Friday, September 28, 2012

Aging in US Prisons -- a Grim Fate

Dear GAA Friend,
Our long-term colleagues at New American Media recently published a study about "Aging and Dying in America's Prisons" that I thought would interest you.  Due to increasingly long prison sentences, inmates are growing old in prisons and often face horrifying lives. What are their human rights to care? to health? to friendship? to kindness? 
What do you think?  Please comment.   Thanks, Susanne Paul for Global Action on Aging  

Stay up to date with NAM's stories by liking us on Facebook and following us on Twitter!


Medicare Bills Jump as Billing goes Electronic

New York Times article on "Medicare Bills Rise as Records Turn Electronic," September 22, 2012

The NY Times describes how US health costs rose steeply when the federal govermnent began incentives to encourage doctors and hospitals to use electronic record-keeping of patients. Why? It appears that the electronic billing forms allowed easy access for "add-on" claims for phantom services. The result?    Medicare costs shot upward and hospitals and doctors collected $1 billion more from Medicare in 2010 than they had received five years earlier.

On September 25, Medicare announced that it will investigate this development and design ways to reduce what appears to be wholesale bilking of sick people, including many of whom are older. But can Medicare devise and enforce effective ways to insure that doctors and hospitals are billing for their actual costs? As consumers, you and I must check our bills for medical services to learn whether the medical professionals actually performed the tasks they claim. If they did not, notify Medicare.

Older persons often need and have a right to quality medical attention. But we must protect Medicare from phantom services. Have you discovered over-billing on your medical bills? If so, share your experience with Global Action on Aging and our readers.

Have a great day, Susanne Paul for Global Action on Aging

Friday, September 21, 2012

Breakthrough News for Older Persons!

Dear GAA Friend,

The countries of Latin American and the Caribbean nations may well be the champions of older persons' rights at the United Nations this fall. It is possible that diplomats may begin work during this UN Session on a binding human rights instrument on aging if proponents can secure sufficient votes among their colleagues.

What can you do to help?  Contact the National Aging Authority in your country to urge him or her to join the delegations supporting this initiative at the United Nations.  GAA will keep you informed with breaking news in the days and weeks ahead.

Today older people everywhere can have tangible hope for a human rights treaty on older people's rights across the globe.  Please write to tell Global Action on Aging readers about your intervention!

Thanks, Susanne Paul for Global Action on Aging

Tuesday, September 18, 2012

The first HIV prevention pill is now on the market.

The Food and Drug Administration approved a new drug, Truvada, on July 16, 2012. While this antiretroviral drug is not a cure for HIV/AIDS, it is meant to help lower the risk of contracting HIV. The pill is for high risk individuals, including sex workers, IV - drug users, gay and bisexual men with multiple sexual partners, uninfected people in long-term relationships with partners who have HIV/AIDS, and heterosexuals who regularly engage in risky sexual behavior.

Truvada is not new. The drug was approved in 2004 and was taken in combination with other antiretroviral drugs for treatment with HIV. Truvada combines the anti-HIV drugs Emtricitabine and Tenofovir disoproxil fumarate into one pill. The drug blocks the action of a protein that HIV needs to replicate in a person's body. The cost is around $14.000 per year. The pill is to be taken once a day, and safe sex still has to be practiced. In order to qualify for Truvada, individuals must be HIV negative and must get tested every third month. This is to assure that you are still HIV negative, otherwise you might develop a resistance to the antiviral.

The Debate
The approval of Truvada has caused contentious debates. Some public health experts argue that Truvada will foster a false sense of security among users, leading people to believe they are immune to the virus and reducing their use of condoms. To prevent this, the FDA has worked with the manufacturer, Gilead Sciences, to develop a risk evaluation and mitigation strategy that includes educational programs for health professionals who prescribe the drug. Physicians are required to talk with their patients regularly about their sexual behavior and how to take the drug in order for it to work correctly. Other health professionals have raised concerns about the possible difficulty of people remembering to take their pill every day and ask how unrealistic it might be to prescribe a daily pill to a healthy, HIV negative person. Another concern is the high cost of Truvada. People who really need it may not be able to afford it. There is no guarantee that Medicaid, Medicare, or private insurance would cover the cost of Truvada. Many of those who are at high-risk are in lower socio-economic groups. Patent laws in the US will likely block the availability of cheaper generic versions of the pill.

