Valerie Harper's husband says he can't send her to hospice
(CNN)Valerie Harper's husband says he will not follow doctors' advice to put his wife in hospice care.
Tony Cacciotti posted a note on his wife's official Facebook page Tuesday regarding her current medical state.
"I have been told by doctors to put Val in Hospice care and I can't [because of our 40 years of shared commitment to each other] and I won't because of the amazing good deeds she has graced us with while she's been here on earth," the note began. "We will continue going forward as long as the powers above allow us, I will do my very best in making Val as comfortable as possible."
The actress, who shot to stardom in the early 1970s as Rhoda Morgenstern on "The Mary Tyler Moore Show" and later starred as that character in a spinoff, has been battling cancer for years.Harper was first diagnosed with lung cancer in 2009.
In 2013, she was given three months to live after she was diagnosed with leptomeningeal carcinomatosis, a condition that occurs when cancer cells spread into the fluid-filled membrane surrounding the brain, known as the meninges.
But the 79-year-old actress has defied the odds and even participated in the reality competition show "Dancing With the Stars" in 2014.
Her family recently announced a GoFundMe account had been established to help pay for Harper's medical care.
On Tuesday, her husband posted in his note that "For those of you who have been in this position, you will totally understand that 'it's hard letting go.'"
"So as long as I'm able and capable, I'll be where I belong right beside her," Cacciotti wrote. "Many, many thanks for your outpouring of kindness and support."
Top concern of seniors? Transportation.
Well past time to bring the rails back.
Virginia Groups Call for New East-West Trains
Demographic trends show need for greater transportation options.
Richmond, VA— A new report finds that expanding Virginia’s rail service to add an east-west corridor would make colleges and universities across the Commonwealth more accessible to students, increase economic development and tourism, and give 3.7 million Virginians additional access to passenger rail.
“This expansion to our rail system would increase points of access for so many people across the state and beyond,” said Danny Plaugher, executive director of Virginians for High Speed Rail, “the corridor could serve nearly 3.7 million Virginians who live within 20 miles of a rail station by expanding our transportation connectivity.”
Virginians for High Speed Rail, the Southern Environmental Law Center, the Hampton Roads Chamber, Virginia21, and Roanoke Regional Chamber jointly released the report, Expanding Virginia’s Passenger Rail: Connecting the Blue Ridge to the Beach with the Commonwealth Corridor.
The benefits of creating an east-west rail service include:
“Mobility is a significant issue for Virginia’s college students and young professionals” said Jared Calfee, executive director of Virginia21. "Virginians under 35 possess the fewest drivers’ licenses per capita of any generation; exploring new options to get from point A to point B has the potential to make our colleges more accessible for students and our communities more attractive to the workforce of tomorrow."
“The Roanoke region is served by the top Regional train in the nation, which generates millions in economic benefits for our region,” stated Joyce Waugh, President and CEO of Roanoke Regional Chamber, “a cross-state train will open numerous economic opportunities for our communities including increased tourism and connectivity.”
“The need for more travel options is obvious,” said Trip Pollard, director of the Southern Environmental Law Center’s Land & Community Program. “To travel by train from Roanoke to Norfolk today would take 16 hours—including a 6-hour layover in Washington, DC. We can and we must do better for Virginians.”
We are asking that the Virginia Department of Rail and Public Transportation complete a feasibility study on the Commonwealth Corridor and outline potential next steps to launch this service as soon as possible.
For more information, please visit www.CommonwealthCorridor.com or here to read the report.
Virginians for High Speed Rail is a non-profit coalition of citizens, businesses, localities, community organizations, and economic development agencies that educate and advocate for the expansion of fast, frequent, and reliable rail service connecting our communities to increase the economic potential of the Commonwealth. We were founded in 1994 as a partnership between the Chamber RVA and the Future of Hampton Roads. www.VHSR.com.
For over 30 years, the Southern Environmental Law Center has used the power of the law to champion the environment of the Southeast. With more than 80 attorneys and nine offices across the region, SELC is widely recognized as the Southeast’s foremost environmental organization and regional leader. SELC works on a full range of environmental issues to protect our natural resources and the health and well-being of all the people in our region. www.SouthernEnvironment.org
The Hampton Roads Chamber is a vigorous advocate for the economic success of its nearly 2,000 member businesses, which employ 280,000 men and women in southeastern Virginia. The Chamber promotes Hampton Roads’ healthy business climate through economic development, public policy initiatives, services, and benefits to members. The Chamber is dedicated to creating economic opportunity and enhancing the quality of life in Hampton Roads. www.HamptonRoadsChamber.com
Virginia21 is a 501(c)3 organization that has engaged over 100,000 young people in the political process by providing information, directing advocacy and coordinating political action on a non-partisan platform that includes higher education, student health and safety, and economic development. www.virginia21.org/
The Roanoke Regional Chamber fosters the growth of our members and our community by offering relevant programs and events designed to address business needs, solve business problems and increase opportunities for members. The Chamber promotes regional business by providing invaluable referrals and connections and influencing public policy to benefit all businesses. The Chamber was founded in 1889 and represents more than 800 businesses with over 75,000 employees and an estimated payroll of more than $1.5 billion. www.roanokechamber.org
A $100 million payday would solve a lot of problems...
Genetic-Testing Scam Targets Seniors And Rips Off MedicareBy Melissa Bailey July 31, 2019
Republish This Story
Sherry Swan is one of many Californians who have filed complaints to the state’s Senior Medicare Patrol about potential fraud related to genetic tests. “It was just a scam from the minute he opened his mouth,” Swan says of a man who knocked on her door in June. (Ana B. Ibarra/KHN)
This story also ran on USA Today. This story can be republished for free (details). The 86-year-old woman in rural Utah doesn’t usually answer solicitations from strangers, she said, but the young couple who knocked on her front door seemed so nice. Before long, she had handed over her Medicare and Social Security numbers — and allowed them to swab her cheek to collect her DNA.
She is among scores of older Americans who have been targeted in a scam that uses DNA tests to defraud Medicare or steal personal information. Fraudsters find their victims across the country through cold calls, door knocking, email, Facebook ads and Craigslist. They also troll low-income housing complexes, senior centers, health fairs and antique shops. Sometimes they offer ice cream, pizza or $100 gift cards. Some callers claim to work for Medicare, according to a fraud alert issued July 19 by the Federal Trade Commission.
