Friday, April 24, 2015

How Should Decisions Be Made About Sexual Rights During Facility-Based Care?

For me, a chilling moment in the trial of State of Iowa v. Henry Rayhons came during the prosecution's case-in-chief, with the reported testimony of a physician at Mrs. Rayhons' nursing home.  According to the coverage of the trial, the doctor testified that based on her decreasing score on the BIMS (Brief Interview for Mental Status), he determined Donna Rayhons lacked the cognitive ability to give consent to sex.  In contrast, a defense expert was reported to have testified it was a "medical mistake" to have used such minimal evaluations of capacity to draw an arbitrary line between permission to kiss or hug, as opposed to engaging in more intimate relations. 

The contrasting testimony put a spotlight on the very serious questions of who makes decisions -- and how decisions are made -- about "capacity" to engage in essential behaviors such as sex for persons with dementia. This topic is further explored, with great prescience, by a law student at the University of Illinois in the current issue of the Elder Law Journal, written well before the Rayhons trial.  Stephanie Tang, who was also the managing editor for the journal in 2014-15, writes:

To best balance the interests of the elderly with those of the states, states should develop and adopt a model assessment tool that employs a clinical perspective to evaluate a person’s capacity to consent to sexual activity. Model assessment tools provide courts with a clear and objective standard, which would increase predictability and uniformity of court decisions.

 

Moreover, identifying specific cognitive functions that need to be assessed would constitute a major step forward in those states that have not yet done so.This Note advocates for the use of two tests: 1) the Socio-Sexual Knowledge and Attitudes Test (SSKAT) and 2) Cognisat. Authors have previously argued for the adoption of the SSKAT to assess sexual capacity to consent among mentally retarded patients. The American Bar Association and American Psychological Association cited use of Cognistat to assess cognitive capacity to consent to sexual activity among hypothetical patients with diminished capacity.

To put this simply, in her article,When "Yes" Might Mean "No": Standardizing State Criteria to Validate The Capacity to Consent to Sexual Activity for Elderly with Neurocognitive Disorders, Ms. Tang is arguing that far more sophisticated and appropriate tools are available and should be used to assist in evaluating capacity to participate in sex. Brava, Ms. Tang!

Ms. Tang's article draws in major part on the detailed factual reporting of Bryan Gruley for Bloomberg News, in his important series on rights of the elderly with dementia.  Mr. Gruley's articles began to appear as early as 2013, and became even more relevant with his investigation of the events underlying the 2014 charges against Mr. Rayhons.

April 24, 2015 in Cognitive Impairment, Crimes, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Health Care/Long Term Care, Science, Statistics | Permalink | Comments (0) | TrackBack (0)

Got an Idea? Maybe You Are an Inventor!

Are you an inventor?  Ever have a good idea for an invention?  There is a renaissance of sorts in American ingenuity with an increasing number of older Americans becoming inventors.  The NY Times ran a story about older inventors on April 17, 2015. More Older Adults Are Becoming Inventors notes this renaissance

Whether as volunteers or for profit, older inventors ... are riding a rising tide of American innovation. They are teaming up, joining inventors clubs and getting their products into the marketplace. And older inventors bring valuable skills to their work, many experts say, like worldly wisdom and problem-solving abilities that can give them an advantage over younger inventors.

According to the article, the Baby Boomers are at least part of the catalysts for this surge of older inventors, as the boomers look for products to assist them as they get older. According to one expert quoted in the article, older inventors may have an edge over younger ones, since "[a]n aging brain can see patterns better.”  Before you get out the proverbial drawing board, the article notes that inventions don't necessarily lead to wealth with less than 5% of inventions making money, not to mention the prototype and startup costs

April 24, 2015 in Consumer Information, Current Affairs, Other | Permalink | Comments (0) | TrackBack (0)

Thursday, April 23, 2015

Nation's Capitol Ranks Fourth for Elders at Risk of Hunger

As summarized in a recent article in the Washington Post, a new study places Washington D.C. fourth in the nation for seniors at hunger risk:   

"The report says that more than 20 percent of the District’s elderly have concerns about eating enough food or the right kind of food, compared with more than 24 percent of seniors in Mississippi.

