“Let it be clear that every one of these allegations are products of the increased confusion and memory loss that Dad has demonstrated in recent years,” Andy and Jan Aldrin said.
Their father had started associating with a few people who were “trying to drive a wedge between Dad and the family,” Andy Aldrin said. The siblings said they would not allow “opportunistic agents to grab the spotlight, break our family apart.”
They said they were also concerned about his increasingly lavish lifestyle, which grew to more than $70,000 a month at a time when he stopped accepting paid speaking engagements. His annual salary from the foundation was $36,000.
Monday, July 16, 2018
The National Academies Press has released Future Directions for the Demography of Aging.This volume contains the proceedings of a workshop and the overview explains
Almost 25 years have passed since the Demography of Aging (1994) was published by the National Research Council. Future Directions for the Demography of Aging is, in many ways, the successor to that original volume. The Division of Behavioral and Social Research at the National Institute on Aging (NIA) asked the National Academies of Sciences, Engineering, and Medicine to produce an authoritative guide to new directions in demography of aging. The papers published in this report were originally presented and discussed at a public workshop held in Washington, D.C., August 17-18, 2017.
The workshop discussion made evident that major new advances had been made in the last two decades, but also that new trends and research directions have emerged that call for innovative conceptual, design, and measurement approaches. The report reviews these recent trends and also discusses future directions for research on a range of topics that are central to current research in the demography of aging. Looking back over the past two decades of demography of aging research shows remarkable advances in our understanding of the health and well-being of the older population. Equally exciting is that this report sets the stage for the next two decades of innovative research–a period of rapid growth in the older American population.
Part 1 looks at trends in health and health disparities, Part 2 examines the implications of social and environmental factors, Part 3 covers families and intergenerational issues, Part 4 covers employment and retirement, Part 5 discusses cognitive issues and disability, Part 6 reviews global aging and Part 7 offers new approaches. You can purchase the softcover book here, download a free pdf of the book by clicking here or read the book online.
Thursday, July 12, 2018
What Lessons Will Emerge From Arizona Investigation of 92-Year Old Woman Who Shot and Killed Her 72-Year Old Son?
Reading the news of a July 2 shooting was chilling, especially for anyone associated with long-term care or elder care. According to Arizona news reports, Anna Mae Blessing, age 92, explained, "You took my life, so I'm taking yours." She used a handgun, drawing it from the pocket of her robe, to shoot multiple times, killing her 72-year old son.
Ms. Blessing had been living in an apartment, along with her son and his girlfriend; she was reportedly upset about her son's plan to transfer her to an assisted-living facility. The apartment was located in Fountain Hills, east of Scottsdale, Arizona. Ms. Blessing also reportedly attempted, unsuccessfully, to shoot her son's girlfriend, who fought her off, dislodging both the first and a second handgun.
Followup stories reported the sheriff's office had responded at least six times to "domestic" calls at that location during the previous six months.
According to a sheriff office statement, Ms. Blessing is now charged with first degree murder, one count of aggravated assault with a deadly weapon and one count of kidnapping.
On the one hand, it could be tempting to dismiss this story as an isolated, sad, ironic tragedy.
But what I've been seeing is that senior living providers, especially those offering assisted living, are recognizing that something is deeply amiss about an individual's perception that assisted living is so horrible as to warrant this reaction.
Steve Moran who publishes the Senior Housing Forum asks "Why did she have such an aversion to assisted living?" He muses, "This is a fixable problem....." For more of Steve's thoughts read: "The Headline: Woman, 92, Killed Son Who Tried Putting Her in Assisted Living."
In an editorial titled "Assisted Living's Image Problem," Lois Bowers, Senior Editor for McKnight's Senior Living News, writes:
The Blessing case undoubtedly is a complex one, with more probably in play than a simple suggestion of a move to assisted living. But even so, it presents an opportunity for introspection for the senior living industry as well.
I mean, it seems that at least one person thought that assisted living was so terrible that a prison cell was preferable. And yes, this appears to be an extreme case, but it's not the first time that an older adult has resisted moving into a senior living community.
We know that senior living can offer physical and mental health benefits for older adults. So how can the industry improve at allaying their fears and educating them about those benefits?
And what can the industry do to educate the general public about the differences between assisted living communities and skilled nursing centers? More elucidation is needed, as was made obvious by articles in the lay press about the Blessing incident that used “assisted living” and “nursing home” interchangeably, despite a press release from the sheriff's office that specified that Thomas suggested assisted living to his mother (I know; I saw the press release).