The woman in Utah said she didn’t know the purpose of the DNA test she submitted to this month — “I’m too old to remember” — but the visit troubled her for several nights, she said.
“I’d lie awake thinking about it, saying, ‘You fool, you shouldn’t have done that.'” (She spoke on the condition of anonymity for fear of being targeted by other scams.)
In interviews with Kaiser Health News, seniors around the country reported feeling betrayed, exposed and confused.
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Sign UpCapitalizing on the growing popularity of genetic testing — and fears of terminal illness — scammers are persuading seniors to take two types of genetic screenings that are covered by Medicare Part B, according to experts familiar with the schemes. The tests aim to detect their risk for cancer or medication side effects.
The scammers bill Medicare for the tests. The patients, who might never receive any results, typically pay nothing. But they risk compromising personal information and family medical history. And taxpayers foot the bill for tests that may be unnecessary or inappropriate.
Scammers can really cash in: Medicare pays an average of $6,000 to $9,000 for these tests, and sometimes as much as $25,000, according to the Office of Inspector General at the Department of Health and Human Services.
DNA test scams appear to be ramping up: Complaints to the inspector general fraud hotline have poured in at rates as high as 50 per week, according to Sheila Davis, an OIG spokeswoman. That’s compared with one or two complaints a week at the same time last year, she said.
The inspector general issued a fraud alert in June, urging seniors to refuse unsolicited requests for their Medicare numbers and take DNA tests only with the approval of a doctor they know and trust. By Medicare rules, DNA tests must be medically necessary and approved by a physician who is treating the patient.
In cases that have gone to court, scammers were accused of breaking those rules by paying kickbacks to doctors who agreed to order DNA tests for patients without ever treating them. The front-line recruiters who solicit the tests might work directly for a lab, or as independent contractors who divide revenue with a laboratory in exchange for bringing in extra business.
Some solicitors try to scare seniors into cooperating, said Shimon Richmond, an assistant inspector general for investigations. They warn seniors that they could be vulnerable to heart attacks, stroke, cancer or even suicide if they do not take the DNA tests.
“That’s a pretty egregious form of patient manipulation and emotional abuse,” Richmond said.
Richmond said the two tests involved in the scams are: CGx, which tests for genetic predisposition to cancer, and PGx, a pharmacogenomic test for genetic mutations that affect how the body handles certain medications. They’re part of a new frontier of preventive genetic health.
In New Jersey, three people were sent to federal prison in May for a scheme that used a purported nonprofit called Good Samaritans of America to persuade hundreds of seniors to take DNA tests. The co-conspirators raked in $100,000 in commissions from labs that ran the tests, according to the government.
“This is a gold-rush area for folks. It’s leading to a big response by the government,” said Assistant U.S. Attorney Bernard Cooney, a prosecutor in the case.
This month, a Florida doctor was charged in federal court for his role in an alleged fraud scheme to order DNA tests for patients in Oklahoma, Arizona, Tennessee and Mississippi. Patients were recruited through Facebook ads offering $100 gift cards, according to court records. The doctor allegedly confessed that he was being paid $5,000 per month to approve these tests, even though he never spoke to any of the patients involved.
Some labs accused of billing Medicare for unnecessary genetic tests — including Companion DX Reference Lab — agreed to repay the government but declared bankruptcy before doing so, leaving taxpayers on the hook.
Meanwhile, older Americans are encountering sales pitches that leave them feeling deceived.
In Weslaco, Texas, Will Dickey, a 71-year-old retired police detective, submitted to a DNA test at a health fair in February.
“I have a bunch of cancer in my family,” he recalled thinking, so “it’d help if I had an idea of what genes I had in me.” Three weeks later, he saw the same salesperson rounding up business at his RV park, where his wife and several neighbors got their cheeks swabbed. Dickey, who spent 10 years working with DNA tests in a police crime lab, said he was surprised at the cost: A lab in Mississippi charged Medicare $10,410 for his tests.
He didn’t get results until he requested them by phone. The report, which listed results as “uncertain,” was “a bunch of gobbledygook that makes no sense to anybody who’s not in the medical field,” he said. He reported the case to authorities as possible fraud.
As in Dickey’s case, scammers often gain access to places that seniors trust by persuading gatekeepers to let them make presentations. Bev Beatty allowed a genetic testing company to run a booth at a senior health fair she organized in Oak Forest, Ill., last year. At least 10 seniors took the tests. Afterward, she was irate to discover they had been roped into a scam. Test-takers told her they never received their DNA results, even though Medicare paid thousands of dollars.
“If somebody’s going to be fraudulent and bill Medicare, it kind of riles me up,” she said. “I would like to see them hanged.”
In Paducah, Ky., Donald McNeill, a 72-year-old Vietnam War veteran, was persuaded at an event at his senior center in December to submit a cheek swab for a DNA cancer screening. The company never sent results, he said. But it billed $32,212.86 to his Medicare supplement insurance plan. He’s worried his personal information will be misused.
“I’ve lost my identity to these people,” he said. “They got my DNA and they got my information through this scam. I’m extremely upset.”
Others may face consequences for merely engaging with scammers. In Idaho, a woman in her late 60s said she responded to an online ad for free genetic testing and got a callback 20 seconds later. She received a cheek swab kit in the mail but, suspecting a scam, never sent it in. Now, she said, she finds her phone suddenly plagued by robocalls.
In California, 1 in 4 cases reported to the state’s Senior Medicare Patrol this year for potential fraud have been related to genetic tests, according to Sandy Morales, statewide volunteer coordinator.
An employee of Whole Home Solutions left a flyer at Sherry Swan’s door. Pathway Labs handled about 20 tests sent in by Whole Home Solutions, but cut ties with the company after receiving complaints about how seniors were being solicited for the DNA tests.(Ana B. Ibarra/KHN)
Sherry Swan of Roseville, Calif., is one of many who have filed complaints. She said she was home one Sunday afternoon in early June when a man named Caleb knocked on her door, and said, “I’m here to do your DNA testing.”
“What are you talking about?” she recalled asking him. She said he failed to produce an ID when asked. “It was just a scam from the minute he opened his mouth.”
Swan said she spent five minutes arguing with the man, then called the police when he left.
“I’m aggressive. I work with homeless in the county,” said Swan, who is 64. But she said she worried about the more passive and trusting neighbors in her senior living complex. She later discovered that many had been persuaded to take the tests and divulge their family medical histories.
