As the American population ages, caregivers are growing younger and more burdened, with the National Alliance for Caregiving estimating that millennials now comprise 24 percent of the nation's unpaid caregivers, up from 22 percent of young adult caregivers in 2009, according to the Wall Street Journal . Meanwhile, a 2018 AARP Public Policy Report reckons that 6.2 million millennials provide care for a parent, parent-in-law, or grandparent. Caregiving duties can come at critical times in the lives of millennials and threaten to derail expected milestones, such as starting families and buying a house, says University of Southern California Professor Maria Aranda. In addition, millennials are expected to start making decisions about another's life when they are still trying to figure out their own. They also must face financial difficulties, as millennials spend a greater share of their incomes on caregiving than older caregivers and their incomes are on average lower. Moreover, about one in three millennials who are caring for someone with dementia have cut back hours, lost benefits, or been fired because of caregiving demands, according to a 2017 report by UsAgainst Alzheimer's and USC Edward R. Roybal Institute on Aging.

This week, Missouri voters will decide whether the state should adopt a "right-to-work" law impeding unionization, which will be nullified if a majority votes against it, reports the Washington Post . Twenty-seven states currently have right-to-work laws on the books, with five having adopted them since 2012 mainly due to GOP dominance of state legislatures. The Missouri vote comes after multiple setbacks for unions at the national level and in other states, as Republicans have used control of the federal government and most legislatures to expedite the reduction of organized labor's influence to its weakest point in decades. Overturning the law would give unions a victory after a Supreme Court defeat in June, when the court ruled it was unconstitutional for public-sector unions to require collective bargaining fees from employees. Unions were already prohibited from using mandatory dues for campaign funding, but the ruling effectively permitted any worker to opt out of paying for any union activity. The Illinois Economic Policy Institute's Frank Manzo says union membership has shrunk in 20 of 26 states that have adopted right-to-work laws. "Missouri went for Trump, but a lot of the workers here are strongly against right to work, because they understand wages are going to go down, period," says the St. Louis City Labor Club's Tom Madden.

A report from the U.S. National Institute of Standards and Technology (NIST) details how organizations can use open source and commercially available tools to keep care recipients' information secure on mobile devices, according to MedCity News . The guide cites specific capabilities of products that an organization can incorporate within its existing infrastructure. In an ideal scenario, a health system should use open source and commercially available tools to ensure beneficiary information is safe when caregivers use mobile devices to share data amongst themselves. "We recommend that organizations implement a continuous risk management process as a starting point for adopting this or other approaches that will increase the security of EHRs," NIST says. The Cleveland Clinic's Vugar Zeynalov notes, "Leveraging mobile technology to increase quality of care and relieve pressures on providers is a cornerstone of the modern digital hospital. This guidance is a practical foundation to opening up new possibilities for caregivers while maintaining our obligation to beneficiary safety and privacy."

A study published in the Journals of Gerontology found a brief period of inactivity can activate diabetes in older adults, reports HealthDay News . The researchers asked overweight individuals with prediabetes to reduce their daily steps to no more than 1,000 a day for two weeks. This caused elevated blood sugar levels and accelerated onset of type 2 diabetes, with some subjects not fully recovering even after resuming normal activity. "We expected to find that the study participants would become diabetic, but we were surprised to see that they didn't revert back to their healthier state when they returned to normal activity," notes McMaster University's Chris McGlory. The results suggest seniors who become inactive due to illness, bed rest, or hospitalization are more likely to experience harmful health effects. "Treatment of type 2 diabetes is expensive and often complicated," says McMaster Professor Stuart Phillips. "If people are going to be off their feet for an extended period, they need to work actively to recover their ability to handle blood sugar." McGlory recommends "active rehabilitation, dietary changes, and perhaps medication" as strategies for prediabetic older adults to follow to recover metabolic health and prevent further declines from inactivity.

A study published in the Canadian Medical Association Journal determined the best time for reducing mortality after hip surgery in medically stable older adults is on the day of admission or the following day, reports Medical Xpress . Canadian Health Ministers have established 48 hours from admission as a standard for 90 percent of hip fracture operations, but the appropriate timing of hip fracture surgery is a matter of debate, with some research suggesting an optimal window of 24 hours. The researchers analyzed data from the Canadian Institute for Health Information on about 140,000 individuals aged 65 or older who had surgery for a first-time hip fracture at 144 hospitals in Canada. They inquired as to how postoperative mortality would change if the same cohort were to undergo surgery on the day of admission, on inpatient day 2, day 3, or after day 3. The team forecast 11 additional deaths for every 1,000 hip fracture surgeries if all surgeries in medically stable persons were performed after inpatient day 3 instead of on admission day. "We suggest that clinicians, administrators, and policy-makers 'not let the sun set twice' on medically stable older adults before their hip fracture repair," says orthopaedic surgeon Pierre Guy. "We estimate that 16.5 percent of in-hospital deaths currently occurring in individuals delayed for more than two days are avoidable by adopting the 'don't let the sun set twice' policy for hip fracture persons."