We know that assisted living communities are different from SNFs, and we know that both types of facilities have evolved over the years, and yet I see this confusion regularly in the general media. I've seen government officials make this mistake, too.
So what's the solution? Surely, sales professionals educate individual prospects and their family members when they conduct tours and hold special events at their communities. Campaigns such as the American Seniors Housing Association's Where You Live Matters effort undoubtedly help, too, as does the advocacy work by organizations representing senior living operators.
I was in Arizona the day the story broke. I confess, I spent extra time with my arm around my own 92-year old mother that week -- at her home in assisted living.
July 12, 2018 in Cognitive Impairment, Crimes, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Health Care/Long Term Care, Housing, State Cases, State Statutes/Regulations | Permalink | Comments (0)
Tuesday, July 10, 2018
We're back! Hope everyone had a lovely 4th. I wanted to be sure you saw this new fact sheet from the ABA Commission on Law & Aging regarding thee right of visitation for persons under guardianship. The fact sheet, Guardianship and the Right to Visitation, Communication, and Interactionsummarizes state statutes that specifically address the issue of visitation. Here's the introduction:
Defining the right to visitation, communication, and interaction under guardianship is an important issue in elder and disability rights law. This issue recently gained media attention when the adult children of incapacitated celebrities such as Casey Kasem and Peter Falk petitioned the courts for the right to visit their parents over a guardian’s objections, and then advocated for legislative change. These high-profile visitation cases highlight an unknown but anecdotally frequent number of instances nationally. In addition, as more state legislatures codify protections for the rights of people with guardians, and the public becomes more aware of the potential risks of guardianship—including isolation from friends, family, and community—more states are debating hotly contested visitation bills.
Estrangement from family, friends, and acquaintances can be a precursor and a consequence of guardianship. The factors that led to the appointment of a guardian–mental illness, dementia, poverty, abuse, and exploitation–may have also led to unwanted isolation. Family, friends, and professionals should all be aware of the potentially devastating effects of isolation on the person; loss of ties to friends, family, and social networks can have a negative effect on anyone’s physical and mental health.
Traditionally, a guardian has the power to encourage or limit important relationships and connections. Recently, national standards and state laws have charged guardians with encouraging and supporting visitation in accordance with a person’s values and preferences. Still, a guardian may have to weigh the important benefits of visitation with the need to restrict contact due to family dysfunction, undue influence, neglect, abuse, and/or financial exploitation.
The fact sheet offers 13 FAQ with various state legislative responses. Twenty-two states have addressed the visitation issue in some form, with summaries of those actions provided as part of the FAQ. The fact sheet also summarizes some of the provisions of the new Uniform Guardianship, Conservatorship and Other Protective Arrangements Act that address the issue.
Click here to access the fact sheet.
I've written in the past about the use of "gun trusts" as a legal device to handle passage of guns to others, while avoiding some laws related to registration by gun owners.
There's another way to think about trust documents with guns, to provide a safeguarding process within families. As one article suggests,
Talk to your loved one about how to safely transfer ownership of their guns if they should become incapacitated. Consider writing a “gun trust,” a legal document outlining that process.
For more, read the Kaiser Health News's piece, Worried About Grandpa's Guns? Here's What You Can Do. Thanks, Matt Lawrence, for sharing this story.
Thursday, June 28, 2018
The share of older Americans with dementia is decreasing, but the total number will rise as the large baby boomer population ages and more people live longer. While education gives older adults an edge, reducing their dementia risk, racial and socioeconomic disparities in dementia are large and persistent. The most effective way to reduce dementia prevalence in the future is to postpone its onset through preventive strategies and treatments.
This infographic summarizes the latest demographic research on dementia trends, published in a 2018 special supplement to Journals of Gerontology. It distills key findings from the supplement’s seven articles for policymakers and public health professionals as they plan for an aging population.
The infographic addresses age, education, gaps, costs and prevention. Check it out!