A man named Freddy, who answered a number on a flyer that Caleb had left at Swan’s door, said he supervised Caleb as part of a team from Whole Home Solutions. He said the operation was aboveboard because they enrolled only eligible Medicare beneficiaries, and that a teledoctor would consult with the person’s treating physician before the tests were sent in. The tests were handled by Pathway Labs in Colorado Springs, Colo.
Pathway Labs CEO Rene Perez confirmed his lab handled about 20 tests sent in by Whole Home Solutions. But he said he cut ties with the company on July 6 on the advice of his attorneys after receiving complaints about how seniors were being solicited for the DNA tests. The lab worked with the outfit for about 45 days, Perez said.
Such experiences make him “reluctant to take on new business” from similar entities sending in DNA tests, Perez said.
“We strongly advocate and believe in the benefits of genetic preventative health,” he said. “But the problem that we see right now is that it’s really picking up momentum on the national level. Unfortunately, when that happens, you get a variety of different sorts of groups that essentially may see dollar signs.”
To seniors curious about these DNA tests, Richmond of the inspector general’s office has this advice: “If anyone calls you, or sends you an unsolicited request for your Medicare number or to convince you or scare you into taking a genetic test, either hang up the phone or say no.”
Seniors interested in the tests should call their primary care provider, he said: “Don’t give into the manipulation or the scare tactics to get this health care test from someone you don’t know.”
If you suspect Medicare fraud, contact the OIG Hotline online or at 1-800-HHS-TIPS.
[Correction: A previous version of this story incorrectly stated the terms of a bankruptcy case involving Millennium Health; as part of its case, the firm paid a government settlement in response to accusations that it billed Medicare for unnecessary tests.]
Tips for Older Consumers to Stop Illegal Robocalls
Tip Sheet • July 2019
Jeremiah Battle, National Consumer Law Center
Robocalls, the persistent automated telephone calls to cell phones and landlines, are a favorite tool of telemarketers, debt collectors, and scammers. Older adults anticipating important calls from medical providers and others may be reluctant to answer the phone due to excessive or unwanted telephone calls. There is no completely effective method to stop unwanted robocalls, and real solutions require that the Federal Communications Commission use the laws effectively to regulate robocallers and require phone companies to authenticate all calls. Yet, the following tips can help consumers take some control:
1. File complaints with the Federal Communications Commission (FCC): Complaint data is the best tool federal agencies have to gauge the extent of the robocall epidemic. While filing a complaint may not prompt an immediate response, complaint data may prompt the FCC to take action. The Telephone Consumer Protection Act (TCPA) is the only legal defense to robocalls and texts made without your consent, and the FCC is tasked with upholding and strengthening the TCPA’s rules and regulations. File a complaint here.
2. Add your number to the Do-Not-Call List: While the Do-Not-Call list does not stop all robocalls, it is a valuable resource for removing your number from the call lists of companies that do not want to violate the law. Sources of robocalls that you do business with, such as banks or loan servicers, and sources of scam calls that ignore the law, will still get through. Add your number here.
3. Revoke consent: If you are receiving robocalls from a bank, lender, or other company you do business with, they likely have your consent (hidden in the fine print) to robocall you. While they like having the option to robocall, it isn’t their right, and you can revoke your consent at any time. Tell the caller you “revoke consent.” If the calls continue, contact customer service and tell them that you do not consent to receive calls and that you want your number to be added to their “do not call” list. This won’t stop illegal scam calls but it will reduce the volume of robocalls you receive.
4. Don’t engage with the caller: Most autodialed robocalls include a prompt to press a key or give a voice command. DON’T! Pressing a key, even if the recording says it’s to remove your number from the list, tells the caller that your number is active and that you’ll likely answer future calls. Even worse, the voice commands can be recorded and used against you by scammers to represent consent to purchase products or services.
5. If possible, block or do not answer calls from unknown numbers on your mobile device: Easier said than done, taking this action will help avoid robocalls. But important calls can come from unknown numbers and most landline phones don’t have call-blocking features. Plus, listening to voicemails left by robocallers can be just as annoying, and costly (if you purchase phone service by the minute), so use this method as a last resort.
6. Install call-blocking apps: Various call-blocking apps, like YouMail and NoMoRobo, provide a free or low-cost service to mobile smart phone users that filter out identified scam robocalls and allow users to block specific numbers and report the calls. However, typically these apps don’t help landline users.
7. Let them know they are calling you at a nursing home or other medical facility: The TCPA prohibits robocalls to a patient or guest room at a nursing home, hospital, or similar health facility.
8. Find out what type of debt collector is calling: Collectors can call about debts owed or guaranteed by the federal government without your consent. There are exceptions to this rule in some states. In those states, robocalls to cell phones from debt collectors collecting federal debt can only be made with consent, as is the rule for all other robocalls to cell phones.
9. Sue the caller: A lawsuit can be challenging, but the TCPA allows consumers to file a lawsuit to stop the robocalls. If successful, the consumer can receive money, either actual damages or $500 per violation, whichever is greater. The damages can be tripled for knowing or willful violations.
This Tip Sheet accompanies NCLER’s webcast and Chapter Summary on Protecting Older Adults Against Abusive Telemarketing Scams. You can also find more information at the National Consumer Law Center’s Robocalls and Telemarketing page.
Case consultation assistance is available for attorneys and professionals seeking more information to help older adults. Contact NCLER at ConsultNCLER@acl.hhs.gov
A 'catastrophic' trend in Maine: A shortage of caregivers
Jeff Stein, The Washington Post
Published 9:32 pm EDT, Wednesday, August 14, 2019
Flaherty's mother, Caroline, has for two years qualified for in-home care paid for by the state's Medicaid program. But the agency could not find someone to hire amid a severe shortage of workers that has crippled facilities for seniors across the state.
With private help now bid up to $50 an hour, Janet and her two sisters have been forced to do what millions of families in a rapidly aging America have done: take up second, unpaid jobs caring full time for their mother.
"We do not know what to do. We do not know where to go. We are in such dire need of help," said Flaherty, an insurance saleswoman.
Across Maine, families like the Flahertys are being hammered by two slow-moving demographic forces - the growth of the retirement population and a simultaneous decline in young workers - that have been exacerbated by a national worker shortage pushing up the cost of labor. The unemployment rate in Maine is 3.2 percent, below the national average of 3.7 percent.
The disconnect between Maine's aging population and its need for young workers to care for that population is expected to be mirrored in states throughout the country over the coming decade, demographic experts say. And that's especially true in states with populations with fewer immigrants, who are disproportionately represented in many occupations serving the elderly, statistics show.
