Citing state laws, assisted living facilities often turn away residents in wheelchairs. A lawsuit in New York seeks to end the practice.
People often ask me where an article of mine came from, and my answer, quite frequently, is “How much time do you have?”
“The Woody Allen Reboot You Won’t See at the Oscars (or Maybe Anywhere),” about a remake of “Annie Hall” with a cast from a Manhattan senior center, began more than 700 miles from New York City, at Indiana University, where Matt Starr took a class about New York’s downtown avant-garde art world.
“It changed my life,” Mr. Starr, now 29 and living in New York, said.
Among the artists covered in the class was the filmmaker Jonas Mekas, whose movies struck a chord with Mr. Starr: “Jonas is just a living legend,” he said.
Mr. Mekas, 95, is also one of six older New Yorkers whom I started following three years ago for a New York Times series called “85 and Up,” and, more recently, a book drawn from the series, “Happiness Is a Choice You Make: Lessons From a Year Among the Oldest Old.” The presence of Mr. Mekas drew Mr. Starr to the series.
Sometimes I think Jonas Mekas is my connection to half the world.
In early January, after the latest installment in the series, “Want to Be Happy? Think Like an Old Person,” in which I wrote about the joys of spending time with older people, Mr. Starr contacted me on Facebook. He and his directing partner, Ellie Sachs, 25, had just finished making “My Annie Hall,” starring a 94-year-old man, Harry Miller, in the Woody Allen role, and Shula Chernick, 73, as Annie Hall.
We were telling the same story in different media.
“Annie Hall” had been one of my favorite movies, but I was more drawn by the generational drama playing out among the new film’s principals. Mr. Starr and Ms. Sachs and their artist friends were struggling to get by in a city that was increasingly unwelcoming to young people and artists. Mr. Miller and Ms. Chernick and their friends from the senior center, by contrast, were bouncing between art openings and lectures and free movies at the center, returning at night to Upper East Side apartments for which many paid anachronistically low — and frozen — rents.
“They’re all dating and having a great time,” Mr. Starr said. “We have bills to pay, it’s New York, and we’re either doing what we like and not making enough money to live a comfortable life, or we’re doing what we hate and making enough money, and not happy.” Plus, he told Ms. Chernick, “You’re much more active than our friends.”
Mr. Miller, who is not dating, said he had never been happier.
Sociologists call this the “paradox of aging,” citing research that shows older people are more content and less stressed than teenagers or young adults.
“There is a life satisfaction that sets in with older adults, but 20-year-olds are the most tortured generational group we know,” said Jessica Balboni, who runs the senior center where the gang all met. “Not just for the living conditions, but developmentally — who am I, what’s my identity, who am I going to become?”
Ms. Chernick sympathized with the young directors. “We had challenges coming up, but I don’t think life was as difficult as it is now,” she said. “It wasn’t as costly. And I enjoy the little things. I walk down the street and I can’t be unhappy when I see a baby or some of the dogs.”
Mr. Starr and Ms. Sachs said they were trying to get there. In the meantime, they had new friends and surrogate grandparents.
As for Mr. Miller, he hoped his next movie would allow him to sing and dance. He even had a number he was interested in, made famous by Maurice Chevalier: “I’m Glad I’m Not Young Anymore.”
Drawing on their own backgrounds and experience, older adults are making new technology work for them in a variety of second careers.
Falling can be a serious thing for older adults. Aging causes the bones to become brittle, and broken ones do not heal as readily.
Today, 18.5 percent of the Dutch population — roughly 3.2 million people — is 65 or older, according to official statistics. In 1950, about the time some of the younger course participants were born, people 65 or older made up just 7.7 percent of the population.
Across the Netherlands, 3,884 people 65 or older died as result of a fall in 2016, a 38 percent increase from two years earlier.
Experts say the rise in fatalities reflects the overall aging of the population, and also factors such as the growing use of certain medications or general inactivity.