Don't despair; there are solutions to these obstacles.
Saying the drug is too dangerous or that people will forget to take the pill every day is paternalistic, some argue. If the drug is prescribed to a patient, the physician must make sure the patient understands that Truvada is not a miracle pill to prevent HIV. There can be no confusion about how to use the drug. If people want to protect themselves, they should have the right to do so. Besides, women in theUS and other countries remember to take birth control pills to prevent pregnancy–demonstrating taking one pill every day can be worked into a person's routine.

Governments should pay for the drug. One might ask why he or she should be responsible for someone else's health, sexual behavior or personal choices. Here is why:

HIV and AIDS are everyone's problem. There are 50.000 new infections in the United States every year. Governments and their citizens have made great progress battling HIV and AIDS. We have launched safe sex campaigns and have educated people about the epidemic, but these efforts will only do so much. Everyone knows that most people will not stop having sex! While Truvada will not end the nation's HIV/AIDS epidemic, it will decrease the rate of new infections in the US over time (and perhaps in the rest of the world too if other countries approve this preventive drug.) The HIV/AIDS crisis is not contained at present; HIV and AIDS do not discriminate. We all need to combat the spread of HIV/AIDS in order to end this epidemic.

Read the FDA's statement here:

Sanna Klemetti

New Developments at Global Action on Aging

Dear Good Friends of Global Action on Aging,

Exciting news!  GAA is adapting its communication strategy to bring you more focussed news on aging developments worldwide.

As our website has grown over the past decade, we've seen many changes that enhance the easy exchange of information.  Now our readers can find useful materials easily due to expert search engines.  You can also get translations into your languages. We are grateful for this development.

At the same time, GAA wants to encourrage more dialogue among our readers and to exchange views on the important aging topics of the day.  These include strengthening the human rights instruments of older persons through the United Nations' treaty processes, documenting older persons' health issues, particularly focussed on HIV/AIDS, addressing the challenges of weakened social protection programs across the globe, and more.

We will use our blog to send you information on these topics and more. We  cordially invite your comments.   If you want to access our website, it is available to you as a very comprehensive archive at

I am grateful for your support and interest.  All of us at GAA look forward to greater discussions and action programs among us over the next months and years. 

With good wishes, Susanne Paul for Global Action on Aging 

Global Action on Aging Report on the UN's Third Session of the OEWG, August 21-24, 2012

Better timing in 2012

Since its creation in December 2010, the UN's Open Ended Working Group on Ageing (OEWG) has met in three working sessions: two in 2011 and one in 2012. The second session in 2011 coincided with the first day of the Muslim fast, Ramadan, and reduced many Muslim member states' participation, particularly from Africa and the Middle East. In its most recent session in August 2011, few Asian member states participated. Consequently, governments, experts and NGOs discussed the human rights of older people who were absent from the table due to their religious observances.  Instead, governments whose social security and protection policies are far more developed dominated the presentations. Fortunately, in the recent 2012 session, some large international NGO’s and the UN Secretariat encouraged NGOs from poor countries to attend.  We heard Member States such as Malaysia, Togo, Sudan, Ghana and Burkina Faso on behalf of the African Union speak out at the four day discussions. The broadened participation of Member States significantly improved the debate and revealed a wide variety of perspectives on elder rights.
Moderator, Maarit Kohonen at the OEWG
Photo credit: Shuang Wang

Content of the panels

Day 1 - August 21

The first day of the third working session, August 21, opened with election of officers, adoption of the agenda and participation of NGOs. After the opening session and extending for two and half days, Member states and civil society organizations discussed the existing international framework on the human rights of older persons and identified existing gaps at the international level. The August 21 afternoon featured three expert presentations on age discrimination: Louise Richardson, Vice-President of AGE Platform Europe; Susan Ryan, The Honorable Age Discrimination Commissioner of Australia and Alejandro Morlachetti, Professor of Law in Argentina. Please click here to read panelists' biographies
Bethany Brown, Policy Director of HelpAge USA summarized highlights of the panel. "Many examples of discrimination involved discrimination in employment, from redundancies, to national policies for early retirements to promote a younger workforce, to hiring practices and advertisements. Discrimination in all sectors of life, not just employment, was also discussed: harassment, goods and services, including health insurance, travel insurance, mortgages and bank loans.
The insidious nature of age discrimination was underscored. Additionally, the panelists raised the point that if people do not realize they are being discriminated against, they will not seek justice.
With discrimination prohibitions in international law lacking an explicit reference to old age discrimination, “other status,” is the catchall phrase under with any existing instrument. The panelists outlined problems with the existing system succinctly. In its current state, the international human rights system cannot: 1. Clarify state responsibilities to prevent age discrimination; or 2. Establish suspect classes with higher scrutiny; or 3. Reaffirm the equality of older people. Prohibitions of discrimination based in the catchall other status make them discretionary rules.
As a Turkish citizen, Australia's anti-discrimination acts on race, sex, disability and age impressed me. Many member states took the floor to describe their national aging policies but very few of these policies appeared sufficiently comprehensive to inspire imitation. Based on Susan Ryan's presentation, I had the feeling that policies were actually working in Australia. She said that Australia has a free and confidential complaint commission, not a court, where older people can file complaints. If older people are not able to do so, their families, neighbors, caregivers or simply a member of the community can do it. Despite its recent creation in 2011, the commission resolved more than 50 percent of the cases satisfactorily.

