Sunday, March 20, 2016

Old and Behind Bars

We have previously written about the topic of elder inmates and the implications for prisons with the graying of the prison population. Here is one more story on the topic, published March 17, 2016. Pew Charitable Trust's Stateline (which "provides daily reporting and analysis on trends in state policy....") ran the story, Elderly Inmates Burden State Prisons.

Nearly every state is seeing that upward tick in elderly state prisoners. In Virginia, for example, 822 state prisoners were 50 and over (corrections officials usually consider old age for prisoners to begin at 50 or 55) in 1990, about 4.5 percent of all inmates. By 2014, that number had grown to 7,202, or 20 percent of all inmates.

For state prisons, the consequence of that aging is money, more and more of it every year. Health care for aging prisoners costs far more than it does for younger ones, just as it does outside prison walls. Corrections departments across the country report that health care for older prisoners costs between four and eight times what it does for younger prisoners.

In terms of reducing the number of elder inmates, according to the study, some states are using diversion programs, early release or compassionate release.  We all have heard about increasing longevity, but that doesn't necessarily explain the rise in elder inmates. The story notes that correctional personnel offer two factors to explain this rise: "[o]e is a steady increase in the rate of older adults entering prison. The second, and more potent, factor is changes enacted in the get-tough-on-criminals 1990s that resulted in longer prison sentences."

Knowing about the physical limitations some may have as they age, one can only imagine the accommodations prisons have had to make, including the use of "ramps and shower handles and ... other physical modifications. Many prisons have had to create assisted living centers with full-time nursing staffs.... In addition, at least 75 U.S. prisons ..., provide hospice services for dying prisoners...."

One prison mentioned in the story has an ALF, but the waiting list is such that prisoners must need assistance with 2 or more ADLs to be considered. Poor health when entering prison is not unusual. And being old and in prison may be even tougher than for younger inmates.

Prison is a particularly treacherous place to get old. Getting to a top bunk is difficult for many aging prisoners, as is climbing stairs. Hearing loss, dementia and general frailty can make it difficult to comprehend or obey rules. And being infirm in an institution full of young predators can make older prisoners vulnerable. “If there’s an old lion or gazelle... the young ones are going to take advantage.”

Once they get out, finding a place to go becomes another challenge according to the article. Some states have taken different approaches to deal with the graying prison population, from financing the facilities that provide the needed care (such as a dementia unit in the prison) to  contracting with a private facility to provide the care to "geriatric conditional release."

And what about the likelihood of reoffending?  "Studies have found that older ex-offenders are less likely than younger ones to commit additional crimes after their release. But politicians and the public don’t seem willing to release former murderers, rapists and sex offenders, even though they are decades removed from their crimes and physically incapable of repeating them...."

March 20, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Thursday, March 17, 2016

Los Angeles Times: "Visitation Rights" Bills Under Consideration in Ten States

To follow up on an earlier Elder Law Prof Blog post about recently enacted "visitation rights bills," we note that the Los Angeles Times has reported on advocacy efforts by high-profile children such as Catherine Falk, daughter of actor Peter Falk, and Kerri Kasem, daughter of Casey Kasem, in support of similar legislation in other states: 

Though Falk and Kasem work independently, they've become a powerful one-two punch for reforming visitation laws, stumping for change in more than 30 states. Falk says her proposed legislation is now being considered in 10 states; Kasem's bill has already been adopted in three — California, Iowa and Texas.

 

The two agree their efforts are getting notice because of their celebrity fathers, and have little problem with such an advantage. "This isn't the Casey Kasem Bill, or the Mickey Rooney Bill, or the B.B. King Bill," Kasem said, referring to other personalities who went through similar elder battles. "It's the Visitation Rights Bill, and it affects thousands in the U.S."

The comments posted in reaction to the article are also interesting, with some pointing out that in both the Kasem and Falk families, the disputes involved women married for decades to the celebrities in question.   Others point to the question of how ordinary families cope with these kinds of access issues, especially without the money or time to pursue rulings by courts.

For more read "These Children of Celebrity Dads Are Taking Their Stepmoms to Court."

