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He spent his final years in a low-income, seniors/disabled persons’, rent-subsidized housing project. He was all three: low-income, elderly, and disabled. And he was also alone and without family. Marginal.

His small “studio” reeked. The county provided a “caregiver” who jabbed, pushed and yelled at him. When she wasn’t with him, she was chatting with the building’s staff. While inventorying his possessions during one of his hospital stays, she was overheard to comment, “We can sell this,” possibly referring to his word-processor. When he was asked why he didn’t request a different caregiver, he responded “I’m afraid.” He was no eccentric recluse-- he wanted to be out and about. Weekends, when no building staff were on the premises, he would walk the length of the corridor, leaning on his walker.

What happens when an old person who has no family dies? Who advocates in their behalf? And who cleans up, so to speak? Friends, you say? Don’t count on it or them.  

England has been reducing the number of people receiving care, providing for only those with both very high needs and very little income. A “care bill” imposing a cap on the amount people can spend on care before the state steps in is the government's response. It raises the threshold at which means-testing will designate people to be eligible for help. To explore the question of how the “care bill” might change things, researchers at the Nuffield Trust looked to Japan, a country that combines the oldest population in the world with high levels of public debt and whose experience illustrates the consequences of retracting state support too far and relying on individual and familial support. 

Japanese policy makers are dealing with the situation by assigning it to business, viz “More elderly singles a boon to business of sorting belongings of deceased,” The Japan Times (an English-language newspaper published in Japan) March 25, 2014 issue. The business of cleaning up the personal belongings of people who have died is booming, reflecting an increase in the elderly single population. (25% of Japan’s population are elderly). However, some problematic firms threaten the reputation of the industry. No official authorization is required to start this kind of business. The industry itself has faced problems caused by some movers, home repair contractors, and industrial waste disposal firms, e.g. excessive fees, theft, and illegal dumping of personal mementos. To address the situation, an association based in Chitose, Hokkaido, established a qualification system for professionals in the business of sorting deceased persons’ possessions. Currently 5,500 persons in the industry have received the qualification for this specialization.  

In Japan, where family is important, many elderly Japanese now have no relatives. The circumstances of their deaths differ, and companies offering cleanup services receive various types of requests. “The work we do is similar to the work of moving companies, but there is a difference in terms of the strong feelings held by bereaved families,” according to 49-year old Satoru Takada, senior managing director of the Kawasaki-based company, Road. He qualified as a professional in the memento cleanup business.  

Until 2000, publicly-funded social care was nonexistent in Japan; caring for the elderly was a family responsibility. There were two main consequences of this approach. (1) Many reports of neglect and abuse of old people being looked after by family members. Caring also restricted the employment options of a growing number of Japanese women. (2) A phenomenon known as "social hospitalization.” Older people were being admitted to hospitals for long periods – not for any medical reason, but simply because they could not be looked after anywhere else.  

The response from the Japanese government was radical: long-term care insurance offering social care to those aged 65+ on the basis of needs alone. The system is part-funded by compulsory premiums for all those over the age of 40 and national and local taxation. Users are also expected to contribute a 10% co-payment towards the cost of the service.  

The result is that older people in Japan can access a range of institutional and community-based services, with few of the barriers to access which exist in England. ["Japan's solution to providing care for an ageing population," by Holly Holder (Guardian_ [London], March 27, 2014).] 

You may have seen Carolyn Jones’ reportage [March 25, 2014 San Francisco Chronicle] of a recent study, “California seniors have highest poverty rate, study finds”. It’s what journalists refer to as a human interest piece. It is accompanied by photos of and comments by well-known Berkeley senior citizen Allen Stross. Allen has served on the elective North Berkeley Senior Center Advisory Council, on the appointive Berkeley Commission on Aging, and as the Center photographer and innovator of its trip committee. 

Senior poverty levels declined in the 20th century due to Social Security and other safety-net programs, but rose again after the 2008 economic collapse, when millions of older people lost their jobs or homes, saw their savings evaporate or pensions slashed. In the Bay Area the soaring cost of living hits fixed-income seniors especially hard. Longer life spans also play a role. Some people simply outlive their savings, and spend more years enduring costly and debilitating medical care. 