 

The estimates of senior hunger range from about 8 percent in Minnesota to more than 26 percent in Arkansas, which was ranked highest among states where seniors face the threat of hunger. Virginia and Maryland both had rates of about 14 percent.

 

The analysis – conducted by two university researchers on behalf of the nonprofit National Foundation to End Senior Hunger and the National Association of States United for Aging and Disabilities – says nearly 15.5 percent of elders, or 9.6 million people, in the United States face the threat of hunger...."

My thanks to George Washington Law Professor Naomi Cahn for sharing this article. We agree -- depressing news. 

April 23, 2015 in Current Affairs, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Food and Drink, Housing | Permalink | Comments (0) | TrackBack (0)

How Does Your Neighborhood Rate for "Aging in Place?" AARP Offers Livability Index

As outlined by The Washington Post, AARP Public Policy Institute has a new "Livability Index" offered as a way to evaluate factors such as safety, security, ease of getting around, access to health care, and housing affordability.

More intangible factors are also assessed, such as WiFi, farmers' markets and "public policies that promote successful aging."

(After following the trauma of the trial in Iowa, I wonder whether "criminal laws on sexual relations between husband and wives if one has dementia" should be added as an express factor?)

For more, read here and here.  Hat Tip to ElderLawGuy Jeffrey Marshall for the pointer. 

April 23, 2015 in Consumer Information, Housing, Retirement, Statistics | Permalink | Comments (0) | TrackBack (0)

Justice in Aging: Webinar on New Person-Centered Care Rules

Justice in Aging (formerly National Senior Citizens Law Center) is offering a free webinar on Wednesday. April 29, from 2 to 3 p.m. (eastern time) on "How New CMS Person-Centered Care Planning Rules Apply to Medicaid Delivered Long-Term Services and Supports (LTSS)."

They report their webinar will focus on the rules as they apply to long-term services and supports delivered through Medicaid home and community-based waivers, and will:

  • Provide background context for the new person-centered planning and service plan      rule
  • Analyze the requirements of the new rule
  • Give examples of how selected states (Minnesota, New Jersey, Tennessee, and Wisconsin) are implementing provisions of the rule
  • Identify gaps where more detailed state rules or better managed care plan contractual terms are needed to ensure that compliance with the intent of the rule

Who should participate?  The program is suggested for health care professionals and their staffs, attorneys for consumers of LTSS services, and public employees --  and consumers, too. 

Here is the link for the registration

April 23, 2015 in Consumer Information, Health Care/Long Term Care, Medicaid, Medicare, State Statutes/Regulations, Webinars | Permalink | Comments (0) | TrackBack (0)

Wednesday, April 22, 2015

Living Longer and the Effect on Pensions

The Center for Retirement Research at Boston College released their April Brief on How Will Longer Lifespans Affect State and Local Pension Funding? The authors considered whether state and local governments are factoring in the increase in longevity into their budgeting for employee pensions. The authors use two alternatives to explore the answer: "1) if public plans were required to use the new mortality table designed for private sector plans; and 2) if public plans were required to go one step further and fully incorporate expected future mortality improvements." The article first discusses the current climate for these pensions, discusses a scenario illustrating longevity's impact on pensions and then covers the two options. 

The authors' conclusion might surprise you.  "The question underlying this analysis is whether outdated mortality assumptions are a serious problem among state and local plans. The answer appears to be "no."...  In short, public sector plans seem to be making a serious effort to keep their life expectancy assumptions up to date."  The brief also has an appendix with a table showing the "life expectancy and funded ratio" for various state and local government pension plans.

 

April 22, 2015 in Current Affairs, Retirement | Permalink | Comments (0) | TrackBack (0)

Iowa Sexual Assault/Dementia Trial -- and the Jury Says....