March 17, 2016 in Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Thursday, March 10, 2016

New Issue of eNewsletter from National Academy on an Aging Society

The Gerontological Society of America has released the latest issue of its e-newsletter from the National Academy on an Aging Society.  The March 2016 Public Policy & Aging Report is focused on elder wealth, cognition and abuse.  As the forward explains

This edition of Public Policy & Aging Report is the fourth coproduced issue between the National Academy on an Aging Society and Age UK in 4 years. It comes at a prescient moment and deals with an increasingly recognized and important challenge: the impact of cognitive decline on the financial health of older people. Age UK has, for many years, been interested in cognitive aging and is recognized as an authority in this area. We were participants in the G7 Summit on Dementia, we contributed to the many G7 legacy meetings, and we were members of the 2014 World Innovation Summit on Health (WISH) dementia working group. In October 2015, we were cofounders of the Global Council on Brain Health, working with our partner in the United States, AARP. We also are very pleased to be hosting the World Economic Forum symposium on “Ageing, Cognitive Decline and Impact on Banking and Insurance” in London on February, 2016. In research, we pioneered one of the world’s leading studies on cognitive aging at the University of Edinburgh, the “Disconnected Mind,” a longitudinal study that is revealing the secrets of cognitive performance and age, in a way in which cross-sectional studies cannot.

We also have been partners in some of the United Kingdom’s leading research on elder financial abuse, notably with Brunel University in London. Our concern in all these endeavors is not only to generate evidence but also to use this knowledge and apply it to the benefit of our aging populations. Our mission is to improve later life, in the United Kingdom and internationally, and to achieve our vision of a world in which people can love later life. So, I welcome this edition, bringing together as it does leading experts from both sides of the Atlantic and distilling their accumulated wisdom into a volume which I hope will inspire, inform, and lead to action in this critical area.

March 10, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care | Permalink | Comments (0)

Wednesday, March 9, 2016

New Survey-Public Views on Alzheimer's

WebMD and the Shriver Report did a survey on people's knowledge, actions and attitudes about Alzheimer's Disease which revealed "[p]eople recognize the seriousness of Alzheimer’s disease, but they aren’t taking steps to learn about their personal chances of getting the disease or to prepare for it financially...."  Survey Reveals Beliefs, Behaviors on Alzheimer’s was published on February 25, 2016 and reveals some startling information, such as a large percentage of those surveyed indicated they aren't prepared, financially or otherwise, to deal with the disease.  The survey results note that there is "a disconnect in how much respondents really want to know about their risk of getting the disease — it’s the sixth leading cause of death in the U.S. and has no cure. Two-thirds of people say they’d want to know their risk for developing Alzheimer’s later in life. But when presented with a list of ways to do that, a much smaller percentage say they have taken or would take steps to do it."  The survey also inquired about caregiving, attitudes about a likely cure for Alzheimer's and whether the respondents knew someone with Alzheimer's; 78% responded they knew someone with the disease. An infographic with key findings is available here.  An earlier issue of the Shriver Report on the topic is available here.

WebMD's special report on Alzheimer's is available here.

 

A companion survey of doctors was done by Medscape.

March 9, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care | Permalink | Comments (0)

Tuesday, March 8, 2016

Continuing Legal Education Courses on Alzheimer's Disease

The promotional material catches your eye: "Every 67 seconds someone in the U.S. develops Alzheimer's Disease.  5.3 million Americans have the disease."

I'm seeing more programming being offered to practicing lawyers on dementia-related issues generally and specifically about Alzheimer's Disease.  An example is an upcoming program (June 2016) from the Pennsylvania Bar Institute, describing a program on Alzheimer's Disease: "From diagnosis to legal documents, everything you need to counsel your client."  The speakers for the day include three medical professionals, Paul J. Eslinger, PhD from Penn State Hershey Medical Center, Barry V. Rovner, M.D. from Thomas Jefferson University in Philadelphia, and Oscar L. Lopez, M.D., from University of Pittsburgh.

For more about the program, see PBI's website here.  