Another contributing factor to the rising senior poverty rate is the decline of marriage and the scattering of families, leaving many seniors single and alone, without a partner or nearby relatives to pool earnings or share costs. Gays and lesbians, who until recently were not permitted to marry, are especially impacted. 

Single seniors have a far greater chance of living in poverty than their married counterparts, largely because they have no spousal or survivor benefits to draw from, no one with whom to share expenses. Twenty-one percent of never-married women over 65, for example, live below the poverty line, compared with 5% of married women in the same age group, according to the report. ["Single people face multiple challenges in retirement," by Chris Taylor (Reuters, April 3, 2014).] Men didn't fare much better. Over 19% of never-married men over 65 live in poverty, while 4.3% of married men do. 

In 1960, 68% of those age 15 and older were married, according to a recent report on marriage trends by the U.S. Government Accountability Office (GAO). By 2010, that figure had sunk to 54%. Meanwhile, the ranks of the divorced, widowed, and never-married have exploded to 46% of the over-15 population. 

The demographic shift has been so major that it could significantly alter the retirement landscape in the years ahead. Never-married Americans, in particular, may lack such safety nets as relying on a spouse's income, inheriting his or her assets, or receiving survivor benefits from a spouse's pension or Social Security. 

The U.S. Senate's Special Committee on Aging opened a hearing in March, looking into the plight of seniors living in poverty. Senators also are looking at a bill that would raise the amount of money a senior can keep - from $2,000 to $10,000 - before qualifying for certain benefits. 

The situation is particularly dire in California, due to the high cost of health care and housing. About 20% of California's seniors - compared to 15% nationally - live below the poverty threshold when taking health care expenses into account, according to the Kaiser Foundation study. 

Allen Stross, for example, receives less than half the amount required for seniors to cover basic expenses in Alameda County, according to the Elder Economic Security Index, which looks at rent, food, transportation, health care and miscellaneous expenses. He and his wife receive Social Security and small pensions, totaling $1,700 a month, but their rent is nearly $1,000 a month and they spend well over $1,000 annually on medications. 

He started working at age 13. Now, at 90, he and his spouse live on about $21,000 a year. After they pay for rent and medications, they're left with just $416 a month. "No restaurants. No movies. No new clothes. We look for a lot of freebies," he said. "But I try not to worry about things I can't control, such as the past or the future. My wife's a Buddhist. That helps." Hyshka is a retired art teacher, and she too frequents the North Berkeley Senior Center. 

I wonder why Allen Stross doesn’t have taxi scrip, which is free for Berkeley seniors. The photos show him taking the AC bus. A $3.00 donation is “suggested” for seniors 60 and older who lunch at the senior center. “Persons under 60 can enjoy a meal for a fee of $5.” Not all seniors find the lunches enjoyable. Women especially, contend they can provide an in-house lunch for less. I have even heard from some who can manage a meatless dinner. 

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NEWS 

Two Florida doctors who received the nation’s highest Medicare reimbursements in 2012 are both major contributors to Democratic Party causes. The pattern of large Medicare payments and six-figure political donations shows up among doctors whose payment records have been released for the first time by the Department of Health and Human Services. (For years, the department refused to make the data public, and finally did so after being sued by The Wall Street Journal.) Topping the list is Dr. Salomon E. Melgen, 59, a North Palm Beach ophthalmologist, who received $21 million in Medicare reimbursements in 2012. ["Political Ties of Top Billers for Medicare," by Frances Robles and Eric Lipton (New York Times, April 10, 2014).]  

Doctors who have been charged with Medicare fraud over the last 16 months were paid $17 million of taxpayer money in 2012, according to an analysis by The Hill (considered by many hotshots a top U.S. political website, read by the White House and more lawmakers than any other site http://thehill.com/). A majority of these Medicare reimbursements went to Detroit-area Dr. Farid Fata, who took home $10 million+ from Medicare in 2012.  

A New York surgeon, Syed Ahmed, was reimbursed “only” $2.4 million by Medicare in 2012 although he billed Medicare for nearly $27 million and stands accused of $85 million in fraudulent billing over a three-year period. ["Medicare millions flowed to doctors charged with fraud," by Jonathan Easley and Elise Viebeck (Hill [Washington, DC], blog, April 9, 2014).] 

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