The Washington Post reported on one of the latest famous persons to be embroiled in a guardianship proceeding. Astronaut Buzz Aldrin is fighting attempts by his kids to place him under guardianship. Buzz Aldrin is suing his children. They say they are trying to protect the legendary astronaut.explains that his kids sought to be appointed as guardian. Mr. Aldrin responded by suing them along with his manager, on the basis that "they sought to take advantage of him [and now], the family is embroiled in a rancorous dispute that has spilled from the courts into a public spectacle that both sides say they don’t want." Mr. Aldrin's suit claimed that "they assumed control of his “personal credit cards, bank accounts, trust money, space memorabilia, space artifacts, social media accounts and all elements of the Buzz Aldrin brand.” The suit accuses [one child] of a breach of fiduciary duty." The children quoted in the article offering a contrary view of matters
June 28, 2018 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care, State Cases | Permalink | Comments (0)
Thursday, June 21, 2018
I've been thinking a lot lately about the tone and words used by individuals in advocating for change. Part of the reason I think about that is many of our students will choose the roles of advocates for change.
Another, perhaps more obvious impetus for this contemplation is the increasing use of demonization to characterize "others" you disagree with. In the language of debate, such an approach is an ad hominem attack, where the argument is directed against the person rather than the position they are maintaining. And it seems the usual adjective to add for that style is to call it a "vicious ad hominem attack."
I understand anger. I understand the emotion that can fuel heightened language. But, the plain fact of the matter is, that style often is not effective in achieving change in the law, especially in the courtroom. I get it, that rationality sometimes isn't effective either. That's enormously frustrating. But what I tend to see as a response to vicious ad hominem attacks is for the target to either respond in kind (more shouting, more name calling) or go "underground." It causes the target to double-down on his or her own personal, now equally angry, position. And courts do not respond well at all to such a style of advocacy.
As I'm typing these words, I'm thinking about some of the advocacy that is being used by opponents of guardianships. I see the occasional such comment (sometimes too long to attach to a post) on the Elder Law Prof Blog. Again, I understand the anger of family members who perceive a loved one to be the victim of a self-dealing agent, whether that bad agent was a guardian, a trustee, someone acting under a power of attorney, or simply someone who was made an accommodation party on a joint account. The anger is justified.
But, when the opponents of the bad agents cast an overbroad net against all courts or all judges or, even, all guardians, using, dare I say, "trumpian" adjectives and nouns to characterize all individuals serving in such roles, it just isn't very effective. It closes the door to change in the law. At least, that's my 2 cents on the topic. We need better solutions for instances where individuals did not choose their own trustworthy agents.
I was struck by a couple of news stories I read today by individuals who use anger to characterize disease, especially dementia. Now, here, I think the anger and harsh language as a rhetorical tool is different, and has a different effect. For example, a recent article described actor Don Cheadle's anger, sorrow, and disbelief following the loss of his mother. He is described as saying:
"She went through a real tough spell. She had dementia and it's just an evil, mean disease. To watch someone just deteriorate in that way, it's hard to believe."
Here, even though obviously the disease isn't a sentient being, the characterization of it as evil, as, in essence, an enemy, seems more effective. The desire might be for an army to rally to oppose the devastation wrought by the disease.
Just a bit of mid-week musing. Some of this is probably influenced by being the daughter of a judge who worked 7 days a week for 30+ years, far harder and longer than necessary for his job or any job. Or, it could be my musing is the result of far too much caffeine as I work on summer law reform projects, and as I try to sort out what arguments are the most likely to be effective.
Monday, June 11, 2018
My good friend and colleague, Pennsylvania Elder Law Attorney Linda Anderson, has a thoughtful essay about her personal journey in elder law in a recent issue of GPSolo, the ABA journal for solo, small firm, and general practitioners. Her closing paragraphs address several core issues, comparing her elder law focus with traditional tax and estate planning concerns. I enjoyed her use of classic lines from the movie Jaws.
My early work with elder clients or their adult children across a variety of asset levels certainly involved tax and estate planning. But it became clear that serving and protecting these clients demanded more than just good lawyering, that good planning needed “a bigger boat.” It entailed comprehensive knowledge of the Social Security, Medicaid, and VA benefits bureaucracies, close engagement with insurance providers, geriatric care managers, social workers, and other professionals, as well as close monitoring of state and federal regulatory and policy changes and housing and age discrimination laws, among others. The eventual next step for me was completing the requirements to become a certified elder law attorney (CELA).