“It’s same as with young children: More and more old people have an inactive lifestyle,” said Saskia Kloet, a program manager at VeiligheidNL, an institution that offers similar courses.
Even inactivity in one’s 30s or 40s could lead to problems later in life, she noted.
Like many people her age, Hans Kuhn, 85, worried that her daily routine — and the ability to live alone — would end if she ever lost her balance and fell.
She has lived in her house for decades, and alone since her partner died years ago. Its steeply winding staircase is equipped with a motorized chair on a rail to help reach upper floors. “I only use it when I have to bring lots of heavy things upstairs,” said Ms. Kuhn, herself a retired physiotherapist.
“This really looks to be a breakthrough in vaccinating older adults,” agreed Dr. Jeffrey Cohen, a physician and researcher at the National Institutes of Health.
What’s causing the enthusiasm: Shingrix, which the pharmaceutical firm GlaxoSmithKline intends to begin shipping this month. Large international trials have shown that the vaccine prevents more than 90 percent of shingles cases, even at older ages.
The currently available shingles vaccine, called Zostavax, only prevents about half of shingles cases in those over age 60 and has demonstrated far less effectiveness among elderly patients.
Yet those are the people most at risk for this blistering disease, with its often intense pain, its threat to vision and the associated nerve pain that sometimes last months, even years, after the initial rash fades.
Almost all older Americans harbor the varicella zoster virus that causes shingles; they acquired it with childhood chickenpox, whether they knew they had the disease or not.
The virus stays dormant until, for unknown reasons, it erupts decades later. The risk rises sharply after age 50.
Shingles is hardly a minor menace. “A million cases occur in the United States each and every year,” Dr. Schaffner said. “If you’re fortunate enough to reach your 80th birthday, you stand a one-in-three to one-in-two chance of shingles.”
Preventing the great majority of these cases — along with the risk of lingering and debilitating nerve pain, called postherpetic neuralgia — would represent a major advance in public health.
So while the old vaccine will remain on the market, the C.D.C. committee voted to make Shingrix the preferred vaccine and recommended it for all adults over age 50 — a group younger by a decade than those earlier encouraged to get Zostavax.
The committee also recommended Shingrix for adults who’ve previously gotten Zostavax, since a smaller study in people over age 65 demonstrated effectiveness and safety in those already vaccinated. The Food and Drug Administration approved Shingrix last month.
Once the C.D.C.’s director endorses the committee’s recommendations, and the agency publishes them, insurers — including Medicare and Medicaid — will start covering the vaccine.
“By early 2018, it should be broadly available to consumers in the U.S.,” said Dr. Thomas Breuer, chief medical officer of GSK Vaccines. (Canada has also approved Shingrix; it awaits approval in Australia, Japan and Europe.)
What makes the new vaccine so promising, especially for older adults?
* It provides better protection against shingles from the start. Though Zostavax, introduced in 2006, can reduce shingles cases by about half (and postherpetic neuralgia by two-thirds), that overall rate conceals big differences by age.
That vaccine’s effectiveness drops from 64 percent for people in their 60s to 38 percent among those over age 70, and falls still lower for people in their 80s.
But the new vaccine protects nearly as well in older groups as in the middle-aged. Shingrix racked up a 97 percent effectiveness rate in adults over age 50 and, in a separate study of people over age 70, prevented 90 percent of shingles in those 70 to well past age 80.
“In groups such as the elderly, who often don’t maintain vigorous responses to vaccines, this represents extremely strong disease protection,” said Dr. Kathleen Dooling, an epidemiologist at the C.D.C.
* Shingrix’s protection appears to last longer. Among seniors, the effectiveness of Zostavax wanes with disappointing speed. “After 11 years, the protection was close to zero,” Dr. Harpaz said.
Regulators don’t yet have 11 years of data on Shingrix, but in some samples, it remained effective for six years or longer, according to GSK. That should greatly reduce the incidence of postherpetic neuralgia, too, assuming the 42 million people in their 50s start getting vaccinated.
