Activism by the Elderly

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As a group, we over 65ers have substantial non-working time. According to the US Census Bureau, in 2011 16.2% of us participated in the labor force. The participation rate falls off steeply with age. Among 65 – 69 year old men (2010 data), 35.8% were working. For 70 – 74 year olds 20.9% were employed, falling to 8.6% for those over 75. For women, the comparable rates are 26.4%, 13.5% and 3.9%.

What will we do with all that non-working time? The answer to that question has a strong potential bearing on the quality of civil society.

A recent article in the Boston Globe illustrates the impact an Over 65 blogger is having by using his non-working time for activism. In the first of his two posts on long term care insurance (LTCI), Ken Deitch described how experiencing a massive premium increase on his own LTCI policy led him to look into how the industry is regulated and then to activism in his home state of Massachusetts.  In the second of his two posts he took the state to task for not meeting the commitments it made in the new “Act Establishing Standards for Long-Term Care Insurance” law to take steps to rein in the out of control premium increases. Ken brought that post to the attention of a Boston Globe reporter, whose front page story was headlined “State Protections Still Awaited for Long-Term Care: Rules on Insurers Delayed.” Ken was quoted in the article. Not surprisingly, the story appears to have jostled the state into moving the regulatory process forward.

This has been a very time consuming process for Ken. It’s not impossible that someone with a full time job could have done the same thing, but it’s not likely. If enough over 65ers do this kind of work on behalf of their vision of a more fair and just society, we can make a meaningful contribution to the quality of our national life.

Volunteer service work has a hallowed history among the elderly. In 1966 RSVP (“Retired and Senior Volunteer Program”) was launched in New York City. Today RSVP is part of a federal agency – the Corporation for National & Community Service – that fosters volunteer activities for more than 300,000 older Americans. Ken Deitch’s activism is a form of volunteer work – not with an organization, but on behalf of an issue he felt passionately about.

Marc Freedman, CEO of Encore, an organization devoted to encouraging “encore careers” in the period from 55 – 80, has taken the traditional idea of volunteerism and connected it to the world of work. Freedman’s vision is that after 30+ years of work from young adulthood to mid-life, some people may want to look for new and remunerated ways to apply their experience, knowledge and skills to contribute to social well being and enhance their own sense of purpose and meaning. Encore sponsors an annual “Purpose Prize” contest with $100,000 in award money for people over 60 who have made extraordinary contributions as social entrepreneurs.

Whether it’s unpaid volunteer work, which is more common among folks in their 70s and beyond, or remunerated “encore careers” for folks in their 50s and 60s, RSVP and Encore share the conviction that many elderly want to “give back” to society and to future generations. This conviction is a major premise of the Over 65 project!

“Giving back” to society needn’t pose an either/or choice between altruism and egotism. Ken Deitch was stung by a 70% increase in his LTCI premium. But his response stands a good chance of benefiting thousands of others, not just himself.

Jim Sabin, M.D., 74, is an organizer of Over 65, a clinical professor of population medicine and psychiatry at Harvard Medical School, and a Fellow of the Hastings Center.

4 Responses to “Activism by the Elderly”

  1. Carol Eblen

    Yes! I commented on Ken Deitch’s blog on Over 65 about the increase in premiums and the failure of the State to quickly implement the new law.

    My “do gooder” instincts are alive and well and a matter of “altruism” and “ego” and “shock” and “anger” and “grief” I persist in trying to get a conversation started about unilateral covert and overt DNR code status placed in the charts of the elderly/disabled on Medicare and Medicaid.

    I, also, had been recently shocked about a proposed increase in my long-term-care premium with Genworth and had already contacted my State Insurance Commissioner about the legality of such a large increase. To date! it hasn’t been changed but I know that it can be changed with 30 days notice if it can be justified under the law.

    I had hoped to engage some of the bloggers on “Over 65” in conversation about the need and/or the legality of unilateral covert and overt(default) DNR Code Status that hastens the death of the elderly and the disabled and the poor for fiscal expediency without their knowledge or informed consent.

    I understand that you are a proponent of “Managed Care” and that managed care in the Medicare/Medicaid scenario has resulted in the unilateral DNR that limits “indicated” treatments (not medically futile) that will not be reimbursed by CMS and private Big Insurance. I understand that the very elderly and the disabled with shortened life expectancies appear to be the more logical candidates for hastening death for fiscal expediency, but how can this be justified without their informed consent?

    From my perspective, I don’t understand why the bioethicists at Hastings did not work to develop policy under the authority of the federal 1991 PSDA to require treating specialist physicians to seek informed consent from elderly/disabled Medicare/Medicaid patients for Curative Care OR Palliative Care/Hospice from their elderly/disabled patients with later term diseases and cancers.

    It would seem that “self rationing” hasn’t been encouraged by the bioethicists or the medical specialists who have been guilty of grievous over treatment of the elderly for the profit motive. Or, am I wrong? Don’t the recent lawsuits filed by the Department of Justice in cooperation with HHS indicate that over treatment of Medicare/Medicaid patients has been a serious problem for Medicare?

    If you believed, Dr. Sabin, that there was an epidemic of unilateral covert and overt(default) DNR Code Status being extrapolated into the hospital charts of the elderly/disabled and the poor primarily for fiscal expediency, would you blow the whistle?

    Thank you for your kind response.

    • James Sabin

      Dear Carol
      I believe the reason none of the bloggers have responded to your concern about “unilateral covert and overt DNR” is that the ethics of these aspects of end of life care are clear. As Muriel Gillick wrote in the post that went up today, conversations with patients and families and collaborative planning are what good ethics and good clinical care call for. If and when this doesn’t happen it’s a failure in applying clear and established standards, not a lack of clarity about what those standards are.

    • Christiana

      A plneaisgly rational answer. Good to hear from you.

  2. Debra Sexton

    My mom is 85 years old and on heavy medication due to back injuries, etc. A real estate developer is trying to scan her out of her property in Marietta, GA that has been in her family over 100 years. Her companion is deceased as is her 1st husband and son. I am her daughter and have retained her an attorney. I would like to know if there is an activist group for the elderly to help me if it goes to court. My home number is 770-926-3617. Of course all would have to be cleared with the attorney I hired, but the support would be greatly welcomed. This man is running a muck and a scam. Thank you Debra Sexton