Solo or general practice attorneys do not have to become dedicated elder law experts when taking on clients seeking long-term care and funding planning. Take those clients, but be prepared to augment tax and estate planning expertise with a deep dive into areas of elder and special needs law and funding mechanisms. All this is doable, of course, but the biggest difference is in mindset. Attorneys often approach estate and long-term care planning as transactional or episodic--needs arise, documents are drafted or revised, and we and the clients move on. But the nature of the legal work I've touched on above demands a continuing, flexible outlook and a lot of homework. When in doubt, consult with or refer your client to a CELA-qualified attorney. These attorneys are listed in the website for the National Elder Law Foundation (NELF, nelf.org). Another resource for lawyers (who may or may not be CELA-qualified) is the National Academy of Elder Law Attorneys (NAELA, naela.org). Both organizations are excellent sources for information and referrals.
Finally, as we all learn in time, everything that we've covered here will become very personal for each of us. This may first happen through our parents or siblings as they transition and age, but it's necessarily part of our own futures as well. That's true whether you're a Baby Boomer looking at 70, a Gen Xer thinking that 40 is “old,” or any age in between.
Aging is the one shark we cannot escape. But as attorneys, we know how to plan and can build our clients' (and our own) “boats” to manage aging as well as possible.
June 11, 2018 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Estates and Trusts, Ethical Issues, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Legal Practice/Practice Management, Medicaid, Medicare, Property Management, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (0)
Friday, June 8, 2018
John Oliver, the star of Last Week Tonight focused on guardianship on the June 3, 2018 show. The segment focused quite a bit on some of the abuses that have been reported recently in the press. But, to Mr. Oliver's credit, he notes that sometimes, despite a person's efforts, a guardianship is needed. He provides suggestions for improving the system and for individuals on planning to minimize the chances of a guardianship going wrong. There is some good info in the segment, and he makes several important points, but in a comedic and satirical format.
The link to the segment is here. Be sure to watch through to the end, to see cameos from several celebrities offering advice on planning for incapacity (although they do get off track quite a bit) including health care powers of attorney and DPOAs. And who wouldn't want Tom Hanks to be their health care agent! (You have to watch the last bit to get that reference). Caveat: there is some "salty" language used throughout the segment.
June 8, 2018 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Crimes, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, State Cases, State Statutes/Regulations, Television | Permalink | Comments (1)
Thursday, June 7, 2018
A recent issue of the Michigan Bar Journal offers interesting practitioner perspectives on disability law and elder law issues. The January 2018 issue includes:
- Elder Bankruptcy
- Coordinating Representation: How Business and Elder Law Counsel Can Work Together to Meet Clients' Needs
- The Impact of Aging on Consumer Law
- The Intersection of Estate Planning, Family Law, and Elder Law
- Significant Regulatory Changes for Social Security Disability Insurance and Supplemental Security Income
- Considerations When Settling a Lawsuit for an Individual Lacking Legal Capacity or a Minor
Introducing the theme of the issue, attorney Christine Caswell writes:
While there may be a perception that the section focuses on helping clients qualify for public benefits, its mission is actually much broader. Elders and those with disabilities have many of the same issues as the rest of the population— divorce, consumer problems, bankruptcy, business ownership, and litigation—but these issues are magnified when questions arise concerning competency, the need for ongoing care, and discrimination. Moreover, these different legal areas may conflict when determining what is in the best long-term interests of these clients.
June 7, 2018 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Estates and Trusts, Ethical Issues, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Legal Practice/Practice Management, Medicaid, Medicare, Social Security, State Cases, State Statutes/Regulations | Permalink | Comments (0)
Wednesday, June 6, 2018
From Ben Mulford, a law graduate working at the Iowa Department on Aging, comes an interesting description of a French village designed to give residents who have Alzheimer's Disease as much freedom and normalcy of life as possible, in a safe setting.
Work has begun on France's first "Alzheimer's village” where patients will be given free rein without medication in a purpose-built medieval-style citadel designed to increase their freedom and reduce anxiety.
Residents of the village in Dax, southwestern France, will be able to shop in a small supermarket, go to the hairdressers, local brasserie, library, gym and even a little farm. They will live in small shared houses designed to reflect their personal tastes and in four districts reminiscent of the southwestern French region between forests and the seashore.
While it may sound similar to a typical residential complex, the inhabitants are all men and women suffering from Alzheimer's, the commonest cause of dementia. . . .
The village is the brainchild of the late Henri Emmanuelli, a former Socialist minister and local MP who launched the project after reading about a Dutch gated model village in Weesp, Netherlands, seen as a pioneering care facility for elderly people with dementia.
Residents are confined to the village for their own safety but are allowed to move around freely inside and are watched over by plain-clothed medical staff. The staff don't treat patients, they care for residents, they say.