"We have added an entire generation since we first put the safety net in place but with no plan whatsoever for how to support them," said Ai-jen Poo, co-director of Caring Across Generations, which advocates for long-term care. "As the oldest state, Maine is the tip of the spear - but it foreshadows what is to come for the entire country."
Last year, Maine crossed a crucial aging milestone: A fifth of its population is older than 65, which meets the definition of "super-aged," according to the World Bank.
By 2026, Maine will be joined by more than 15 other states, according to Fitch Ratings, including Vermont and New Hampshire, Maine's neighbors in the Northeast; Montana; Delaware; West Virginia; Wisconsin; and Pennsylvania. More than a dozen more will meet that criterion by 2030.
Across the country, the number of seniors will grow by more than 40 million, approximately doubling between 2015 and 2050, while the population older than 85 will come close to tripling.
Experts say the nation will have to refashion its workforce, overhaul its old-age programs and learn how to care for tens of millions of elderly people without ruining their families' financial lives.
The results of not doing so fast enough are already visible in Maine. At the Hibbard Nursing Home in a rural slice of the state, Beth Lagasse cried softly as her father recovered down the hallway in Room 113.
Lagasse's mother broke her back in May and died in June. Her father suffered a stroke in July. The nursing home near her has no open beds, so she drives an hour every day to care for her ailing father after spending months caring for her mother.
Lagasse has not been able to read a book, go canoeing or take care of her 1-year-old Shetland puppy, Paddy, since her mother first got sick. Lagasse, a physical education teacher, and her three siblings cannot afford the cost of 24/7 care, although Medicare temporarily covered her father's hospitalization.
"I love them. I love them dearly," Lagasse, 55, says of her parents. "I just wish this weren't so hard."
- - -
Over the past two years, Mark Honey's rare form of muscular dystrophy has proved so debilitating that he has lost control of his hands, legs and arms. Living alone in the small town of Ellsworth, Maine, Honey, 63, has for about 18 months looked for a nursing home where he can receive 24-hour care.
But with nursing homes across Maine closing at an unprecedented rate, Honey has been unsuccessful. Medicaid pays for a care aide to come to his home for 70 hours a week. But the state has told Honey it cannot find enough workers to cover the hours, even though he legally qualifies for the care.
Care workers in Maine were paid about $11.37 an hour in 2017, according to an AARP report, with a 2019 minimum wage of $11 an hour. As Kristi Penny, who has cared for Honey for four years, noted over the phone: "Even Dunkin' Donuts pays you more."
Honey said he lives in fear of one of the caretakers getting sick and quitting or finding another job. "When you're confined to a bed, there's not much you can work with," Honey said. "It only takes one or two of the girls being sick, or one of the two of them quitting, for me to not be covered. And then you're up the creek without a paddle."
With its 65-and-older population expected to grow by 55 percent by 2026, Maine needs more nurses, more home-care workers and more physicians than ever to keep pace with demand for long-term-care services.
But the rising demand for care is occurring simultaneously with a dangerously low supply of workers. About one-third of Maine's physicians are older than 60. In several rural counties in the state, close to half of the registered nurses are 55 or older and expected to retire or cut back their hours within a decade.
Maine's largest long-term-care provider, North Country Associates, has been forced to temporarily close admissions in each of its 26 nursing homes because of staffing shortages, sometimes for as long as several months, in an unprecedented change from a few years ago.
It has also permanently shut down two of its nursing homes over the past year, while about a dozen nursing homes across the state have closed their doors over the past several years. Mary Jane Richards, chief operating officer at North Country Associates, said she has already raised wages four or five times in a bid to hire or retain staff.
"There are simply just not enough people to go around," she said. "We try to elevate our wages, but then the nearest facility brings theirs up."
Betsy Sawyer-Manter, president of the SeniorsPlus agency responsible for placing care workers with Medicaid enrollees, said she was not surprised by Flaherty's story of failing to find a worker for her mother, despite qualifying for care. Sawyer-Manter said that every week her agency cannot fill more than 6,000 hours of direct care that have been authorized by the state because of worker shortages.
"If there aren't any workers in that area, there's nothing we can do," Sawyer-Manter said. "As people retire, we just don't have enough workers to do all the jobs we need done."
- - -
From 2015 to 2050, the number of Americans 85 and older will increase by more than 200 percent, while those ages 75 to 84 will rise by more than 100 percent, according to AARP. By contrast, the number of Americans younger than 65 will increase by about 12 percent.
America's federal programs have not kept pace with this enormous demographic shift. With a few minor exceptions, Medicare does not pay for long-term-care services. Medicaid offers limited benefits but is available only to the very poor. The private market also has not been able to fill the void, as 7 percent of costs in the long-term-care market are covered by private long-term insurers.
"The U.S. is just starting this journey, and Maine is at the leading edge," said Jess Maurer, executive director of the Maine Council on Aging. "As we are living longer, all the systems that have always worked for us may have to be changed."
Congress created a commission to study the long-term-care problem. In 2013, it issued dozens of recommendations, including a "national strategy" to help family caregivers, but "a fair number of these things have not been implemented. Those that have been implemented are being implemented far too slowly," said Bruce Chernof, co-author of the commission's report and president and chief executive of the SCAN Foundation, which advocates on long-term-care issues.
"Left unaddressed, this will be catastrophic. We as a country have not wrapped our heads around what it's going to take to pay for long-term care," Chernof said.
Other countries have responded to their aging populations with government-provided care, and many have beefed up the number of aides and providers. America and England are the only economically developed nations in the West that do not provide a universal long-term-care benefit, said Howard Gleckman, author of a book about long-term care and a senior fellow at the Urban Institute, a nonpartisan think tank.
"With climate change, towns get burned down, or people die in fires," which helps focus national attention, Gleckman said. "This is one family at a time suffering in silence."
- - -
Albert Rose sits on the wharf of his seafood business and fumes that he cannot find help with his daily work of moving and unloading 50 crates of lobster, each often more than 100 pounds. In Harpswell, median age 57, he lives in the oldest town of America's oldest state.
Rose, 40, has suffered from two torn rotator cuffs and a herniated disk but continues to perform the heavy labor himself in part because he has for the past five years been unable to find young workers, absent sporadic help from college students during their summer vacations.
"Ten years ago, every spring you had young people wanting work on the wharf or want to work on a lobster boat," Rose said. "I haven't seen a single person this spring or summer looking for boatwork."