On Wednesday, April 22, 2015, at approximately 2:30 p.m. central time, after almost two full days of deliberations on a single count of statutory sexual abuse of his wife, a nursing home resident with dementia, the jury found 79-year-old former Iowa legislator Henry Rayhons NOT GUILTY. 

As shown with pictures posted by KIMT.com Twitter, there are many tears in the courtroom.

Interestingly, as another indication of the State's aggressive prosecution of this case, the prosecutor filed a "Statement" with the court in Garner, Iowa yesterday, while the jury was still deliberating, asking that in the event of a conviction, Mr. Rayhons be taken immediately into custody. The explanation? The state contended that under Iowa law, sexual abuse in the third degree is covered by Iowa Code Section 709.4.(2)(a), and that any exception to "forcible felony" treatment for criminal sexual acts occurring between husband and wife does not apply, because they were not "cohabiting," at the time. 

Therefore, argued the state, if convicted Mr. Rayhons would have been barred from posting bail pending appeal.  Further, the prosecution argued the defendant would not have been eligible for a deferred or suspended sentence, and, once released, would be subject to restrictive, special parole terms for the rest of his life.  See Iowa Code Section 701.11(1) on "forcible felony."  See also Iowa Code Section 811.1.  See also Iowa Code Section 907.3.

Fortunately for this defendant, the incarceration arguments are now moot. 

This case has demonstrated, all too clearly, that we need better understanding of the relationship between dementia and legal capacity. The Rayhons case challenges us to consider carefully the appropriate balance between protection of individuals with Alzheimer's and recognition of fundamental human rights.

As additional details emerge, we'll supplement this post. 

Here are two early stories on the aftermath of the jury's verdict:

From Bloomberg News' Bryan Gruley: Iowa Man Accused of Raping Wife with Alzheimer's is Acquitted, noting that this case "offered a rare look at a complex dilemma that will become more common as the 65-and-over population expands."

From The Des Moines Register (Tony Leys): Jury finds Henry Rayhons Not Guilty.

And from Iowa Public Radio and the local Globe Gazette, a brief video interview with a tearful Henry Rayhons. (Note the comments posted by viewers after the interview.)

April 22, 2015 in Cognitive Impairment, Crimes, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (1) | TrackBack (0)

New Report Spotlights Ineffectiveness of Enforcement of Nursing Home Care Standards

LTCCC press release says new study assesses nursing home citation rates nationwide, finds little or no punishment when nursing homes fail to provide care that meets the standards they are paid to achieve, even when such failures result in significant suffering.

Widespread and persistent nursing home problems, including serious deficiencies in care, result in unnecessary harm to thousands of vulnerable residents every day. Deficient and worthless services also cost taxpayers hundreds of millions of dollars a year. The nursing home industry frequently complains that it is one of the most highly regulated in the country. But what does that mean when so many nursing homes are consistently paid to provide care that fails to meet those standards?

LTCCC’s new report, , presents a comparative overview of every state’s (50 states + DC) performance on several key criteria. LTCCC assessed overall state citation rates, number and amounts of fines that each state has imposed in the last three years for violations of minimum standards and the rates at which the states identified resident harm when they found deficiencies. In addition to reviewing state citations as a whole, the study focused on three criteria important to quality care – pressure ulcers, staffing and antipsychotic drugging.

“While no data are perfect, we felt that assessing overall citation and penalty rates, as well as citations for three critical quality criteria, would together provide valuable insights into State Survey Agency performance and the extent to which important problems are being addressed in each state” said Richard Mollot, LTCCC’s Executive Director and author of the report.

Select findings:

1.     Resident Harm. States only find harm to residents 3.41% of the time that they cite a deficiency. California and Alabama tied for lowest in the country, finding harm only 1.14% of the time.

2.     Inappropriate Antipsychotic Drugging. The nationwide average antipsychotic drugging rate is 18.95% while the average citation rate for inappropriate drugging is 0.31%.  This indicates that there is a significant amount of inappropriate antipsychotic drugging that is not being cited by the states.