Monday, May 28, 2018
Here's a challenging but potentially important topic for many families on this holiday weekend.
Becky has a post last week about the importance of doctors asking older patients about guns as a safety risk. I've posted in the past, here and here, about related issues, including laws affecting registration of gun ownership when intervivos or testamentary trusts are used as the legal vehicle to pass down weapons to succeeding generations.
The New York Times continues the conversation with In Elderly Hands, Firearms Can Be Even Deadlier. From Paula Span's article:
While older adults make many fewer suicide attempts than younger cohorts, they die more often, in part because they use such lethal methods. Yet health care providers who ask older patients about driving and wandering may not ask about guns.
“Safety planning for adults with dementia is something every clinician thinks about, but I don’t think firearms are often on the radar,” said Dr. Donovan Maust, a psychiatrist at the University of Michigan Medical School and co-author of a recent article on guns and dementia in the Annals of Internal Medicine.
They should be. At various stages of dementia, people may grow unable to distinguish loved ones from intruders. Their decision-making ability deteriorates. They can become paranoid, depressed, impulsive, agitated or aggressive.
Dr. Maust's co-authored commentary, linked above, is worthy of closer reading. Perhaps in an attempt to allay the fears of gun owners that dementia is not an automatic disqualifier for gun ownership, the piece suggests that doctors consider the stage of any neurocognitive impairment as part of a multi-party discussion about access:
A diagnosis of cognitive impairment or dementia does not in itself mean that a person should not have access to firearms—the level of cognitive impairment is probably most important. In a recent review, Patel and colleagues proposed using the clinical dementia rating scale to estimate the stage of dementia and the person's ability to safely complete complex tasks, including firearm handling.
For patients with minimal cognitive impairment, approaches could be similar to those related to driving, including acknowledging the emotions involved and allowing the PWD [person with dementia] to maintain agency in the decision for as long as it is safe. As with an “advance driving directive”, PWDs, their family members, and their health care providers may proactively discuss firearm access and consider setting a “firearm retirement date”. This patient-centered approach may allow an older adult to maintain decisional control and identify trusted family members or providers as future surrogate decision makers. To our knowledge, no one has tested the acceptability or efficacy of this approach.
May 28, 2018 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Health Care/Long Term Care, Property Management, State Statutes/Regulations, Statistics | Permalink | Comments (0)
Friday, May 25, 2018
Of course, I'm supposed to be finishing my exam grading. Instead, while stopping by my office, I find a copy of a short story from one of my colleagues. The accompanying note says,"Not even my sci-fi 'escape' is untouched by elder care issues. Thought you'd get a kick out of this."
And indeed, I do. I definitely recommend "Today I Am Paul," by Martin L. Shoemaker. The author draws upon his personal experiences in visiting his mother-in-law in a nursing home to craft a true tale ... with a difference ... as the narrating caregiver is an android.
While my printed-page-loving self recommends reading the short story, I also found a great podcast of the story being read aloud by Kate Baker and I'm linking it here, from Clarkesworld Magazine.
I now plan to use this story to introduce my Elder Law course in the autumn. So much to talk about, including the roles of family, caregivers, technology, fear..... I suspect my co-blogger Becky Morgan, with her often expressed enthusiasm for tech including driverless cars, will appreciate this story too. Happy reading or listening for Memorial Day weekend!
Many thanks to Dickinson Law Professor Matthew Lawrence for this unique, caring experience.
Friday, May 18, 2018
Kaiser Health News published a compilation of recent stories about gun safety and one caught my eye: the advantage of doctors discussing gun safety with elder patients. Doctors Should Be Discussing Gun Safety With Aging Patients, Researchers Say.
The reference to the story from the LA TImes, As more older Americans struggle with dementia, what happens to their guns?seemed particularly on point and the KHN story published the opening from the LA Times article
The man had been a patient for decades, retired now from a career in which firearms were a part of the job. He was enjoying his days hunting, or at the shooting range with friends. But episodes of confusion had led to a suspicion of dementia, and the nights were the worst: At sundown, he became disoriented, anxious and a little paranoid, and had started sleeping with his loaded pistol under the pillow. One night, he pointed it at his wife as she returned from the bathroom. It wasn't clear whether he recognized her, but he was certainly confused — and she was terrified. Thankfully, the incident did not end in disaster.
