HD 2510 Prelim 3 SG PDF

End of life decisions Euthanasia (active/passive) and assisted death ○ Euthanasia: ancient greek term for ‘a good death’ ○ Active: deliberate intervention to end a person’s life ○ Passive: not doing sth (withdrawing life supporting therapy) that leads to a...

End of life decisions Euthanasia (active/passive) and assisted death ○ Euthanasia: ancient greek term for ‘a good death’ ○ Active: deliberate intervention to end a person’s life ○ Passive: not doing sth (withdrawing life supporting therapy) that leads to a person’s death Risk factors for suicide ○ Social isolation, widowhood/bereavement, dementia, cognitive impairment, physical illness Clinical depression & late-life depression ○ Depression in older ppl is underdiagnosed Ppl ages 85+ have the highest rates of suicide Clinical depression or Major Depressive Disorder (MDD) Late-life depression (no previous history of depression) ○ Symptoms of depression: fatigue, decreased motivation, Rational suicide ○ Wishes of older adults who contemplate ending their lives at some future itme Brain death ○ Irreversible loss of brain function Principle of autonomy ○ Ppl have basic right to accept or reject medical treatment What standards have courts relied upon to determine when it is proper to withhold or withdraw life-sustaining treatment? ○ Standard of substituted judgment → what would this patient have wanted udner these conditions? ○ Best-interest standard: what is the Advance directives ○ Legal document authorizing decisions to be made, typically involving withholding life saving medical treatment, should circumstances arise in which a person has lost the capacity to make those decisions Suicide in the United States (laws, public opinion) ○ Assisting a suicide does remain a crime in most jurisdictions in the US but states make their own decisions ○ Public opinion has continued to evolve in favor of greater choice abt end-of-life decisions Social and economic issues ○ Old age as a leveling influence Important principle of heterogeneity ppl’s paths and experiences are different so outcomes are different Aging stereotypes & how to overcome them -> reflect on personal experience and apply overcoming strategies ○ ‘Older adults are sick and frail’ ○ Overcoming:  Recognize how structures of inequality shape experiences View ppl in the context of historical forces Acknowledge individual experience Sex ratio ○ There are more women than men over time Life course implications of inequality ○ Double or triple jeopardy: older person who belongs to 2 or 3 disadvantaged groups are especially different Income vs wealth/assets ○ Income= available money or purchasing power ○ Wealth = all economic assets of value (regardless of cash) Trends in income for older people ○ Social security is larger portion of income as older ○ Rising importance of private pension and assets ○ Retirement income has increased significantly But not for everyone Those whose work lives were constricted by prejudice Those w unpaid caregiving responsibilities It is less generous for wives (home makers) The “Third Age” and the roleless role ○ Life course following middle age, characterized by retirement and the pursuit of leisure activities, personal interest, and continued learning ○ Roleless roel: highlights the transition from traditional occupational roles to seeking meaningful engagement and purpose in later life Individual equity vs social adequacy ○ Individual equity: make more, pay more tax, collect more ○ Social adequacy: everyone has access to a basic standard of living, regardless of income Older Americans Act ○ Created a national aging network of services ○ Growth in senior centers but reach 5-10% of older adults ○ Criticism of the professionalized aging network Don’t do enough and do nothing abt underlying causes Services for aging are wasteful social spending Age vs need debate Trends in public policy & aging Increases in spending for older Americans over time Social security and medicare have no means testing But these programs are quite popualr Gradual expansions and growth of benefit programs Rapid growth in recent decades  Solutions for population pressures Permissive consensus Both social security and medicare arose from a ‘permissive consensus’ that depicted the aged as weak Generational equity Idea that differing cohorts should be treated similarly w respect to benefits over the life course Are older ppl getting too much? Concern abt large government deficits Key federal legislation on aging The Social Security Act (1935) Age Discrimination in Employment Act (1967) Congregate Housing Services Act (1978) Direct provision of social services Poverty Supplemental Poverty Measure (SPM) An experimental income based method first released in2011 that accounts for more factors than does the official poverty level calculation Supplemental Social Security Income (SSI) Cash benefit program that is administered by social security for older adults who are poor, are blind, or have disabilities Or young ppl who are blind/have disabilities Tweeners → ppl caught ‘in between’; lower-middle class adult who are