Maine's aging population, and its dearth of young workers, falls particularly hard on poorer businesses and parts of the state that do not have enough resources to compete amid the shortfall.
Piscataquis County, a region in the north battered by the closure of its lumber mills, will see the number of people ages 75 to 84 increase by 81 percent from 2015 to 2025, according to the Muskie School of Public Service at the University of Southern Maine.
The biggest impact likely is in health care for the elderly.
There are 34 physicians in the county, about 70 percent less than the state average per person, and fewer available nursing home beds per person, according to a Maine Health Access Foundation report. Half the physicians in the county are older than 50, as are half the nurses.
Stepping into the breach is Pine Tree Hospice, one of the few dozen volunteer hospices in the United States. The hospice's volunteers do not provide medical services, but they go to the homes of patients in end-of-life care, cooking, cleaning or playing a game of cribbage. About one-quarter of the volunteers are themselves in their 70s. They like reciting the hospice's motto: "We can't add years to your life, but we can add life to your years."
When Jane Stitham began as the executive director of the hospice about a decade ago, she urged as many elderly people as possible to call for free end-of-life care. But over the past two years, Stitham said, the hospice has shifted its focus to recruiting new volunteers, as its waiting list has grown dramatically. Every month, Stitham has to turn away one to two people whom the hospice cannot reach.
"There are far too few younger people in the mix of volunteers," said Meg Callaway, who ran a program in the county focused on helping older people.
Cliff Singer, who runs an Alzheimer's clinic in an isolated northern region of the state, said his waiting list has more than doubled to 70 people, meaning it takes 10 months for patients to see him. Singer is trying to hire nine nurses, which would allow him to cut his waiting list dramatically, but he only has three, in part because of fierce competition from other hospitals and clinicians.
"It feels awful not to be able to help more people," Singer said. "But we really can't."
Aging In Place Programs That Really Work
Richard Eisenberg Contributor
Aging in place is an appealing idea to many of us: the ability to continue living in the homes we cherish as we age into our 70s, 80s and 90s, rather than move. There are just two problems: many homes aren’t designed for health issues that can come with getting older and aging in place alone can be lonely. Have I got some ideas for you. Four, actually.
They’re the three winners and one honorable mention of the Innovation@Home contest for smart, effective age-friendly housing practices around the world. (The National Association of Area Agencies on Aging also recently honored 48 programs that help older adults age in place, with its 2019 Aging Achievement and Innovations Awards.)
The Innovation@Home competition was conducted jointly by Grantmakers in Aging (a group for philanthropies who aim to improve the experience of aging) and the World Health Organization Global Network for Age-Friendly Cities and Communities. It was funded by the Robert Wood Johnson Foundation.
Also on Forbes:
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Share: House Zero: The Smart House Of The FutureProfessor Ali Malkawi is leading the charge in creating a smart house that can regulate energy use and efficiency by using hundreds of sensors that control the windows, air flow, and CO2 levels. Welcome to the future.FacebookLinkedInPinterestTumblrTwitter
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Today In: Money The Innovation@Home Competition
The idea: to find the best age-friendly housing innovations that could be implemented around the U.S. Clearly, there’s a huge interest — the Innovation@Home report was downloaded 1,200 times the first two weeks after it was released.
When the judges selected among aging in place entries from 15 countries, two winners came from Europe — the Home Refurbishment Program of Barcelona, Spain and the Aconchego home-matching program in Porto, Portugal. One winner, the No-Cost Building Permits program of Sausalito, Calif., and the honorable mention , CHORE Volunteer Handyman Service of Bergen County, N.J. are in the United States.“People don’t want to be forced to go to someplace they’ve never lived in their life,” said John Feather, CEO of Grantmakers in Aging (and a 2016 Next Avenue Influencer in Aging). “And a lot of programs we saw emphasize that.”
Feather said he believes aging in place in the United States is developing rapidly around the world but added that “there’s still very far to go.” One reason: “Practically none of the people who do zoning have training in aspects of aging,” Feather said. “And traditionally, aging services agencies have not developed a willingness to talk to them on a systematic basis.”
Susan Mende, senior program officer at the Robert Wood Johnson Foundation, said the competition’s judges were “looking for approaches and programs that could be adapted and replicated somewhere else. The question they asked was: ‘Is this a one-off or can it go to scale?’”
Here’s a bit about the three Innovation@Home winners and the honorable mention:
Winner: No-Cost/Low-Cost Building Permit Program of Sausalito, Calif.
Sausalito is a gorgeous, quaint seaside community just over the Golden Gate Bridge from San Francisco; 34% of its residents are over 60. But since many Sausalito homes are multi-level and built on a steep hillside, they can be difficult for older inhabitants and can lead to falls.
So, Age Friendly Sausalito, a volunteer group of older residents, worked with municipal officials, to create The Age-Friendly Home Adaptation Grant program in 2018. It lets Sausalito homeowners age 60 and older (or younger ones with a disability) get free or reduced-cost building permits for projects of up to $10,000 to improve the safety and accessibility of their residences. The program has been so successful, all California cities and counties can now waive building permit fees for this purpose.
“For a $2,400 construction job putting in a ramp or a chairlift, you might save $800,” said Sybil Boutilier, chair of Age Friendly Sausalito. “One person said, ‘I was thinking I would have to leave. There are so many entry stairs in my home. I was able to put in a ramp and handrail and make my bathroom more accessible. It really made a huge difference.’”
Winner: Aconchego Home-Matching Program of Porto, Portugal
This program in the university town of Porto matches residents age 60 and older who have extra room in their homes with students ages 18 to 35 who need a place to live. The older people get
companionship; the students get free housing. Nearly 400 people have participated in the Aconchego Program since it was launched by Porto City Hall and the Academic Federation of Porto in 2004.
“Social isolation and loneliness is a very big issue for many older people around the world, including in the U.S., and it’s tied to ill health,” said Mende. “At the same time, housing can be expensive in university towns. Lots of students in Porto had trouble finding places they could afford.”
An added bonus: the Aconchego program helps prevent older people from spending time only with older people and younger ones from spending time only with younger ones.
Winner: Home Refurbishment Program of Barcelona, Spain
Here, the most vulnerable people age 65 and older in the Barcelona region (other than the city of Barcelona itself) can get non-structural home repairs, mostly in bathrooms and kitchens.