3.     Pressure Ulcers. Pressure ulcers (bed sores) are a problem for over 86,000 nursing home residents. Though they are largely preventable, states cite nursing homes the equivalent of less than 3% of the time that a resident has a pressure ulcer. When states do cite a facility for inadequate pressure ulcer care or prevention, they only identify this as harmful to residents about 25% of the time.     

4.     Sufficient Care Staff. Insufficient care staff is one of the biggest complaints made by nursing home residents and their families. Studies have repeatedly identified it as a serious problem in a majority of US nursing homes.  Nevertheless, insufficient staffing is rarely cited by the states. The annual rate of staffing deficiencies per resident is infinitesimal: 0.042%. Less than 5% of those deficiencies are identified as resulting in harm. Twenty one states never connect insufficient care staff to resident harm in their states.

The report is available on LTCCC’s dedicated nursing home website at http://www.nursinghome411.org/articles/?category=lawgovernment. The website includes interactive charts showing key rates for each state as well as national averages.  They include state rankings on criteria identified as important to nursing home resident care and the protection of taxpayer funds that pay for the majority of nursing home care. These charts can be used to gain insights into the strengths and weaknesses of quality oversight in any state. 

April 22, 2015 in Consumer Information, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Health Care/Long Term Care, State Statutes/Regulations | Permalink | TrackBack (0)

Does "Age in Place" + "This Old House" = Affordable Plan?

Most of my family likes the PBS television show "This Old House." (Not me: I prefer "International House Hunters.")  I have a good friend-- we'll call her Louise --  who is getting ready to celebrate her 90th birthday and has the ability to turn a good phrase.  For years she has been saying her plan was to stay in her home, a lovely "old house" built in the 1920s, until "whatever happens next."  (She also refers to my writings here for Elder Law Prof as my "blobs.") 

Recently, however, Louise admitted to considering a new plan.  One thing after another in "this old house" was going wrong.  First it was her land-line phone that would intermittently crackle and pop, eventually making all calls impossible. Next it was seemingly random problems with loss of electricity to one side of the house or the other.  Finally, when everything in the kitchen lost power, she got serious. Soon there was a big trench behind the house, as the electricians tried to locate the problem. 

Eventually they found about a 4 foot length of burned wiring in the ground, inside of the buried conduit leading to the house (!).  They explained the wiring in and to Louise's house was just "too old." Fortunately, my friend could afford the massive repairs (not cheap), but that still meant living with her daughter 45 minutes away, and commuting to meet with the workers during the weeks without any power.  And as she asked, "what's next?"  Her house is about 3 years older than Louise.

Louise's story plus a recent article from the Patriot News got me thinking.  In Harrisburg, PA, the mayor was proposing a way to help a 92 year-old-woman get help to deal with sewer line repairs from the street to her house that cost $10,000.  Helping one person -- the proposal was for $2,000 -- was just the tip of the iceberg (so to speak -- I'm running out of metaphors).  The article explained:

Continue reading

April 22, 2015 in Current Affairs, Health Care/Long Term Care, Housing, Property Management, Retirement | Permalink | Comments (0) | TrackBack (0)

Fundamentals of SNT Administration webinar-it's not too late to register

Stetson College of Law and the Center for Excellence in Elder Law at Stetson Law (full disclosure, I'm hosting this webinar) is offering the annual Fundamentals webinar on Friday April 24, 2015 from 1-5 p.m..  This half-day webinar features presentations by Stu Zimring, Mary Alice Jackson and Robert Fleming.  More information, the schedule and registration information are available here.

April 22, 2015 in Estates and Trusts, Other, Programs/CLEs | Permalink | Comments (0) | TrackBack (0)

Tuesday, April 21, 2015

Closing Arguments in the Iowa Sexual Assault/Dementia Trial (Updated)

Coverage of the closing arguments on Monday, from State of Iowa v. Henry Rahons, including video excerpts from each side's attorney, is provided here by the Des Moines Register.