Regardless of your position on the gun control debate, consider these statistics from the LA Times article
Roughly 1 in 3 adults over 65 in the United States is thought to own a gun. An additional 12% live in a household with someone who does.
As seniors turn 70, their odds of developing Alzheimer's disease in a given year jump from less than 1% (among those 65 to 69) to 2.5% (among those 70 to 74), and keep rising from there. By 2050, the number of older Americans with Alzheimer's is expected to reach 13.8 million.
The article discusses driver safety and draws corollaries to gun safety. The article highlights the lack of response to this issue at the state level:
No federal laws prohibit the purchase or possession of firearms by a person with dementia. Only two states, Hawaii and Texas, explicitly mention dementia or similar conditions in their firearms statutes.
In Hawaii, any person under treatment for "organic brain syndromes" is prohibited from owning a gun. Texas law makes individuals diagnosed with "chronic dementia" ineligible for a license to carry a handgun in public. But it does not limit such a person's right to purchase or possess firearms.
One expert quoted in the article describes this as not an issue of taking away someone's guns but instead a decision that focuses on the person's safety.
May 18, 2018 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Other, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (0)
Tuesday, May 15, 2018
Pennsylvania has several interesting bills pending that would make significant changes to the laws governing court-appointed guardians for incapacitated adults, and at least one of these could move forward this legislative session. I've learned to expect late night action from the Pennsylvania legislature once it reconvenes in late May and before it adjourns in late June or early July. The pending legislation includes:
- Senate Bill 884 (Printer's No. 1147), with Senator Greenleaf as the lead sponsor, offered as a comprehensive reform package for adult guardianship laws, relying in large part on model legislation, and drafted before the most recent high profile news stories and editorials that involve allegations of improper appointment of a particular fee-paid guardian in a number of guardianships for incapacitated adults on the eastern side of the Commonwealth. On April 16, 2018 this bill was referred to the Senate Appropriations Committee.
I've seen recent drafts of proposed amendments to SB 884 that would require alleged incapacitated persons to be represented by a lawyer during the guardianship proceeding, require criminal background checks through the State Police (without creating automatic disqualifications if there is a history of convictions), and would also mandate "certification" for "professional guardians." Professional guardians are defined to include individuals or entities that are appointed to serve 3 or more incapacitated persons. The responsibility for certification of the professional guardians would be assigned to the Pennsylvania Department of Human Services, although the proposed language would appear to permit the department to accept certification through an outside program such as that offered by the Center for Guardianship Certifications.
- House Bill 2247 (Printer's No. 3296), with Representative Gillen as the lead sponsor, and submitted in April 2018 following the high profile articles, would mandate criminal background checks for all current or prospective guardians and provides that courts "shall disqualify a guardian or prospective guardian convicted of an offense classified as a felony under the laws of this Commonwealth or a substantially similar offense under the laws of another jurisdiction."
While the proposed amendment to S.B. 884 would require criminal background checks for potential guardians, unlike HB 2247, it stops short of banning appointment of individuals who have any particular criminal history. No doubt this decision reflects a 2003 ruling by the Pennsylvania Supreme Court in Nixon v. Commonwealth. In that case, a per se ban on employment of individuals as long-term care workers if they were convicted of certain crimes was deemed unconstitutional. Senate Bill 884, even if amended, would give greater discretion to the courts to consider the individual history and the nature of the offense than would HB 2247.
May 15, 2018 in Cognitive Impairment, Crimes, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, Housing, Property Management, State Cases, State Statutes/Regulations | Permalink | Comments (2)
Monday, May 14, 2018
As reported by the New York Times, Japan is using mandated screening tools to remove older drivers who are identified as displaying signs of cognitive impairment:
Since 2009, all drivers 75 and older must submit to a test of their cognitive functioning when they renew their licenses, typically once every three years. Under a new traffic law that took effect in March 2017, those who score poorly are sent to a doctor for examination, and if they are found to have dementia, the police can revoke their licenses.
More than 33,000 drivers who took the cognitive test last year showed what the police deemed to be signs of cognitive impairment and were ordered to see a doctor. The police revoked just over 1,350 licenses after doctors diagnosed dementia.
For more, including photos of some of the screening tools, plus interesting demographic data about rural Japan, read Japan Moves to Ease Aging Drivers Out of Cars.