 

March 8, 2016 in Cognitive Impairment, Dementia/Alzheimer’s, Estates and Trusts, Health Care/Long Term Care, Programs/CLEs | Permalink | Comments (0)

Monday, March 7, 2016

The Casey Kasem Legacy? States Adopt "Notice, Communication and Visitation" Laws

In the last months before the death of Casey Kasem, children from his first marriage and his second wife engaged in a high profile struggle over where, how and with whom the aging celebrity would spend time, with the disputes -- and the famous disc jockey himself -- crossing state borders. The controversies lasted even after his death on June 15, 2014, as his second wife reportedly flew his body out of the U.S. for burial in Oslow, Norway.  

Drawing upon these traumatic experiences, one daughter, Kerri Kasem, advocates for passage of state legislation in an effort to better define family members' rights of access and communication in such complicated family matters. Her foundation, Kasem Cares, will host a "Conference on Aging" on April 21-23, 2016 in Orange County California and it seems likely from the agenda that proposed better practices will be discussed.  

To date, at least three states have adopted new laws that appear to reflect the legal issues in the Casey Kasem family disputes, including:

  • Iowa, I.C.A. Section 635.635 (amended) and Section 633.637A (added), providing that all adult wards subject to a court-ordered guardianship continue to have the right to communicate, visit and interact with other persons, and that a court will approve a guardian's denial of such interaction "only upon a showing of good cause."  Changes to the law became effective on July 1, 2015.
  • Texas, Estates Code, Section 1151.055, "Application by Certain Relatives for Access to Ward; Hearing and Court Order, and Section 1151.056 on "Guardian's Duty to Inform Certain Relatives About Ward's Health and Residence," effective June 19, 2015. Together these guardianship-connected rules permit designated family members to apply for a court order permitting communication or visitation with a ward, and obligate a guardian to give family members notice of the ward's admission to medical facilities, change of residence, or death, unless the family member makes a written "waiver" of such communications.  For more see the Texas Guardianship Law Update in the September/October 2015 issue of The Houston Lawyer.
  • California, Assembly  Bill No. 1085, amended Cal. Prob. Code Section 2351, to provide that not only does a person who is the subject of a guardianship or conservatorship continue to have "personal rights" such as the "right to receive visitors," but that the court may issue an order that "grants the conservator the power to limit or enforce the conservatee's rights, or that "directs the conservator to allow those visitors, telephone calls and personal mail."  The California Probate Code was further changed to add provisions, Section 2361 and Section 4691, expressly providing that conservators shall mail notice of a conservatee's death to any spouse, domestic partner or, in essence, any person who has "requested special notice," and imposing a similar duty of notice regarding death of a principal, for certain agents acting under specified powers in a power of attorney for health care.  For more on the California legislation, signed by California  Governor Brown on July 14, 2015, and made effective on January 1, 2016, see the Los Angeles Times article, Casey Kasem Controversy Leads to New Rights for Children of Ill Parents.

These three new pieces of legislation, despite similarities in purpose -- i.e., recognition of family members' interest in continued communications with a loved one who has become a "court ward," -- are quite different in effect.  It will be important to see whether such provisions can be used to ease family tensions or instead serve as a frustrating, procedural gauntlet for warring factions. The Texas law seems to me to go the furthest in recognizing an affirmative right of a family member to challenge an attempt by a guardian or conservator to limit access.

Continue reading

March 7, 2016 in Cognitive Impairment, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (1)

Sunday, March 6, 2016

An App For Medication Reminders

People Magazine ran a story last week about six Kentucky Middle-Schoolers (you read that right) who have created an app to help those with dementia and Alzheimer's to remember to take their medications. "The Meyzeek Middle School seventh-graders recently became one of eight teams to win the prestigious Verizon Innovative App Challenge, earning $20,000 for their school's STEM learning and a chance to bring their app to life with the help of Massachusetts Institute of Technology coding experts."