According to KIMT.com's twitter feed, attorneys and Mr. Rayhons went into the judge's chambers at about 3:30 p.m. Central time on Tuesday, the second day of deliberations -- could a jury verdict be close?

UPDATE:  Apparently the conference in the judge's chambers was to address jury questions. At approximately 4:15 on Tuesday, April 21, the jury "left for the day," to return to deliberations on Wednesday.

April 21, 2015 in Cognitive Impairment, Crimes, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (0) | TrackBack (0)

Funding Opportunity: Senior Medicare Patrol and State Health Insurance Assistance Program

Seeking Applications for Hard-to-Reach Beneficiary Project

The Administration for Community Living oversees two programs geared toward educating and empowering Medicare beneficiaries; the Senior Medicare Patrol (SMP) and the State Health Insurance Assistance Program (SHIP). The SMP helps beneficiaries spot and report fraud related to their use of Medicare, and the SHIP provides information and counseling to help Medicare beneficiaries select health insurance programs that best meet their needs.

ACL seeks to assist these state-based programs in providing their services to hard to reach beneficiaries.  Cooperative agreements of up to $150,000 will be awarded to successful applicants proposing to develop new and creative strategies and tools for connecting with hard to reach beneficiaries.  Entities eligible to apply include domestic public or private non-profit organizations.  Hard to reach populations include, but are not limited to, the following groups:

  •  Medicare Beneficiaries under age 65
  •  Lesbian, Gay, Bisexual, and Transgender Medicare Beneficiaries
  •  American Indian/Alaska Native Medicare Beneficiaries
  •  Beneficiaries located in rural areas
  •  Limited-English Speaking Beneficiaries
  •  Medicare Beneficiaries of Racial/Ethnic Minority Communities

An informational conference call will be held on Thursday, May 7, 2015 at 2:00 p.m. ET. To participate in the call, dial 1-888-566-5976, when prompted, enter passcode: 5922266.

Letter of Intent Due: April 30, 2015

Application Deadline: June 14, 2015

Click here to see the full announcement.

April 21, 2015 in Consumer Information, Grant Deadlines/Awards, Medicare | Permalink | TrackBack (0)

Talking about Sexuality, Gender, Aging and Cognition


On April 20, while the jury was hearing oral arguments on the high profile case of State of Iowa v. Henry Rayhons, I joined an academic colleague, Dr. Claire Flaherty, a neuropsychologist from Penn State Hershey Medical Center, to discuss the implications of this criminal case, during a Smart Talk public radio program in central Pennsylvania.  Claire and I have been engaged in a cross-discipline dialogue for about two years about a host of legal questions that can arise with a diagnosis of any form of dementia, including FTD and Alzheimer's Disease.   This time we were talking about the challenges of finding the right balance between protection from harm and recognition of human rights when the issue is sexual intimacy. Dr. Flaherty's clinical background, including her experience counseling individuals and families who are coping with the realities of dementia, helped make this a very down-to-earth conversation on a sensitive subject for live radio.

Our half of the program, was preceded by Joanne Carroll, president of TransCentral PA, and therapist and social worker Alexis Lake, a therapist and social worker who counsels LGBT clients, who discussed challenges and rights for transgender, gay, lesbian, and bi-sexual people, and the progress that has been made in the last decade, even as more progress needs to be made.  I was struck by their frankness, both about their personal journeys, and the potential costs for anyone transitioning, including simple costs associated with new documents of identity, to bigger questions about how to pay for any surgeries, including whether Medicare will pay for the older person's surgery. 

To listen to the two half-hour segments, here's a link to the podcast of WITF'-FM's Smart Talk program for April 20, 2015.

UPDATE:  Here is an alternative link to the Smart Talk Program described above, on "SoundCloud," and available in three segments, each about 15 to 20 minutes in length.  Our discussion of dementia and consent to sexual relations starts at about the 9 minute mark of Segment B.