Sunday, May 13, 2018
News publication sites affiliated with USA Today and the Associated Press have been running a recent piece on "bullying" among older persons, often with a provocative headline such as "It's like 'Mean Girls,' but everyone is 80": How nursing homes deal with bullies. The title undoubtedly catches many a reader's eye, simply because of the heightened discussions of bullying at a national level, including Melania Trump's recent announcement of her Be Best platform for younger persons. The topic isn't actually all that new from a journalism perspective. Paula Span wrote on "Mean Girls in Assisted Living" for the New York Times in 2011, and the same publication carried a granddaughter's Op Ed on "Mean Girls in the Retirement Home" in 2015.
On a parallel track, and perhaps more disturbing, are reports of bullying among nurses, a profession normally associated with empathy and caring. See e.g., "When 'Mean Girls' Wear Scrubs," a 2013 post on DiversityNursing Blog, tracking a several studies and a book.
More important than the clever headlines, however, are the reports of affirmative efforts to counter the bullying, which at the older end of the spectrum of life, seems to focus on name-calling, gossip, and ostracising behavior, rather than physical intimidation. From the most recent USA Today writer's article:
After the cafeteria exiles and karaoke brouhahas, the 30th Street [Senior] Center [in San Francisco] teamed up with a local nonprofit, the Institute on Aging, to develop an anti-bullying program. All staff members received 18 hours of training that included lessons on what constitutes bullying, causes of the problem and how to manage such conflicts. Seniors were then invited to similar classes, held in English and Spanish, teaching them to alert staff or intervene themselves if they witness bullying. Signs and even place mats around the center now declare it a “Bully Free Zone.”. . .
Robin Bonifas, a social work professor at Arizona State University and author of the book “Bullying Among Older Adults: How to Recognize and Address an Unseen Epidemic,” said existing studies suggest about 1 in 5 seniors encounters bullying. She sees it as an outgrowth of frustrations characteristic in communal settings, as well a reflection of issues unique to getting older. Many elderly see their independence and sense of control disappear and, for some, becoming a bully can feel like regaining some of that lost power.
I think that last line rings true. I've certainly seen older adults sudden strike a "meaner" demeanor as their freedom is limited by physical health issues and as their frustrations increase. But I also think it can be important to assess whether a "mean" trait -- or at least a "meaner" dynamic -- is a reflection of cognitive impairment, such as disinhibition associated with certain types of neurocognitive impairments.
On an even more worrisome level, is there a danger of misinterpreting fear or irritation as "meanness," perhaps arising from compelled interactions in a congregated living situation? In one instance, I've seen an older woman who had regularly chose to sit with the same group of 3 other individuals at meals for several weeks, suddenly reject one member of their informal club. It took careful listening to realize the rejection was actually uneasiness bordering on fear -- on some level not completely rational -- but associated with that targeted individual's tendency to wander at night into others' rooms and thus to lead the "mean girl" to try to keep the other away from her around the clock. Targeting the "bullying" behavior could be addressing the wrong problem in the latter case.
Finally, I think there is a danger associated with the admittedly clever tendency to use the "Mean Girls" movie as the analogy for older bullying, thus implying this is only an issue (and problem) associated with women, not men. As a later paragraph in the most recent article makes clear, bullying behavior among older adults is not "just" about women. But perhaps that is obvious from the larger national news?
May 13, 2018 in Books, Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Retirement | Permalink | Comments (0)
Sunday, May 6, 2018
As is true for many states, Maryland is increasing the education, support and supervision for guardians appointed by the Maryland courts. In connection with this, beginning on January 1, 2018, prospective guardians must watch a video-based "orientation program" before they are appointed guardian of a minor or disabled person. The 9-minute video introduces the "roles, duties and responsibilities" of a guardian and explains mch of what to expect if appointed by the Maryland Courts. Here is a link to the video.
What I particularly like about this video is the message "You Are Not Alone as a Guardian," and the emphasis that Court-appointed guardians are subject to the ultimate authority of the Court. I think that many courts are still struggling with their own roles in this regard, but here the lines of responsibility are explained clearly.
The balance here is delicate, requiring careful thought about how to provide threshold information essential for a candidate to make an informed decision about whether to serve, but without making the information so overwhelming that good candidates decline the role. The Maryland courts caution that this particular orientation and the related training requirements do NOT apply to public guardians or guardianships that terminate parental rights.
In my opinion, this type of video is a good first step. But just a first step.