The Home Refurbishment Program, run by La Diputació de Barcelona, also improves home energy efficiency and provides technology like assistive devices to help residents have greater independence and a better quality of life.
The Barcelona County Council coordinates and finances projects and works with a private firm to manage the construction. Roughly 10,500 people have been helped since the program began in 2009.
“Sometimes, it’s just a question of getting someone in to fix that broken step or that cracked tile or that broken light that a person can’t reach,” said Mende. “That can make a big difference to being safe at home.”
Honorable Mention: CHORE Volunteer Handyman Service of Bergen County, N.J.
Bergen Volunteers’ CHORE helps residents age 60 and older in the 70-municipality northern New Jersey county (as well as people with disabilities) live safely in their homes by performing minor home repairs.
What’s more, most of the crew volunteers in this 42-year-old program are retirees. Some are skilled and a lot “are home tinkerers” said Lynne Algrant, CEO of Bergen Volunteers.
“There is something about seniors helping seniors that is very special about this program,” noted Algrant. “There’s a really charming sensitivity on the part of the volunteers about making a visit and puttering around and asking how folks are.”
CHORE charges clients for parts, if the residents can afford it, but not for labor.
“We’ve done a couple of thousand grab bars,” to help people maintain balance and grab onto in case of a fall, noted Michelle Ogden, CHORE’s director. “We can change light bulbs. We also do banisters and light electrical work and light plumbing work. It’s really a relief for seniors to get a service call. An electrician or plumber is outrageously expensive.”
CHORE estimates clients save an average of $500 by using the service.
Kimberly Malone, director of Bergen Volunteers, recalls a client who said CHORE had been coming to her home for 20 years. The woman said, “My children sometimes want me to transition [to another place], but this is my community, and this is what I know,” noted Malone.
Richard Eisenberg I'm the Senior Web Editor of the Money & Security and Work & Purpose channels for Next Avenue, a new site for people 50+ from PBS. I have helped people manage th...
When patients with dementia become combative, there’s often nowhere to go but a state psych ward
By MARIE ALBIGES
AUG 14, 2019 | 2:17 PM
Cindy Piccirilli was out of options.
The Chesapeake assisted living facility where her spouse, 57-year-old Catherine Wright, had been living for nearly three months could no longer handle her violent outbursts and aggressive demeanor.
Wright, whose cognition had been steadily declining since she was diagnosed with early-onset Alzheimer's disease five years earlier, periodically had what Piccirilli called violent, random episodes — she would hit other residents and staff, and push and throw furniture around.
The former Virginia Beach public school teacher was younger than most residents in the memory care unit, and more able-bodied. It often took four staff members to bathe her.
When Wright became aggressive, staff at the assisted living facility, Commonwealth Senior Living at Georgian Manor, said Wright needed to go to a psychiatric facility, where her medications would be adjusted to deal with her dementia symptoms.
So one day in March 2018 after Wright had a particularly difficult weekend, Piccirilli finally agreed, hoping someone at a psych facility would figure out what was triggering the aggressive behavior and find a way to calm Wright down.
Piccirilli didn't realize it would end with her wife — who she described as usually calm and mild mannered — strapped to a gurney with her wrists chained to her ankles, screaming and crying, "You're hurting me!" as law-enforcement officers wheeled her out of a hospital emergency room and into a medical transport vehicle that would take her to a state psychiatric hospital 70 miles away, where she would develop a bowel infection and never walk again.
Health officials and experts agree this never should've happened. They acknowledge a state psychiatric hospital like Eastern State in Williamsburg wasn't the appropriate place for people like Wright, who become combative as a result of their dementia.
But a state law allows Wright and countless others living with dementia to be placed into involuntary hospitalization if they are in a psychiatric crisis and are deemed a threat to themselves or others.
Called a temporary detention order, or TDO, it's normally reserved for mentally ill individuals, but it's being used on people like Wright because there simply isn't anywhere else for them to go in Virginia for treatment.
There are a few factors that contribute to people like Wright ending up in state psychiatric hospitals, said John Oliver, who worked in the Chesapeake city attorney's office for 31 years and now represents people held under involuntary commitments.
First, there's an increasing number of people with behavioral and mental health issues that need medical attention, and a growing number of people with dementia.
According to the Alzheimer's Association, by 2025, more than 190,000 Virginians who are at least 65 years old will have some form of Alzheimer's.
And an estimated 200,000 people already have early-onset Alzheimer's, which can often affect people who are younger than 65.
Second, there's a limited number of facilities that are set up to manage the challenges of dementia, including the aggressive behavior, which can happen when a patient has a medical issue — like a urinary tract infection — but can't articulate it.
There aren't a lot of options for private inpatient hospitalization or crisis stabilization services close to home.
Third, there's a staffing shortfall. It's hard to retain people to work in those environments for low pay, and hard to find people properly trained to handle aggressive patients, Oliver said.
"When you reach that kind of situation, the state psychiatric hospitals are the backstop and they end up with these patients, ready or not," he said.
Ready or not, because state psychiatric hospitals aren't equipped to treat complex physical illnesses — they often lack oxygen tanks or supplies for ulcers — and don't have enough beds to treat everyone coming through the doors.
Virginia's "bed of last resort" law — passed in 2014 following the suicide of State Sen. Creigh Deeds' son after a psychiatric bed wasn't available for him — says the state psychiatric hospitals have to admit patients in a mental health crisis if no private facility will take them.
Since that law was implemented, state hospital TDO admissions have risen by 294%, and many of the hospitals are at or near capacity.
Private hospitals aren't required to admit those patients, and many of their beds are taken by an increasing number of people voluntarily committing themselves for psychiatric treatment.
State hospitals were traditionally designed for mentally ill patients who were having trouble getting their illness under control and were typically admitted for longer. But now, many of the TDO patients stay less than a week, according to the Department of Behavioral Health and Developmental Services.
Dr. Daniel Herr, the department's deputy commissioner for facility services, estimates 38% to 40% of people admitted to state psychiatric hospitals under a TDO require specialized care beyond mental health treatment.
Rick Jackson, a member of the state's Alzheimer's Disease and Related Disorder Commission, said there's been a debate happening for years in Virginia around the best place for someone with dementia whose behavior puts themselves or others at risk.
"We as a society have been struggling with this for decades," said Jackson, who's the executive director of the Riverside Center for Excellence in Aging and Lifelong Health.
Some, he said, argue the state should be responsible for their care. Others say that task should be handled by community-based for-profit and nonprofit facilities like nursing homes and assisted living facilities with memory care units.