Download 150420 SHOW A

 Download 150420 SHOW B

Download 150420 SHOW C 

April 21, 2015 in Cognitive Impairment, Crimes, Current Affairs, Dementia/Alzheimer’s, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Medicare, Science, State Cases, State Statutes/Regulations | Permalink | Comments (0) | TrackBack (0)

Medicare "Doc Fix" Bill-Impact on Medicare Beneficiaries

If you haven't had a chance yet to read the new law, you should take a look. Medicare Access and CHIP Reauthorization Act of 2015 was signed by the President on April 16, 2015. Among some of the provisions to note is section 211 which provides for a permanent extension of the QI program (which had expired effective April 1 and had been reauthorized a year at a time), a change to Medigap plans (section 401) and a change to the income-related premium increases for higher income beneficiaries for Part B and D (section 402). These last 2 are part of the offsets in the bill.  For the Medigap plans, effective in 2020, those newly eligible for Medicare won't be able to buy a gap plan to cover the Part B deductible.  The changes to the income-related premium adjustments take effect a little earlier (2018)  and those beneficiaries affected by the change will be paying more for their Medicare coverage.

April 21, 2015 in Current Affairs, Federal Statutes/Regulations, Medicare | Permalink | Comments (0) | TrackBack (0)

Monday, April 20, 2015

Day 8 Report from the Iowa Sexual Assault/Dementia Trial

On Monday, April 20, prosecution and defense made closing arguments in the trial of State of Iowa v. Henry Rayhons, a former state legislator, for alleged sexual abuse of his wife with Alzheimer's.

KIMT.Com's twitter account has photos combined with excerpts from the arguments, here

Over the weekend, reporter Sarah Boden at Iowa Public Radio ran a report on the trial, with the podcast available here.

Bryan Gruley, whose detailed December 2014 feature article for Bloomberg News on the Rayhon couple's history and the charges, remains the best account of the anticipated issues, has written a follow-up story for Bloomberg News about the trial itself, pointing to the potential long-range impact from the case.  See today's Questions about Sex and Dementia Go to Jury for the First Time. 

As before, if new details become available on public media about the trial, including any jury verdict today, we'll capture them on this post, with an update.

UPDATE: According to Iowa media sources, the jury adjourned for the day about 5 p.m. central time, after approximately an hour and a half of deliberations, including two questions from the jury.  

April 20, 2015 in Cognitive Impairment, Crimes, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (0) | TrackBack (0)

Compliance, Compliance, Compliance (a CCRC gets trapped by Medicare Rules)

Whenever I look at national programs on "hot topics" in healthcare law, I'm seriously impressed by the number of offerings on regulatory compliance issues connected to Medicare and Medicaid payments. There are abundant reasons for this emphasis. Each year the Department of Justice touts its statistics on "recoveries" for False Claim Act cases.  For the fiscal year ending September 30, 2014, the DOJ enthusiastically reported its "first annual recovery to exceed $5 billion" in a single year.  No wonder health care law is a hot field.  And remember, much of the money is connected to senior care in all of its guises. 

A recent $1.3 million settlement on a Medicare-related False Claims Act case might seem like small potatoes at first glance.  But, I was struck by the fact that it was a DOJ settlement with a (non-profit) Continuing Care Retirement Community.  I don't usually think of CCRCs as being a major target of False Claim Act allegations.  Details are a bit sparse, but the size of the payment seemed pretty hefty when you consider that Asbury Health Center near Pittsburgh, PA actually "self-disclosed" its violation of Medicare regulations.  The DOJ press release on April 15 explains:

"For post-hospital skilled nursing care, Medicare regulations require that a facility obtain a physician certification at the time of admission or as soon thereafter as reasonable and practical. The facility must also obtain a physician recertification within 14 days of admission and every 30 days thereafter. Based on information provided by Asbury, the United States alleged that it had civil claims against Asbury resulting from Medicare payments for post-hospital skilled nursing services that were not supported by physician certifications and recertifications."