* The new vaccine may protect people with compromised immune systems.
A substantial number of older Americans have suppressed immunity because they’re undergoing chemotherapy or transplants, have H.I.V. or take steroids. For them, the previous vaccine was off-limits because it was made with a weakened live virus.
Yet immune suppression itself leaves the people vulnerable to shingles. Shingrix, a recombinant vaccine made from a glycoprotein and a combination of immunity boosters called adjuvants, doesn’t pose the same danger.
The C.D.C. committee held off on recommending Shingrix for the immunocompromised, because GSK is still running trials with these patients. But since the F.D.A. did not declare Shingrix contraindicated for them when approving it, they can get the vaccine once it’s available.
Public health advocates do foresee a couple of potential problems.
First, Shingrix requires two doses, administered at least two months apart. Prodding the older population to get a single shot has proved tough: barely 31 percent of those over age 60 have been vaccinated against shingles. How much harder will it be to persuade people to get two Shingrix injections?
Further, “it tends to be a bit of an ouch-y vaccine,” Dr. Schaffner cautioned.
In studies, most older recipients said they’d experienced pain, redness or swelling in their upper arms for a day or two after the shot, and 8.5 percent of those over age 70 deemed those symptoms uncomfortable enough to interfere with normal activities.
About half of those over age 70 reported more systemic side effects like fatigue, fever or aching joints, lasting one to two days. Physicians and pharmacists should prepare people for such reactions, Dr. Schaffner said.
“If people anticipate it, they’ll cope with it better. They’ll take a couple of Tylenol” — and not worry that something is seriously wrong.
They may feel pocketbook pain, too. Zostavax is the most expensive adult vaccine, and at $140 for each dose (plus the cost of administering the injection), Shingrix will be pricier still.
The 50- to 65-year-old cohort, many of whom have coverage under employee health plans, may not find that much of a barrier. At older ages, cost matters more.
Medicare will cover Shingrix under Part D (like its predecessor), not under Part B like the flu vaccine. That complicates reimbursement for those seeking vaccination in doctors’ offices, so Medicare patients will probably find it simpler to head for a pharmacy.
But not all Medicare recipients have Part D, and those that do could face co-payments.
Still, it’s no contest: The hazards of shingles and its complications dwarf any problems yet reported with Shingrix.
“Compared to shingles, a little arm pain for a day or so is a small price to pay,” Dr. Schaffner said. “If you know people who’ve had this illness, you’ll be first in line for this vaccine.”
But Roslyn Savings Bank wouldn’t accept the New York State power of attorney that the relative had signed three years earlier, when she sold her house. (In this case, the bank wants a longer state form.) In the meantime, the relative has developed dementia.
“We have a power of attorney, but we can’t use it,” a frustrated Dr. Ullman said. “People sign these anticipating incapacity. Once incapacity arrives, it’s too late to sign another one.”
It’s not clear how often similar scenarios, with their Catch-22 absurdity, take place. But elder-law attorneys across the country say they have encountered financial institutions unwilling to honor valid powers of attorney.
Even in states where statutes require banks to accept a durable power of attorney, or waive their liability when they do accept it, elder-law attorneys have seen some balk.
“Numerous clients have had this dilemma,” said Bernard Krooks, a founding partner of Littman Krooks in New York. “They listened to all the pundits and drew up the documents. Then the bank says, ‘That’s very nice, but it’s not our form.’”
In Long Beach, Calif., Sally Gutierrez had helped her mother, Dorothy Hutchings, with a checking account at a local credit union.
Parkinson’s disease hadn’t affected Mrs. Hutchings’s memory or judgment, but at times she couldn’t write. “She had bad tremors on her right side, and she was very weak,” Ms. Gutierrez said. “Even making an X was too hard for her.”