Kentucky Middle School Girls Develop App to Assist Alzheimer's and Dementia Patients: 'This Is a Tribute to My Grandfather' explains the project is the brainchild of Ellie Tilford who experienced first-hand the struggle for many of those with dementia to remember to take meds. "The girls' concept, Pharm Alarm, sends alert messages to patients when it's time to take their meds – if they forget, family members and doctors are immediately notified." Not only does the app have the alarm that alerts the phone-tree of contacts, it also  includes "a pill log, which allows caregivers to scan in medicinal information through a pill container's labeled barcode, and a compliance graph for doctors to measure what percentage patients are taking their pills and attending doctor appointments."  The article notes that the app should be available for download in June of this year.  

Thanks to Stetson Law alum Erica Munz for sending me the link to the story.

March 6, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Web/Tech | Permalink | Comments (0)

Tuesday, February 23, 2016

More Articles on Physician-Aided Dying

Here are three recent articles of note on Physician-Aided Dying (PAD) that might be useful in your classes.

First,  the Journal of the American Medical Association (JAMA) Psychiatry ran at article on February 10, 2016, Physician-Assisted Death for Patients With Mental Disorders—Reasons for Concern.  As the article opens: 

Physician assistance to help people end their lives—by prescribing or directly administering medication—is now legal in some form in 4 American states, Canada, and 4 European countries. In the United States, laws permitting physicians to write prescriptions for medications intended to end patients’ lives are limited to patients with terminal conditions and preclude physician administration of the medication. However, other countries, including the Netherlands, allow direct physician involvement and have expanded the criteria to include patients with irremediable suffering, whatever the cause. Therefore, the door has been opened for people whose suffering is primarily due to mental disorders to seek assistance in dying. (citations omitted)

Next in the same volume is the article about the study referenced in the first article: Euthanasia and Assisted Suicide of Patients With Psychiatric Disorders in the Netherlands 2011 to 2014.  The full article is free, and the tables and references are also available in the online version.  The authors conclude

Despite some limitations, an important strength of our study is that we examined reports of actual psychiatric EAS cases across an entire jurisdiction, rather than asking physicians to recollect their experiences or opinions. The results show that the patients receiving EAS are mostly women and of diverse ages, with various chronic psychiatric conditions, accompanied by personality disorders, significant physical problems, and social isolation or loneliness. Refusals of treatment were common, requiring challenging physician judgments of futility. Perhaps reflecting the complexity of such situations, the physicians performing EAS generally sought multiple consultations (but not always), and disagreement among physicians—especially regarding competence and futility—was not unusual. Despite these complexities, a significant number of physicians performing EAS were new to the patients. We conclude that the practice of EAS for psychiatric disorders involves complicated, suffering patients whose requests for EAS often require considerable physician judgment. The retrospective oversight system in the Netherlands generally defers to the judgments of the physicians who perform and report EAS. Whether the system provides sufficient regulatory oversight remains an open question that will require further study.

The New York Times ran an article about the study on February 10, 2016. Assisted Suicide Study Questions Its Use for Mentally Ill notes that

A new study of doctor-assisted death for people with mental disorders raises questions about the practice, finding that in more than half of approved cases, people declined treatment that could have helped, and that many cited loneliness as an important reason for wanting to die. The study, of cases in the Netherlands, should raise concerns for other countries debating where to draw the line when it comes to people’s right to die,

Discussing the findings from the study, the NY Times article notes that that it

finds that cases of doctor-assisted death for psychiatric reasons were not at all clear-cut, even in the Netherlands, the country with the longest tradition of carefully evaluating such end-of-life choices. People who got assistance to die often sought help from doctors they had not seen before, and many used what the study called a “mobile end-of-life clinic” — a nurse and a doctor, funded by a local euthanasia advocacy organization.

Good sources for your classes and for students writing papers on the topic!

 

February 23, 2016 in Advance Directives/End-of-Life, Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, International, Science | Permalink | Comments (0)

Only Limited Authority as Health Care Agents? The Latest Grounds to Challenge Dreaded Arbitration Clauses in NH Cases

The New York Times offers another window into concerns about pre-dispute binding arbitration provisions that are routinely found in nursing home agreements.  This is a long-simmering war, with many battlefronts and tactical arguments, as documented in the article.  However, the article also focuses on a narrow group of cases where courts have rejected a binding effect for arbitration clauses signed by someone serving "merely" as a health care agent for the incapacitated resident. (I hope my Contracts course students this semester are reading this article!)  