Law 360 reports the explanation of Asbury's Chief of Staff about the settlement here.

April 20, 2015 in Current Affairs, Ethical Issues, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare | Permalink | Comments (0) | TrackBack (0)

Updates on the 2015 White House Conference on Aging

The 2015 White House Conference on Aging held two more regional forums, one in Phoenix and one in Seattle. There are two regional forums left, one in Cleveland on April 27 and one in Boston on May 28.

As well, the WHCOA will be sponsoring a webinar on April 23 on retirement security.  The website offers the following information about the webinar

With Americans living longer, pension options changing, and fewer workers spending careers with a single employer, the sources of retirement security are also changing.  This webinar will provide an overview of best practices to help ensure greater opportunity and ability to enjoy a financially secure retirement.  Speakers will include officials from the U.S. Treasury Department, the Women’s Institute for a Secure Retirement, and Harvard University.  Registration is required and open until April 22nd....  This is the third in WHCOA’s webinar series designed to raise awareness of the challenges and opportunities for older adults in the U.S. We hope you will join us for this engaging discussion of best practices for a secure retirement.

The webinar is free; registration is required. Click here to register.

April 20, 2015 in Current Affairs, Federal Statutes/Regulations, Programs/CLEs, Retirement, Social Security | Permalink | Comments (0) | TrackBack (0)

Friday, April 17, 2015

Day 7 Report from the Iowa Sexual Assault/Dementia Trial

On  April 17, the trial continued in State of Iowa v. Henry Rayhons.  The evidence included:

  • Testimony by a Des Moines geriatrician, Robert Bender: Testified as an expert witness for the defense to explain that Alzheimer's patients often retain sexual desire, even after losing other brain functions such as speech or memory, and can make a "meaningful decision" to be intimate with the person.  According to the Des Moines Register, Dr. Bender testified that it would be a "medical mistake" for a doctor to draw an arbitrary line between allowing a patient to kiss and hug but not allowing her to have sex, unless there was evidence the patient was being harmed by the activity.

Further, the defendant Henry Rayhons testified, giving his memory of key events, stating he did not have "sexual intercourse" with his wife on the night in question, while also describing what he means by their "playing."  A  video segment of his trial testimony is available here. Additional print media coverage of the final day of testimony on Friday is available here

Additional audio-recording evidence was reportedly presented, from a care conference between Henry, his wife's daughters, and the nursing home staff at which the prosecution alleges Mr. Rayhons was advised of the doctor's conclusion about his wife's inability to consent to sexual activity.  Both parties rested their cases on Friday, and according to media reports, the trial is scheduled to resume on Monday, April 27, with closing arguments by both the prosecution and defense. 

As additional media reports from the trial today become available, I will supplement this post. 

Additional, more comprehensive coverage of the testimony of Henry Rayhons is provided by Bloomburg News' Brian Gruley in Sex with your Wife or Rape? Husband of Alzheimer's Patient Takes the Stand.

In addition, Bloomberg News has "Let's Talk About Sex ... in Nursing Homes," an infographic that charts state policies on sexual rights of nursing home residents and other relevant demographics on population aging.

April 17, 2015 in Cognitive Impairment, Crimes, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (1) | TrackBack (0)

Searching for Answers to Questions about Continuing Care: Point/Counter Point

Scott E. Townsley, a very bright attorney, an adjunct associate professor at UMBC's Erickson School of Aging Studies, and a principal with CliftonLawsonAllen LLP, invited me to join him recently for a presentation to the 2015 Mid-Atlantic Region Resident Council Conference in Silver Spring, Md. (The lovely D.C. area cherry trees were in full bloom that day.) Cherry Trees at Riderwood Community 2015

Our theme was "Hot Topics in Continuing Care."  Scott, a regular consultant to nonprofit CCRCs, used his deep experience in senior housing to outline his perspective on the biggest issues facing CCRCs. In preparation for my part, I reached out to my contacts in resident groups around the country and asked them to share with me their biggest concerns. 