So Ms. Gutierrez put her own signature on the checks and, in the spirit of full disclosure, carefully wrote underneath, “POA for 2007 Amended Hutchings Trust.” She had all the necessary paperwork, too, or so she thought.
In 2008, however, the credit union informed her by letter that it would no longer honor the power of attorney. Staffers insisted the family fill out the credit union’s own form, accompanied by letters from two physicians attesting to the account holder’s inability to make financial decisions.
“It was shocking,” Ms. Gutierrez said. “I was panicked.”
Financial industry executives said they couldn’t provide estimates of how many banks and brokerages insist on their own power of attorney forms, but “I don’t think it’s uncommon,” said Nessa Feddis, the American Bankers Association senior vice president for consumer protection.
She defended the practice. “Banks hold important assets,” she said. “They have to be very careful when someone is asking for access to a customer’s account.”
You can see her point: Government agencies and advocacy groups increasingly warn about the financial exploitation of older adults, especially those with cognitive impairment; the perpetrators are often family members.
Some financial institutions now train staff members, who should indeed be alert to abuse, to recognize signs of diminished capacity.
But banks have other motivations, too. “Typically, when they’re insisting on their own forms, they’re concerned about liability,” Ms. Feddis said.
If Nefarious Nephew A illicitly drains a senior’s account to buy a Ferrari, Upright Nephew B might sue the bank. Sometimes, too, banks dismiss a power of attorney as being “stale” — signed too long ago — or for other reasons.
The Financial Industry Regulatory Authority, the nongovernmental organization overseeing securities firms, recently issued an investor alert about powers of attorney. It cautioned, among other things, that you may need a firm’s own form.
What can exasperated families do? One avenue: A lawyer can often cajole, reason or badger banks and brokerages into honoring valid powers of attorney by going above local managers to higher-ups.
“Once we get to the right people, they accept it,” said Craig Reaves, a past president of the National Academy of Elder Law Attorneys who practices in Kansas City, Mo. “I’ve never had to go to court or even threaten litigation.”
Of course, you then have to pay the lawyer.
Or you can be proactive by asking a brokerage or bank if it requires its own durable power of attorney document and, if it does, having your relatives sign it when they are still capable of doing so. You’ll have to do this for every institution where they have an account.
But read those bank forms carefully or have a lawyer review them, Mr. Reaves advised. They can contain disadvantageous indemnity or arbitration clauses, or provisions that contradict the individual’s general power of attorney. In such cases, “I’ll tell clients not to sign, and we’ll fight the fight,” he said.
Though it’s usually unnecessary, lawyers must go to court sometimes to make financial institutions accept a power of attorney. Stonewalled families have had to petition to become their relatives’ guardians or conservators — a long, expensive process — when all they wanted was to pay their bills.
The caregivers who told me about their travails found less drastic solutions.
Ms. Gutierrez managed to open accounts for her mother at a new financial institution. Dr. Ullman’s relative keeps most of her money elsewhere, so the family’s inability to consolidate several small bank accounts has been maddening but not harmful.
Sometimes, though, people just wing it.
Eric Murray felt relieved when his mother, Jane Asbury, completed her power of attorney and health care proxy before moving into an assisted-living facility in San Jose, Calif., several years ago.
A few months later, he learned that Wells Fargo wouldn’t allow him to access her accounts to pay her bills because she hadn’t signed its form. Mr. Murray, a software engineer, argued that his mother had signed California’s statutory form. No dice.
So he took Wells Fargo’s document, waited for one of his mother’s better days — she had Alzheimer’s disease but could still chat pleasantly — and drove her to a local notary. “I crossed my fingers that the notary wouldn’t ask too many questions and notice that she was impaired,” he recalled. “I did most of the talking.”
Mrs. Asbury signed; the notary stamped; Wells Fargo was placated. How this charade protected anyone is debatable, but the gambit worked. Mr. Murray was able to handle his mother’s finances until her death in 2013.