Duygu Basaran, Global Action on Aging, addressing a question to the panelists 
Photo credit: Shuang Wang

Day 2 - August 22

The second day started with an expert panel on autonomy, independent living and healthcare. Panelists were Amanda McRae, Disability Rights Researcher from Human Rights Watch; Nena Georganzi, Legal and Research Officer from AGE Platform Europe; Horst Krumbach, Nursing Home Administrator from Germany. Please click here to read panelists' biographies.
Forced institutionalization, lack of support at home and healthcare limitations block older people who wish to continue living at home. Amanda McRae discussed the importance of palliative care and how it can improve the quality of life of those with incurable diseases. The World Health Organization WHO defines palliative care as "an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual."  HelpAge USA summarized the session:
 "The right to health is subject to progressive realization, but access to essential medicines is part of the minimum core content of the right to health. Fourteen essential medicines on the WHO’s essential medicines list are palliative care medicines, she noted. In spite of this, she gave examples of unnecessary government regulation of these essential medicines which impede the provision of essential medicines for treatment of pain.
An aging expert from Europe focused on autonomy, forced institutionalization, and discrimination in healthcare delivery. Home care, she emphasized, despite being the preference of many older people, is not protected by law. Violence and abuse can take place in institutional settings, or in the home. Older people may face increased risk to their right to self-determination and dignity in institutions. Their risk of forced institutionalization may also increase where family members seek to have them institutionalized for financial reasons.
In Europe, she reported, supports for home care are lacking.  Home care is often maintained by women over 55 in the “sandwich generation” taking on multiple generations of caregiving responsibility, which adds a dimension of gender discrimination to the issue of home care. While the CRPD might apply to older people with disabilities, the attribution of older people’s disabilities as the inevitability of “old age” by society and individuals alike, limits its equal protection.
In the discussion, it was noted that the misuse of neuroleptics (anti-psychotic medications) as chemical restraints are a risk of institutionalization, particularly for older women. Forced institutionalization was underscored as an area of international law with provisions for persons with disabilities, but without equal protections for older people. Further, international law articulates standards of training for those with custody of prisoners (CRPD, CAT), as well as a variety of professionals and staff working with people with disabilities."
I learned that despite a “rights charter” in Europe, older citizens face inconsistent enforcement of their right to healthcare. Although While the Charter of Fundamental Rights of the European Union guarantees rights of all people, at the national level, policies differ. For example, in Belgium, free breast cancer scan is available to women aged between 60 and 69 years old, stated Nena Georgantzi from AGE Platform Europe. Such disparity in one of the world’s wealthiest countires, points to the need for strict enforcement of any future convention aimed at elders.  A German NGO showed a five minute video of his work to engage children with nursing home residents in mutual activities. While appealing, this activity seems unlikely to change basic issues facing older persons worldwide, particularly in poor countries.
The afternoon session hosted experts to address life in dignity, social security and access to resources: Anne-Meette Kjaer Hesselager, Head of Section, Law and International, Danish Ministry of Social Affairs and Integration; Alejandro Morlachetti, Professor of Law from Argentina and Najat Mekkaoui, Member at the National Council of Human Rights of Morocco, in charge of social protection for older people. Please click here to read panelists' biographies.
In this panel presentation, member states' interests differed widely, revealing how can be different and how difficult it may be to reach a consensus at international level about protecting older people's dignity. We have a long way to go. For example, Denmark's current government is worried about funding older people’s needs. Progress policies now on the book face many threats due to a reduced population in the paid workforce.  Its representative claimed that there are too few in the workforce to support the benefts of older citizens. The Head of Section of the Danish Ministry of Social Affairs and Integration said that her grandmother, who is 82 years old, has received a pension since she was 53 years old and lives in a nursing home with a view of Sweden. Denmark now is trying to balance its budget so that  it does not have to abandon its welfare assistance for older people. Followng Ms. Kjaer Jesselager's presentation, we heard Najat Mekkaoui from Morocco say that only 16 percent of older people in her country receive a monthly pension; 83 percent of its older population is illiterate. These presentations spelled out the some of the difficulties that will exist in the negotiation process between rich and poor countries; between old and young in a society; between developed and developing nations. But clearly many NGOs believe that a common standard enforced by a human rights convention could help reduce many of the inequities that many people face simply due to their advanced age.