But assisted living facilities have to balance caring for those with behavioral issues with protecting their other clients, Jackson said.
Often, like in Wright's case, the combative patients are sent to the emergency room, where doctors can try to treat the short-term issue causing the behavior — if they can identify it.
If they can't, and the assisted living facility is reluctant to take them back, the only other option is usually a state psychiatric hospital, Jackson said.
Cindy Piccirilli stands with her wife, Catherine Wright, in their home Thursday afternoon May 16, 2019. Wright has early-onset Alzheimer's and after an outburst at an assisted living facility was issued a temporary detention order. (Jonathon Gruenke)
Cindy Piccirilli reflects while discussing her wife, Catherine Wright, Thursday afternoon May 16, 2019. Wright has early-onset Alzheimer's and after an outburst at an assisted living facility was issued a temporary detention order. (Jonathon Gruenke)Wright moved into the memory care unit at Georgian Manor on Jan. 9, 2018, and over the next 10 weeks, staff struggled to bathe and feed her.
"Very combative when we changed her. It took four staffs to change her," read one entry in Wright's medical chart, a copy of which Piccirilli provided to The Virginian-Pilot. "She really fights. All four staff helped together to changed (sic) her," another entry states.
In the 10 weeks she lived at Georgian Manor, staff recorded at least 11 instances where Wright was labeled as "combative" or attacking staff members who tried to change her. Piccirillli said she noticed bruises on Wright's arms from where she suspected staff members gripped her to bathe her.
She also didn't eat much, Piccirilli said. Even though she was paying for three meals a day, she mostly ate chocolate nutritional drinks. By the end of her stay, Piccirilli said Wright had lost 30 pounds.
On that March day, she was originally sent to Chesapeake Regional Medical Center for medical clearance before being voluntarily admitted — through Piccirilli's medical power of attorney — to The Pavilion at Williamsburg Place, a private inpatient psychiatric facility.
Nearly 18 hours into their stay at Chesapeake Regional, with the medical evaluation done, the Pavilion said it could no longer accept Wright as a patient.
Mike Post, Pavilion's CEO, would not discuss Wright's case but said there are several reasons why the facility would turn someone away. It could be full; it could lack the resources to treat a medically complex patient, like someone who has cancer or needs dialysis; or the patient doesn't fit the population the Pavilion serves — for example, it doesn't admit children under 18.
In Wright's case, her medical records show she wasn't admitted because there appeared to be something wrong with her EKG.
So, like so many others in her situation, her next stop was Eastern State Hospital on a TDO.
TDOs, signed by a magistrate, involuntarily commit people experiencing a mental health crisis who might harm themselves or others to a hospital for up to 72 hours. After that, a judge can order further treatment if it's still needed.
More than 25,500 TDOs were issued in fiscal 2018 according to the state behavioral health department. The region that includes Hampton Roads had the second-highest number after Southwest Virginia.
That day in the ER was the first time Piccirilli — herself a retired Navy neurosurgeon — had ever heard the term temporary detention order.
She didn't know it involved a social worker calling around to different hospitals to see if they could admit her wife. She didn't understand why, after the eight-hour limit to find a bed mandated by state law, the only option was Eastern State Hospital, a place she'd been told by Chesapeake Regional staff to avoid if possible.
Piccirilli wasn't told a TDO meant armed officers would show up and take her wife to Eastern State in handcuffs, even though she said Wright was medicated and calm at that point.
And she didn't understand why her medical power of attorney — which she and Wright had obtained before Wright's cognitive decline — was powerless to stop it.
Patients under a TDO are usually taken to the psych facility in a police car, though a new state alternative transportation program is trying to make that less common. Wright couldn't get out of bed, so a medical transport vehicle was called, and Piccirilli followed it and a police car up Interstate 64 to Williamsburg in the middle of the night.
"Catherine was a frightened child, being arrested and chained," Piccirilli said.
Similar ordeals are happening more frequently in Virginia, Herr said in a phone interview.
In fiscal 2013, 16 people with a primary diagnosis of dementia were admitted to the state's psychiatric hospitals under a TDO, according to the state behavioral health department. By this year, that number had risen to 115.
The state code section around TDOs doesn't have any exceptions for people with dementia who are experiencing behavioral changes because of underlying medical issues.
In Wright's case, that issue was extreme constipation. At Chesapeake Regional, a test showed no medicine in her system, despite what had been prescribed to her at Georgian Manor.
And a week into her stay at Eastern State, she developed bed sores and a fever and was taken to Sentara Williamsburg Regional Medical Center, where doctors discovered a bowel infection.
But the state code is clear — if a person is in a crisis and is deemed a threat to themselves or others, the only place for them is at a psychiatric hospital. And often that means handcuffs and a police car.
Someone with a chronic condition like dementia needs different treatment than a person in the midst of a psychiatric crisis. But in the eyes of the law, Herr said, they both meet the definition of someone who should be temporarily detained.
Larry Fitch, a professor of mental health law at the University of Maryland law school, studies involuntary commitment proceedings and said situations like Wright's happen all over the country.
He said some states have found ways to prevent people with dementia from being involuntarily committed.
In Wisconsin, the state Supreme Court ruled in 2012 that someone suffering exclusively from Alzheimer's disease couldn't be subject to Wisconsin's version of a TDO. Instead, they are appointed a guardian ad litem, who can place them somewhere other than a psychiatric facility.
In Kansas, the state Department of Aging and Disability Services and the Alzheimer's Association partnered to create the Kansas Dementia Bridge Project, which provides crisis support to dementia patients and tries to avoid hospitalization at all costs. Coordinators work with families to provide direct support, counseling, and advocacy in crisis situations at home, the hospital, at the doctor's office or during transitions to facilities.
Researchers found the Bridge Project significantly reduced patient anxiety, depression, resistance to care, impulsive behavior, verbal outbursts and wandering. Patients also were hospitalized less frequently, and people living at home were able to hold off on being placed in nursing homes.
In Virginia, a state-mandated work group consisting of mental health advocates, the private hospital system, law enforcement and state health officials wants to tackle one part of the temporary detention order cycle: reducing the number of people admitted involuntarily to the state's psychiatric hospitals, as Wright was.
Members are considering extending the eight-hour window Community Services Board workers have to evaluate the patient and find them a bed in a psychiatric facility. That could be key, because finding a facility that's also equipped to address the patient's physical issues often takes longer.