We then trimmed down our two respective lists and used a Point/Counter Point approach to the debate.  Do any of our readers remember 60 Minutes' James Kirkpatrick and Shana Alexander?  (Okay, how about Dan Aykroyd and Jane Curtin's lampoon of the Point/ Counter Point format?  I think it is fair to say that we were less political than the first combo, and more polite -- if less humorous -- than the SNL crew.  But we had fun.)

With a tip of the hat to David Letterman in borrowing his "top ten" format, here is a very distilled version of my list of Resident Concerns:

10. What does it really mean to be a nonprofit CCRC in 2015?

9.  Do we need to worry about conversions of nonprofit CCRCs to for-profit?

8.  What is the right response to the trend that residents are older and more disabled, even when first entering the community?

Continue reading

April 17, 2015 in Consumer Information, Dementia/Alzheimer’s, Discrimination, Health Care/Long Term Care, Housing, Property Management, Retirement, State Statutes/Regulations, Web/Tech | Permalink | Comments (3) | TrackBack (0)

Thursday, April 16, 2015

Day 6 Report from Iowa Sexual Assault-Dementia Trial

April 16, 2015 was the sixth day of trial in the criminal prosecution for sexual abuse in the third degree, in State of Iowa v. Henry Rayhons.  The prosecution completed its case-in-chief, the trial judge denied defense counsel's motion for judgment of acquittal, and the defense counsel called several witnesses for Mr. Rayhons.  Today's evidence, as described by various media sources linked below, included:

  • Final Witness for the Prosecution:  The state called a state criminologist to explain testing on various items of physical evidence,from the night in question.  According to media coverage of the trial, the criminologist  testified that "she did not find any seminal fluid in the sexual assault kit [on swabs from Donna taken on the night in question] but says that is not uncommon." She testified there "appeared to be a seminal fluid stain in the inside of Donna’s underwear," the same underwear that was alleged to have been deposited in a laundry hamper by the defendant on the night in question. Tests on the stain "detected DNA from [the defendant]."
  • The First Witness for the Defense, the "Roommate:" The woman who shared Donna Rayhons' room in the nursing home the night on question, was reported as testifying that  "Donna had become a good friend. Someone who she could count on to go to activities and speak with."  She is reported to have testified she’s "uncomfortable talking about that day but says she does remember something happening, but only assumed that it was sex on the other side of the curtain."
  • A Clinical Physician (and Assistant Professor of Medicine from the University of Iowa):  The defendant's expert witness is reported as having given opinion testimony to the effect that based on review of evidence, ""I believe Donna would've been more likely to give consent than not."
  • Patricia Wright, a Daughter of Donna Rayhons (called by the Defense): Reported as saying her mother "lit up" whenever Henry Rayhons entered the room.
  • The Son and Daughter of Henry Rayhons:  Describing their relationship with their father, their  father's relationship with Donna, and their own respect for Donna.

As described by the Globe Gazette, there appeared to be especially poignant testimony from one of Donna's daughters, Patricia: 

In July, Donna Lou Rayhons asked her daughter, Patricia Wright, if she had seen Henry. “He can’t come anymore,” Wright remembered her mother saying.

 

“Mom was talking very softly. Much more softly than she usually did and she kept putting her hand to her head. My impression was she was very sad,” Wright told the jury. “Then she would say things like ‘I love him. I love my girls. I love him. I love my girls.’ And she would say that kind of repeatedly.”

As more reports are published from the 6th day of the Rayhons trial, I will try to capture them here with a supplement to this Blog Post. 

UPDATE: Here is a link to a more detailed account of the trial testimony on Thursday from The Des Moines Register, explaining that Donna Rayhons had three daughters, including Patricia, from a prior marriage.  One of the other daughters testified for the prosecution.

April 16, 2015 in Cognitive Impairment, Crimes, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (0) | TrackBack (0)