May 6, 2018 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Legal Practice/Practice Management, Programs/CLEs, Property Management, State Cases, State Statutes/Regulations, Webinars | Permalink | Comments (0)
Tuesday, May 1, 2018
My thanks to Dickinson Law Professor Laurel Terry for pointing us to an upcoming seminar offered by the American Bar Association on "Competency and Cognitive Decline in the Legal Profession: Ethical Pitfalls Encountered by Lawyers with Diminished Capacity," on May 9, 2018, from 1 to 2:30 p.m. (ET).
The promotional materials are a bit lean, but discussion topics are described as follows:
- Understanding the effects of aging on the human brain
- How to recognize some of the signs of diminished capacity
- The practical and ethical considerations for intervention
- Advice on how to facilitate discussion with the impaired person (or others who can help)
- Resources and ways to locate assistance in your area
- The importance of succession planning, and resources to help you develop or review your own succession plans
The speakers include Dr. Doris Gunderson, a psychiatrist in Colorado.
Co-sponsors of the program including the ABA Center for Professional Responsibility, its Commission on Law and Aging, the Commission on Lawyer Assistance Programs, the Section for Civil Rights and Social Justice, the Senior Lawyers Division, and the Solo, Small Firm and General Practice Division.
For more information on registering, see here.
Monday, April 30, 2018
I'm always interested in articles about the use -- misuse? -- of antipsychotic medications for older adults. Therefore I was eager to read the recent post on the Health Affairs Blog by David Introcaso entitled The Never-Ending Misuse of Antipscyhotics in Nursing Homes. The article begins:
In response to a generic question about post-market drug surveillance posed during a February 2007 House Energy and Commerce Committee hearing, Dr. David Graham, then associate director of science and medicine in the Food and Drug Administration’s (FDA’s) Office of Surveillance and Epidemiology, stated: “I would pay careful attention to antipsychotic medications. … The problem with these drugs are that we know that they are being used extensively off label in nursing homes to sedate elderly patients with dementia … . It is known that the drugs don’t work in those settings. … But the fact is, is that it increases mortality perhaps by 100 percent. It doubles mortality. So I did a back-of-the-envelope calculation on this and you probably got 15,000 elderly people in nursing homes dying each year from the off-label use of antipsychotic medications for an indication that FDA knows the drug doesn’t work. This problem has been known to FDA for years and years and years.”
I've highlighted in bold the words that are the focus of my interest: "It is known that the [antipsychotic] drugs don't work in those settings." No citation to authority here - and it is the authority for this statement that I would like to see. Is there a study of the use of antipsychotic drugs showing they "don't work" for dementia patients? What does it mean "not" to work? Is all "use" a "misuse" for patients who "only" have dementia?
I ask because I saw my father struggle at home for several years with dementia. As the disease robbed him of the ability to understand where he was and why he couldn't remember things, he sometimes became aggressive. He was still very strong. His doctor tried various mild anti-anxiety drugs, but they seemed to interact with his blood pressure issues (and perhaps his other medications). He would sometimes swing between aggressive behavior and losing consciousness. Finally his doctor suggested a very small dose of an antipsychotic. My mother was desperate for help at the time -- and thus, Dad started on the drug. This is an example of "off label" use. I was worried, and said so, because I knew the associated concerns about increased mortality for those with dementia. I looked for specific studies of risk versus benefit and frankly, all I could find were records showing the ratio of deaths for individuals with dementia who also were taking an antipsychotic drug. Mere correlation is not necessarily evidence of causation. What I was looking for was a careful study of risk versus benefit.
Over time I saw that the small dose did "work" for this one individual, my father. He wasn't "knocked out." He wasn't "docile." He wasn't "asleep all the time" -- typical of the accusations that are often made about misuse of antipsychotics. What we did see was that he was much less likely to strike out an arm or push someone hard when he was frustrated (and yes, he was still frustrated). The small dose did not interfere with his blood pressure or the other medications he was taking. Perhaps most importantly, he continued to live at home for many more months. Eventually it was appropriate to wean him off the antipsychotic altogether.
One anecdotal account is not evidence. But the fact that there reportedly continues to be "widespread"use of antipsychotic drugs by the elderly means there could be some very real need for safe, effective alternatives. Behavioral health approaches are important, but those too can have limits in effectiveness. I'd certainly like there to be "good" studies of the use of these drugs and any drug that might be able to help a person suffering from dementia live a less tormented life. Not zoned out and not asleep all the time, but also not likely to harm themselves or those who on a daily basis are trying to help them live as normally as possible.