The article offers an additional opportunity to consider the tensions between public policies on either side of the debate over "fairness" of arbitration as a forum for consumer claims:

Arbitration clauses have proliferated over the last 10 years as companies have added them to tens of millions of contracts for things as diverse as cellphone service, credit cards and student loans.. Nursing homes in particular have embraced the clauses, which are often buried in complex contracts that are difficult to navigate, especially for elderly people with dwindling mental acuity or their relatives, who can be emotionally vulnerable when admitting a parent to a home.

 

State regulators are concerned because the secretive nature of arbitration can obscure patterns of wrongdoing from prospective residents and their families. Recently, officials in 16 states and the District of Columbia urged the federal government to deny Medicaid and Medicare money to nursing homes that use the clauses. Between 2010 and 2014, hundreds of cases of elder abuse, neglect and wrongful death ended up in arbitration, according to an examination by The New York Times of 25,000 arbitration records and interviews with arbitrators, judges and plaintiffs.

 

Judges have consistently upheld the clauses, The Times found, regardless of whether the people signing them understood what they were forfeiting. It is the most basic principle of contract law: Once a contract is signed, judges have ruled, it is legally binding.

 

Mr. Barrow’s case [set for trial in Massachusetts] is pivotal because, with the help of his lawyers, he has overcome an arbitration clause by using the fundamentals of contract law to fight back. As is often the case when elderly people are admitted to nursing homes, Mr. Barrow signed the admissions paperwork containing the arbitration clause on his mother’s behalf.

 

Although his mother had designated Mr. Barrow as her health care proxy — someone who was authorized to make decisions about her medical treatment — his lawyers argued that he did not have the authority to bind his mother to arbitration.

For more, read Pivotal Nursing Home Suit Raises a Simple Question: Who Signed the Contract?

Our thanks to attorneys Karen Miller in Florida and Morris Klein in Maryland, plus Dickinson Law students Joe Carroll, Corey Kysor and Kadeem Morris in Pennsylvania for sending us the link to the NYT coverage.

February 23, 2016 in Cognitive Impairment, Consumer Information, Crimes, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare, Statistics | Permalink | Comments (0)

Monday, February 22, 2016

Good News on the Dementia Front?

The latest issue of the New England Journal of Medicine (NEJM) has two articles about a recent study on dementia.  The first Is Dementia in Decline? Historical Trends and Future Trajectories and the second is Incidence of Dementia over Three Decades in the Framingham Heart Study.

A subscription is required to access the full article about the Incidence article, but a free preview is available.  Here is an excerpt from the preview

Background

The prevalence of dementia is expected to soar as the average life expectancy increases, but recent estimates suggest that the age-specific incidence of dementia is declining in high-income countries. Temporal trends are best derived through continuous monitoring of a population over a long period with the use of consistent diagnostic criteria. We describe temporal trends in the incidence of dementia over three decades among participants in the Framingham Heart Study.

The Dementia in Decline perspective article is available for free. A pdf of the article is available here.  Here is the opening paragraph from that article

In 2005, researchers from the Duke Center for Demographic Studies reported a “surprising trend”: data from the National Long-Term Care Surveys showed that the prevalence of severe cognitive impairment in the Medicare population had decreased significantly between 1982 and 1999. At a time when baby-boomer demographics led to predictions of a looming dementia crisis, this finding offered hope. Since that time, other reports have similarly shown that the incidence or prevalence of dementia is decreasing in various populations. Researchers have offered many possible explanations, including increased wealth, better education, control of vascular risk factors, and use of statins, antihypertensive agents, and nonsteroidal antiinflammatory drugs. However, even as researchers describe their “cautious optimism” about specific populations, they still project a quadrupling of global prevalence over the coming decades. (citations omitted)

February 22, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Science | Permalink | Comments (0)

Friday, February 19, 2016

Call for Papers: Aging & Society: Sixth Interdisciplinary Conference

The 2016 Aging & Society: Sixth Interdisciplinary Conference has released a call for papers for the October 6-7, 2016 conference to be held in Sweden. The call for papers includes papers,  poster presentations, workshops/interactive sessions, or colloquia on one of the four conference themes.  The themes are economic and demographic perspectives,  social and cultural perspectives, medical perspectives and public policy perspectives. More information is available here.