And if the time window is extended, a follow-up assessment could lead to a CSB worker deciding a TDO isn't necessary and placing them in a more appropriate setting, like a geropsychiatric facility.
The problem remains, however, that more appropriate settings are pretty slim, Herr said.
"Virginia doesn't have that in any consistent kind of way," he said.
Piccirilli still can't believe Wright's experience under a TDO was legal.
"The state treated her worse than a dog, and like a common criminal, because she has dementia," she said. "It was immoral, it was medically inappropriate —- they hurt her — and it was so inhumane."
After safely returning Wright home — she didn't want to bring her back to Georgian Manor — and hiring 24-hour help, Piccirilli finally had some time to think.
She wrote a letter to Commonwealth Senior Living, and the state department that regulates assisted living facilities. The department sent an inspector to investigate the claims, and found instances where medications weren't being administered according to physician's instructions, according to the Department of Social Services inspection report.
The inspector also found the facility "failed to ensure" that it not admit or retain clients "presenting an imminent physical threat or danger to self or others."
Bernie Cavis, who oversees residence programs at five Commonwealth Senior Living facilities in Hampton Roads including Georgian Manor, said the facility thoroughly assesses each potential new resident to determine their needs and appropriate level of care.
But sometimes, especially if the resident becomes violent, her staff doesn't have the capacity to restrain them and aren't able to safely calm them down, so hospitalization is inevitable.
"It's a process we avoid at all costs," she said.
Piccirilli drafted a letter to Gov. Ralph Northam — a pediatric neurologist — but never sent it. She read it over it once, and realized it was filled with raw emotion.
She spoke with a former Virginian-Pilot reporter who wrote about a case similar to Wright's four years ago.
She commiserated with another caregiver who wrote about her experience losing her husband to early-onset Alzheimer's.
More than a year later, she's still grappling with who to hold accountable, and what to tell her elected representatives. She wants to write to members of Virginia's congressional delegation and Deeds, the state senator whose son died.
"I don't know why the legislature keeps lumping dementia with psychiatric illness," she said.
She wants to see staffing standards put in place at assisted living facilities. She wants to see a facility that can give individualized care to people living with dementia, with physicians available to detect and treat underlying symptoms that cause aggressive behavior.
Six years into being officially diagnosed, Wright needs less intensive care as her condition has worsened. She sleeps more, and when the aides aren't there, Piccirilli sits with her, occasionally listening to the Carpenters.
Piccirilli often thinks about what Wright would've wanted if she'd hadn't gotten sick. She regrets taking Wright out of their home in Great Bridge, but the one positive outcome of the TDO ordeal was that Wright got to come home.
Now, Piccirilli's goal is to ensure her spouse has a dignified, peaceful death at home.
Correction: This article has been updated to reflect John Oliver worked for the Chesapeake city attorney's office, not the Commonwealth Attorney's office.
Marie Albiges, 757-247-4962, email@example.com
Uber Taps Lucrative Medicare Business With Logistics Deal
Bruce Japsen Senior Contributor
I write about healthcare business and policy
Uber has signed a contract with a key medical transportation company that has relationships with some of the nation’s biggest health insurers.
Uber Health, the healthcare business of the ride-sharing giant, said it is partnering with American Logistics Company in “the rideshare company’s first national collaboration with a healthcare transportation management company.” Financial terms of the partnership weren’t disclosed.
Uber’s partnership with American Logistics offers another glimpse into the expanding and lucrative opportunities for ride sharing companies including rival Lyft as well as other startups and new entrants like Ford Motor Company’s GoRide Health invest into expansion for non-emergency medical transportation services.
“The combination of Uber's vast driver-partner network and American Logistics' full-service, turnkey transportation solution delivers an unmatched level of access to millions of healthcare plan members,” Uber Health said in a statement. “Healthcare plans and organizations can now provide smarter patient pickup and drop off, scheduling, real-time GPS tracking, and messaging through one unified platform.”
To be sure, American Logistics contracts with Caremore, a unit of Anthem, the nation’s second-largest health insurance company with more than 40 million health plan members.
Anthem’s CareMore contracts with American Logistics to provide patients with transportation to their doctor’s offices and other medical appointments, which is a goal of health insurers to try to make sure their health plan enrollees are getting primary care upfront before they get sick and end up in a more expensive care setting like a hospital.
As health insurers like Anthem move away from fee-for-service medicine to value-based care and population health models that make sure patients are getting quality care in the right place and at the right time, ride-sharing companies say they can have a key role.
CareMore is an integrated delivery system that provides care to about 150,000 patients enrolled in Caremore or Anthem Medicare Advantage plans as well as Medicaid health plan subscribers depending on the state.
Medicaid patients suffer multiple chronic conditions and are known to have difficulty accessing medical care services so insurers and Medicaid programs see ride-share as a potential solution to making sure they get to their doctor’s appointments. And seniors are flocking to Medicare Advantage plans, which are increasingly covering more supplement health benefits thanks to rule changes by the Centers for Medicare & Medicaid Services.
“Transportation touches many aspects of a person’s life and reliable transportation is fundamental to healthy communities,” Dan Trigub, head of Uber Health said. “As we find more ways for Uber to help Medicare and Medicaid beneficiaries, partnerships with organizations like American Logistics are critical to our success. Uber Health along with American Logistics will reduce barriers to care for our most vulnerable populations, including the elderly and low-income patients.”
Trigub said American Logistics’ integration with Uber’s application programming interface (API) “creates a single-platform solution that, coupled with our dedicated team of healthcare professionals, will drive significant value."
For Uber, the American Logistics partnership shows a commitment to the healthcare space, Uber executives said. Landing more deals with health insurance companies and medical providers could also be a boon to Uber as the ride-sharing company is trying to boost sales and become profitable.
“Our Uber Health platform that helps improve access to healthcare organizations grew at over 400% year-on-year this quarter,” Uber CEO Dara Khosrowshahi told analysts last week during the company’s second-quarter earnings call.
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Jeff Sodoma, MPA, Esq. is a lawyer based in Virginia Beach, Virginia
Hello, there! Welcome to my blog. I will use this blog as a platform for my writing. I will write about topics in the legal world, certainly, as well as everything else under the sun, because I have many interests (and viewpoints). All views expressed in this blog, unless otherwise noted, are mine alone. One of my interests is music--my wife believes that I should go on "Beat Shazam" because I know so many songs--and I will be, from time to time, analyzing song lyrics and how they relate to the legal world.