Day 3 - August 23
The third day of the working session continued with presentations on abuse and violence of older people. Nena Georganzi, Legal and Research Officer from AGE Platform Europe; K.R. Gangadharan from International Federation on Ageing in India; Claudia Martin, Co-Director of the Academy on Human Rights and Humanitarian Law and Bem Angwe, Executive Secretary of the National Human Rights Commission of Nigeria made up the panel. Please click here to read panelists' biographies.
Most elder abuse remains unreported. Also, no legal definition of elder abuse is currently accepted. Nena Georgantzi stated that the Toronto Declaration of Elder Abuse is based on a trust relationship. Yet, she added that under-reporting is due to lack of confidence. Older people hesitate to report abuse, because they are usually bound to live with their perpetrators. Dr. Gangadharan from India underlined the fact that having money does not guarantee an abuse-free life. He said that poor and rich older people can be subject to abuse and violence; he showed some disturbing photos of older people neglected in Indian hospitals. Dr. Gangadharan said that poverty, illiteracy and rural feminization exacerbate elder abuse. Claudia Martin focused on the unclear character of multiple legally binding documents on elder abuse. 
Helpage summarized the morning session: "There is no reference to many of these types of crime in international law, or indeed across the board in national laws. Many national laws relating to violence and abuse are limited to domestic violence with a focus on spousal abuse. And existing international definitions of violence and abuse are too narrow to capture much of the violence and abuse older people encounter from communities and strangers. In the dialogue, many Member States see this as an immediate problem, with the need for urgent action. States have a positive obligation to protect their citizens, but without clearer standards, they cannot meet this obligation."
Access to justice was the theme of the afternoon session. Panelists included Professor Claudia Martin, from the American University School of Law and Charles Sabatino, Director of American Bar Association Commission on Law and Aging. Please click here to read panelists' biographies.
Claudia Martin highlighted some gaps in the justice system such as legal capacity and guardianship rights, lack of a free form of consent in the case of long term care, compulsory institutionalization, and detention of older people (prisons and death penalty). Martin also underscored that access to justice should include prevention not only access. Charles Sabatino listed three key possible remedies: promote accessibility, ensure fairness and increase efficiency of the juridical system. There are 39 states in the United States of America that have created certificate programs to provide experience and expertise on elder law for other states. According to Sabatino, elder law should be based on three goals: autonomy, dignity and quality of life. Charles Sabatino presented a chart showing the ideal system. (You can read all the panelists' presentations by clicking here.) For example, in the US, there is one legal aide professional for every 6,000 poor elders; whereas there is one private aide for 429 private clients. Statistics reveal that there are 1,500,000 older people under guardianship in the US, but Sabatino said that the informal number is close to 3,000 000. The number of prisoners aged 65 or older increased by 63 percent between 2007 and 2010; whereas other groups increased by only 1 percent, a startling number.

A view of the NGOs listening to the panel
Photo credit: Duygu Basaran

Day 4 - August 24
The closing session featured a lineup of Member States reading their closing statements:  Burkina Faso on behalf of the African Union, the European Union, Brasil, Venezuela, Sweden, Switzerland, Argentina, Uruguay, Netherlands, US, Japan, Albania, Chile, El Salvador, Malaysia, Costa Rica, Mexico, Canada, China and a considerable number of NGOs including Global Action on Aging, Age UK, IFA, HelpAge International, New Future Foundation, and INPEA expressed their research and views about the Third working session and what they expect from the next session. 
All the information about the third session of the Open Ended Working Group on Ageing can be found at the UN's official website.
Duygu Basaran Sahin
Global Action on Aging