February 19, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, International, Programs/CLEs | Permalink | Comments (0)

Tuesday, February 16, 2016

Diane Rehm and More on Assisted Dying

Many of you recognize the name Diane Rehm, from NPR, where she has had her show, The Diane Rehm Show, for many years. "Retiring" at the end of 2016 doesn't mean she will be out of the public eye, according to a recent article in the Washington Post. Diane Rehm’s next act: Using her famed voice to fight for the good death is a profile of Mrs. Rehm that also summarizes her writings.  Her 2014 memoir relates how her husband ended his life on his own by refusing food and fluids, since physician-aided dying is not legal in their state. 

Mrs. Rehm is quoted "[I]t’s time for me to retire, especially on the issue of right-to-die, to be able to speak out and to speak freely....”  In addition to supporting the right to die, she plans to champion research on Alzheimer's and Parkinson's.

February 16, 2016 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Retirement | Permalink | Comments (0)

Monday, February 15, 2016

Time Magazine's 4th Cover Issue on "Hope" for Alzheimer's Disease Solutions

Time Magazine's February 29 issue has a provocative image and title, showing a silhouette of a young woman about to ingest a spotlighted, shining capsule.  The issue, titled "The  Alzheimer Pill: A Radical New Drug," focuses on a pill called LM 11 A-31.

By my count, this is at least the fourth cover by Time focused on the latest hopes for a solution to this disease. Prior issues include:

  • October 25, 2010: Alzheimer's: At Last Some Progress Against the Most Stubborn Disease
  • May 14, 2001: Believe it or Not, this 91 Year-Old Nun Could Help Your Beat Alzheimer's, promoting a "landmark study of the disease." 
  • July 17, 2000: The New Science of Alzheimer's Disease

 

February 15, 2016 in Cognitive Impairment, Dementia/Alzheimer’s, Science | Permalink | Comments (0)

Friday, February 12, 2016

Family Dynamics and Caregiving: A Bumpy Road or Smooth Sailing?

Every family has its own unique dynamics with siblings having specific relationships with siblings and with parents.  When a parent needs caregiving, those dynamics can play a role, according to an article posted on the AARP website on January 27, 2016.  The article, When a Troubled Past Affects Present Caregiving, quotes a family therapist who explains:

According to family therapy pioneer Ivan Boszormenyi-Nagy, we subconsciously keep tallies in our relationships — who has done what for whom over time. As a result, our past interactions with family members powerfully shape our responses to calls for care... [a] history of feeling neglected generally creates resentful caregivers.

The article offers several suggestions for helping focus past relationships into positive caregiving decisions including not being trapped by the past, remembering the good, and focusing on values rather than revenge when decision-making. "Living that value through caregiving doesn't completely erase the pain of a flawed past relationship. But it affirms that you are not so hamstrung by old hurts that you can't rise above them and be the kind of person you wish your parent, sibling or whomever you're caring for had been."

 

February 12, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Health Care/Long Term Care | Permalink | Comments (0)

Thursday, February 4, 2016

New Brochure-Caregiver Advocates

The National Center on Elder Abuse (NCEA) sent an email to the elderabuse listserv on February 4, 2016 that announced the release of a new brochure for family caregivers on how to advocate for those in their care with dementia.  The email announcement explained that the

material was created by the USC Department of Family Medicine, with funds provided by the Archstone Foundation, and was developed using input from actual family caregivers of people with dementia through informant interviews and focus groups. The brochure provides information about elder abuse, tips for caregivers on how to protect and advocate for their loved ones, real life scenarios, and resources. The goal of this brochure is to help family caregivers of people with dementia to learn how to take care of themselves in order to prevent mistreatment....

The brochure explains elder mistreatment, offers tips on advocating for and protecting relatives with dementia and provides helpful contacts along with examples. The web version is available here and the print version, here.