not well off economically but they are not poor enough to be eligible for programs such as SSI How does Social Security affect poverty among older adults? w/o government cash transfer programs like social security, approximately 40% older adults would fall below the poverty line Most older adults rely on social security for most of their income Poverty in children and families Declining government programs for younger poor families (welfare, food stamps) Basic causes of rising child poverty Family structure Unemployment Declining wages Medicaid trends Benefits increasing for older ppl but stagnant for children and families b/c medicaid has become a major payer for long-term care, especially nursing homes Dependency ratio Numerical measure of the economic burden on the working population (18-64yo) caused by those not in the labor force Means testing  Eligibility based on whether a person’s income or assets fall below a certain amount Progressive taxation /ability to pay Diff tax percentage based on your income Tax reduction for low-income older homeowners Cost sharing Principal that recipients of services provided should contribute part of the cost of those services Combines elements of means testing and progressive taxation Universal vs targeted programs Social Security When (and in what context) was it established? Social security act of 1935 Centerpiece of the New Deal, a response to Great Depression at a time when only 5% of US pop was 65 or older Not intended to be the sole retirement income When and how was it reformed? Social security reforms of 1983 1983 social security reforms responded to earlier anxiety and succeed in putting the program on a more secure footing Cost of Living Adjustments (COLA) enacted in 1975 Benefits automatically adjusted for inflation w the Consumer Price Index (CPI) In 1983, government started taxing Social Security benefits for those w higher incomes/benefits Individuals > $25K, or couples > $32K Social security benefits are taxed for only one-fourth of older ppl Public opinion of social security Enormously popular and widely supported by American adults of all ages Americans have a high level of Dd dd What are the different components of Social Security? SSDI Benefits for children Survivors benefits (life insurance) Social Security Disability Insurance (SSDI) Provides income support to individuals who can’t How is Social Security funded? Social security payroll tax - regressive Tax rate is same across income levels Federal income tax - progressive Tax rate increases w income  Regressive vs progressive (tax/benefits) Benefits are progressive, pay more get more Regressive: tax same for everyone ,benefit same for everyone Progressive: benefits increase as more Replacement rate Amount of pre-retirement income provided by retirement benefit Social security aims for 40% replacement rate Pros and cons of the current system of Social Security → free response Q? Pros Provides a minimum income for older americans Helps those who are at risk of total disability Helps families w only one wage earner Universal Cons Future recipients may get less than current recipients Compulsory – some would prefer a personal savings account w interest dd Pay-as-you-go system Today’s workers pay for today’s retirees Possible solutions More immigration Improve worker productivity Increase retirement age Alternatives Privatize social security – allow ppl to control their own savings Invest part or all of the social security trust fund in the stock market Use money from general tax revenue to make up for any future shortfall Pig in the python pattern Social security was implemented when less older population, have to find a way to balance the increased older population Social Security Trust Funds Two separate social security trust funds Old-age and survivors insurance (OASI) trust fund – pays retirement and survivors benefits Disability insurance (DI) trust fund – pays disability benefits Federal government borrows money and pays it back in the future Ways to reduce the shortfall Reducing future Modestly increasing tax rate Raising max level of earnings subject to payroll tax Cutting benefits Social Security eligibility & considerations Age of eligibility (+10 yrs of work history) Reduced benefits: 62  Full benefits: 67 Increased life expectancy → more years collecting retirement benefits Reducing social security benefits to make them reflect actual rate of inflation Some estimates say CPI overestimate cost of living by 1.1% Means testing – only those whose income falls below a threshold would be eligible Affluence testing – eliminate benefits for ppl above a threshold Privatization of Social Security Move from a pay-as-you-go system to a funded system Investing the social security trust in the stock market Let individuals choose to privately invest their individual retirement savings Eliminate the way social security (quietly) redistributes benefits Issues Transition costs Must pay for current and future retirement benefits Problems w stock market Too much national influence over capital markets → puts funds at risk Emphasis of