by the elderly. Because it’s experimental and simply a result of reweighing the existing CPI measures to more heavily account for goods like housing and health care, the BLS doesn’t publish the data on its website, but it’s available upon request. Stewart, who helped develop CPI-E, explains that it’s an unchained measure, and because of that its numbers don’t need to be revised.

In the mid-2000s, the housing bubble and boom in health-care prices meant that CPI-E, which weights both more heavily, rose faster than conventional inflation measures. In 2008, for instance, adopting CPI-E as Social Security’s inflation measure would have given our hypothetical retiree $327.88 more a year.

However, since the housing bubble burst and health-care prices started slowing in growth, that effect has diminished. “Medical care inflation has been relatively subdued,” Stewart says. “Shelter prices have also been very tame in, really, the last seven or eight years.” As a result, in 2013 CPI-E would have resulted in only $56 in additional annual benefits for our test retiree.

The measure is not without its disadvantages. The biggest, noted by the Committee for a Responsible Federal Budget’s Adam Rosenberg and Marc Goldwein here, is that a third of Social Security beneficiaries are not elderly. If the goal is to accurately represent inflation for beneficiaries, you’d also have to look at spending patterns among survivors and the disabled, which would be a considerable new project. Also, CPI-E uses a small sample size as it relies on the same sample that normal CPI does. To bring it from the experimental phase to become ready for prime time, that’d need to change. “We’d have to do a lot of research as to where those folks are shopping, what exactly they’re buying, and what prices they’re paying,” Stewart says. “It’s very difficult and costly to measure.”

But ultimately, the question of which you prefer likely has more to do with whether you think Social Security benefits need to be pared back to ensure the program’s long-run solvency, or whether you think the elderly need, if anything, a benefit bump. Those are policy questions, not technical ones, and all the debate in the world about chained CPIs and CPI-Es relative methodological merits won’t resolve them.