 

February 4, 2016 in Cognitive Impairment, Consumer Information, Crimes, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship | Permalink | Comments (0)

Thursday, January 28, 2016

If The Issue Is Accountability, Which Is Better? Power of Attorney or Guardianship?

Here are two recent appellate cases that offer views on issues of "accountability" by surrogate-decision makers.  

In the case of In re Guardianship of Mueller (Nebraska Court of Appeals, December 8, 2015), an issue was whether the 94-year-old matriarch of the family, who "suffered from moderate to severe Alzheimer's disease and dementia and resided in a skilled nursing facility," needed a "guardian."  On the one hand, her widowed daughter-in-law held "powers of attorney" for both health care and asset management, and, as a "minority shareholder" and resident at Mue-Cow Farms, she argued she was capable of making all necessary decisions for her mother-in-law.  She took the position that appointment of another family member as a guardian was unnecessary and further, that allowing that person to sell Mue-Cow Farms would fail to preserve her mother-in-law's estate plan in which she had expressly devised the farm property, after her death, to the daughter-in-law.  

The court, however, credited the testimony of a guardian-ad-litem (GAL), who expressed concern over the history of finances during the time that the daughter-in-law and the mother-in-law lived together on the farm, and further, expressing concerns over the daughter-in-law's plans to return her mother-in-law to the farm, even after a fall that had caused a broken hip and inability to climb stairs.  Ultimately, the Court of Appeals affirmed the lower court's appointment of the biological daughter as the guardian and conservator, with full powers, as better able to serve the best interest of their elder.  

Despite rejection of the POA as evidence of the mother's preference for a guardian,  the court concluded that it was "error for the county court to authorize [the daughter/guardian] to sell the Mue-Cow property.... There was ample property in [the mother's] estate that could have been sold to adequately fund [her] care for a number of years without invading specifically devised property." 

In an Indiana Court of Appeals case decided January 12, 2016, the issue was whether one son had standing to request and receive an accounting by his brother, who, as agent under a POA, was handling his mother's finances under a Power of Attorney.  In 2012, Indiana had broadened the statutory authority for those who could request such an accounting, but the lower court had denied application of that accounting to POAs created prior to the effective date of the statute.  The appellate court reversed:

The 2012 amendment did confer a substantive right to the children of a principal, the right to request and receive an accounting from the attorney in fact. Such right does apply prospectively in that the child of a principal only has the statutory right to request an accounting on or after July 1, 2012, but not prior to that date. The effective date of the powers of attorney are not relevant to who may make a request and receive an accounting, as only the class of persons who may request and receive an accounting, and therefore have a right to an accounting, has changed as a result of the statutory amendments to Indiana Code section 30-5-6-4. Therefore, that is the right that is subject to prospective application, not the date the powers of attorney were created

These cases demonstrate that courts have key roles in mandating accountability for surrogate decision-makers, whether under guardianships or powers of attorney.

January 28, 2016 in Advance Directives/End-of-Life, Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Property Management, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Wednesday, January 27, 2016

Learning for Learning's Sake?

Isn't that a great thought. Students learning for thee sake of learning!  The New York Times ran at article on January 1, 2016 on that exact topic. Older Students Learn for the Sake of Learning explains those "the 150,000 men and women nationally who participate each year at more than 119 Osher Lifelong Learning Institutes. The institutes, affiliated mostly with colleges and universities, are among the best-known advanced adult educational programs in the country. Along with an array of other such programs fitting under the “lifelong learning” umbrella, they tend to attract educated, passionate people who are seeking intellectual and social stimulation among peers who often become new friends."

The article distinguishes this type of learning from the more traditional adult ed classes, since "lifelong learning programs position themselves as communities where the participants not only take on challenging subjects but also seek to engage more deeply with their fellow students."  The article runs through the research on the advantages to ongoing education to a sharp brain.

Keep on learning everyone!

January 27, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Retirement | Permalink | Comments (0)

Monday, January 25, 2016

Stopping Alzheimer's?