Last week, the Trump administration finalized a rule requiring hospitals to post a list of their standard prices online, reports The Hill . Hospitals are already mandated to publicize this information on request, but the Centers for Medicare and Medicaid Services (CMS) said the new rule would require the information be posted online to "encourage price transparency" and improve "public accessibility." Hospitals will be required to update the information annually starting Jan. 1, 2019. CMS also said it is considering how to "allow consumers to more easily access relevant healthcare data and compare providers." Boosting price transparency has been a priority for the administration as a way to lower healthcare costs. "This is a small step towards providing our beneficiaries with price transparency, but our work in this area is only just beginning," said CMS Administrator Seema Verma in July. "Price transparency is core to beneficiary empowerment and making sure Americans ... have the tools they need so they can make the best decisions for them and their families."

A study from the Consumer Bankruptcy Project found the rate of people 65 and older filing for bankruptcy is three times what it was in 1991, with this demographic being the largest filer population, reports the New York Times . Between February 2013 and November 2016, there were 3.6 bankruptcy filers per 1,000 people 65 to 74, compared to 1.2 in 1991. Meanwhile, 12.2 percent of filers are now 65 or older, up from 2.1 percent in 1991. The increase is apparently being driven by a 30-year shift of financial risk from government and employers to individuals. The effects of this change include longer waits for full Social Security benefits, the replacement of employer-provided pensions with 401(k) savings plans, and increasing out-of-pocket healthcare expenses, all of which are worsened by shrinking incomes. "When the costs of aging are off-loaded onto a population that simply does not have access to adequate resources, something has to give, and older Americans turn to what little is left of the social safety net — bankruptcy court," the study says. University of Idaho Professor Deborah Thorne says filing for bankruptcy is often "too little too late" for older Americans. "By the time they file, their wealth has vanished and they simply do not have enough years to get back on their feet." The study also found the next generation nearing retirement age is filing for bankruptcy in greater numbers, and the average age of filers is climbing as well. "The only explanation that makes any sense are structural shifts," Thorne says.

A study published in JAMA Network Open details a method for measuring inclusiveness of workplace culture using six variables, reports ScienceDaily . Those factors include the presence of discrimination; silent witness; effectiveness of organizational leadership and mentors; interplay of hierarchy, recognition, and civility; support for work-life balance; and perceptions of exclusion from inclusion efforts. The researchers also found environments lacking inclusion appeared to affect the well-being of those who either experienced or witnessed it alike, and induced stress, anxiety, and feelings of hopelessness, social isolation, and expendability. Narratives frequently described how micro-aggressions and favoritism eroded participants' sense of value and restricted their engagement and contributions to the organization. Approaches for cultivating an inclusive organizational culture came from the narratives in the form of direct recommendations and positive examples of inclusion. Most respondents cited a systemic culture that influenced their group and interpersonal dynamics, with recommendations centered on system-level interventions, such as delivering inclusive skills training to existing leadership, revisiting organizational policies, developing advocacy campaigns, and broadening professional networks to gain new perspectives and create a greater sense of community.

Companies attempting to vet potential hires by scrutinizing their social-media histories are coming under fire, reports the Wall Street Journal . The New York Times ' hiring of journalist Sarah Jeong as a technology writer for its editorial board prompted a social-media outcry when past tweets she had posted denigrating white people were cited. A 2017 CareerBuilder poll of more than 2,300 hiring managers and human-resources executives found 70 percent said they screened candidates' social-media histories, compared to 60 percent in 2016. One-third said they had uncovered discriminatory comments that caused them to refrain from hiring someone. However, experts note both too little and too much social-media vetting present legal and reputational problems. Furthermore, few employers have consistent guidelines on how they rate and assess prospective employees' online histories. Companies hiring talent abroad risk breaching digital privacy laws, such as the European Union's General Data Protection Regulation. Moreover, hiring managers studying applicants' Facebook pages and tweets could easily learn other things that could bias hiring decisions that are legally barred from being taken into account. Employment attorney Kate Bischoff advises job seekers to delete offensive comments in the hopes they do not resurface.

The Ohio House's Task Force on Alzheimer's and Dementia has proposed changes to state law that include uniform training requirements for communities advertising "memory care units," reports the Columbus Dispatch . A draft policy implies that supervisors and direct-care staffers complete eight hours of initial instruction and indirect-care staffers complete four hours. Only 50 percent of the training could be conducted using video or online presentations, and employees would have to complete two hours of additional training each year. Topics to be addressed by the policy include communication skills, pain assessment, medication management, family dynamics, dealing with challenging behavior, and triggers of dementia symptoms. The task force also cited a lack of transportation options for people with Alzheimer's and dementia in rural regions as a pressing issue to be dealt with during budgetary discussions. Vince McGrail with the Alzheimer's Association's central Ohio chapter notes Ohio is the only state that lacks a comprehensive plan to address the growing problem of caring for the Alzheimer's population. The Ohio Department of Health already has rules concerning training in its licensed communities that look after persons with cognitive impairment, but they differ from the task force's recommendations by not specifying the subjects to be taught, and by failing to mention Alzheimer's or dementia.