equity over adequacy Women & Social Security (equity issues, spousal benefits) Women depend on social security more than men, but they earn less money than men Equity problems – social security has not been reformed to recognize change in gender roles Widowhood and poverty – widows 4x more likely to live in poverty than married women Gender pay gap widens in retirement If you are amrreid to your spouse for less than 10 yeras, you cannot collect social security benefits if you are divorced Spousal benefits may be higher than you own 2011 social security caregiver credit act (not enacted) Proposed up to 5 yeras of caregiving counts for social security Favors economically advantaged women Double-decker system: retirees receives a fixed amount of money + benefit related to prior work history Earnings sharing plan: divide total earnings of the married couple b/t social security accounts of both spouses Retirement Three-legged stool ○ Social security, private pensions, other income-yielding asset or savings Historical age of retirement & current patterns ○ For many ppl,, social security is the main form of income during retirement ○ Legally, cannot force someone to retire  ○ 19c Industrial Revolution → first introduced age 65 as basis for pension ○ By the early 20c, many european countries began to institutionalize retirement through government pension systems ○ Percent of older workers, specifically men, was high in the 1890, then decreased in the 1950-2000, then increased again a bit after the 2000s Defined benefit plans (e.g., pensions) ○ Guaranteed to pay a specified level of income in retirement pension ○ Job lock is a problem w this ○ Shift from defined benefit plans to defined contribution plan Defined contribution plans (e.g., 401(k)) ○ Based on regular contributions made by the employer, employee, or both: 401K ○ Positives: more control over retirement savings, more ownership if changing jobs frequently ○ Negatives: less investment gains, higher costs for beneficiaries, unpredictable as equity markets change Individual retirement accounts (IRAs) ○ A person can accumulate money until retirement, subject to certain limitations, but on a tax-deductible and tax-deferred basis Labor force participation trends for older adults ○ Retirement uncertainty and insecurity are increasingly serious manifestation of inequality ○ Average age of retirement fell throughout the 20c, a trend that held not just in the US but also internationally ○ Older adult labor force participation rates in later life have had steady since the mid 1980s and even increased in the first part of 21c Findings from the Cornell Study of Occupational Retirement: ○ No evidence e for the idea that 'retirement causes ill health’ ○ Previously accepted but mistaken belief that persists ○ Documented a drop in income upon retirement ○ Most retirees reported their income was sufficient ○ Similar results found by National Institute on Aging longitudinal study of health and retirement Origins of late-life leisure ○ Changes in the (postindustrial) American economy ○ Shorter Hours Movement: 8 hours work, 8 hours rest, 8 hours leisure ○ The Great Depression, the New Deal & World War II ○ US government took on a new responsibility for managing the economy ○ 65 became the fixed retirement age ○ Establishment of a standard 40 hour workweek Job lock ○ Risk losing pension benefit if changing jobs Mandatory retirement ○ The age discrimination in Employment Act of 1967  Forbids employers from limiting older works’ employment Yet age discrimination in the workplace is still widespread ○ Positive changes in recent years Mandatory retirement has been eliminated ‘Earnings penalty’ was repealed in 2000 Defined-contribution plans encourage part-time work Productive aging ○ We need to expand our definition of ‘productivity’ Housework, family caregiving, volunteering ○ Adults (55+) represent an overlooked national resource Estimated contribution = 12 million full-time workers ○ Remarkable vitality of older ppl >50% of old-ol report being in ‘excellent’ or ‘good’ health ~25% of the old-old are currently volunteering or caregiving ○ Volunteering and productive aging - Senior Community Service Employment Program (SCSEP) for adults aged 55+ - Created under the Older Americans Act (1965) - Senior Corps – government-run volunteering program - Senior Companion Program – assists those who need help staying in their homes - Retired and Senior Volunteer Program (RSVP) - Volunteering is correlated w high life satisfaction Older adults in the workplace ○ Usually perform on par w younger workers ○ Increasing proportion of the workforce ○ Plasticity: the potential for retraining ○ Decline in performance and speed Discourages older workers Techniques can help compensate Retirement prospects in the U.S ○ Only 17% of American workers have high confidence they will enjoy a good retirement ○ Most household approaching retirment have low savings ○ 25% of working Americans have nothing saved ○ Solution to shortfall in retirement income: work longer Except that’s not always possible due to unexpected life events like illness ○