Earlier this month I read an article about the role of brain inflammation in Alzheimer's.  Scientists May Have Just Discovered the Key to Halting Alzheimer's  was published on January 11, 2016 in Huffington Post Science.  "Researchers at the University of Southampton in England conducted a series of experiments showing a chemical that reduces neuroinflammation may have the potential to protect against the memory and behavioral changes associated with the disease that affects roughly 5.3 million Americans."  The article explains the research and notes that "[a]n overactive immune system can result in chronic inflammation, which previous research has linked to Alzheimer's. These new findings makes it increasingly apparent that inflammation is not a result of Alzheimer's as much as a key driver of the disease." Further research will be taking place.  Exciting!

January 25, 2016 in Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Science | Permalink | Comments (0)

Science, Elder Law and Genetic Counseling...

I think I might like winter better, if it always happened "conveniently" and with plenty of notice, as did Saturday's snow in Pennsylvania.  For once, I was prepared to be at home, with a stack of good reading materials for catching up when the joys of house-cleaning and snow shoveling faded. 

I am intrigued by the Fall 2015 issue of the NAELA Journal that focuses on how advances in genetic testing and medicine may be reflected in the roles of lawyers who specialize in elder and special needs counseling.  A leading article in the issue introduces the three primary uses of modern genetic testing -- for diagnosis of disease, for determination of carrier status, and for predictive testing -- while reminding us there are limits to each function.  In looking at age-related issues, the authors note:

 

Genetic testing is beginning to reveal information regarding susceptibilities to the dis­eases associated with old age: Alzheimer’s disease, Parkinson’s disease, diabetes, and cancer. Genetic test results showing a higher risk of such diseases can result in a cascade of conse­quences. Francis Collins, mentioned at the beginning of this article, responded to his test results thoughtfully by making lifestyle changes to reduce the probability that the increased genetic risk would be expressed in actual disease. It is important to note that, for some con­ditions, lifestyle factors’ influence on disease risk is understood; however, for many of the conditions that affect seniors, this influence is not yet known.

 

Other reactions to a high-risk test result may be more aggressive than diet and exer­cise changes. A well-publicized example is Angelina Jolie’s bilateral mastectomy. She was cancer-free but learned that she carries a BRCA1 mutation, which increases her lifetime risk for breast and ovarian cancer. She chose to undergo prophylactic mastectomy to reduce her breast cancer risk, whereas other women choose to increase breast cancer surveillance, such as undergoing more mammograms and breast MRIs. Both options are available to women who carry a BRCA1/2 mutation.

 

Will those found to be at elevated risk for more complex conditions such as Alzheimer’s disease or Parkinson’s disease make premature life choices, such as early retirement or mar­riage, based on perceived risk? Earlier in this article it is explained that an individual’s geno­type rarely determines his or her medical destiny. For example, many people with a higher genetic risk for Alzheimer’s disease will not actually develop it, while many with no apparent higher genetic risk will. Is the risk that members of the general public will misunderstand and overreact to the results of a genetic test sufficient reason to prevent them from obtaining the information gleaned from such a test? Should we be ensuring that those undergoing genetic testing are aware of its benefits and limitations through individualized genetic counseling? This, of course, presents its own challenges of access and availability.

In reading this, it seems likely that lawyers may encounter complicated issues of confidentiality, especially when counseling "partnered" clients, while also increasing the significance of long-range financial planning and assets management.  

For more, read Genetic Testing and Counseling Primer for Elder Law and Special Needs Planning Attorneys, by CELA Gregory Wilcox  and Rachel Koff, Licensed Certified Genetic Counselor. 

January 25, 2016 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Discrimination, Estates and Trusts, Ethical Issues, Retirement, Science | Permalink | Comments (0)

Wednesday, January 20, 2016

JAMA Current Issue Death, Dying and End of Life

The January 19, 2016 issue of the Journal of the American Medical Association (JAMA) is a theme issue on Death, Dying and End of Life.  There are 15 articles and opinion pieces on a range of topics, including several on physician-aided dying, as well as an audio of the editors' summary.  Check it out!

January 20, 2016 in Advance Directives/End-of-Life, Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care | Permalink | Comments (0)