Thursday, February 4, 2016
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.
Thursday, January 28, 2016
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
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!
Monday, January 25, 2016
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!
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
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!
Tuesday, January 19, 2016
Last summer, I blogged on news about the University of Southern California's controversial challenge to University of California-San Diego's position in Alzheimer's research, including USC's successful lure of top researchers (and their money). Lawsuits were unsuccessful in blocking the move, an attempt to avoid the loss of key research dollars.
However, the latest news is that UC-San Diego has "recruited a prominent Canadian neurologist to rebuild and lead" its Alzheimer's disease research program. From the news coverage:
Dr. Howard Feldman comes to La Jolla from the University of British Columbia in Vancouver, where he achieved international acclaim for his examination of dementia and for carrying out large-scale drug trials. A science journal nicknamed him the “master of dementia.” He’s also known as a rainmaker for his ability to raise money for research.
Feldman, 61, is receiving a recruitment package that includes $10 million to set up his laboratory and support his research program. His annual salary is $390,000.
Let's hope this means that there are now two stronger sites for research into diagnosis, treatment and cure for this dreaded disease.
Friday, January 15, 2016
I recently ran into an article published in December of 2015 that I thought was interesting. Fighting Ageism in the Twitter Era (Getting Old Isn't All That Bad) was published in the Arizona Republic/New America Media. The December article followed up a late November opinion piece titled, Valdez: Getting old isn't all that bad by Linda Valdez that opened with this:
The baby boomers, AKA the nation’s silver tsunami, had better pay as much attention to changing attitudes about aging as they did to shaking up all those previous social norms.
In our culture, old things get replaced with something nice and new. Like the latest smart phone.
Apply the concept to people, and it’s called ageism.
It’s as current as Twitter.
A team of researchers at Oregon State University took a look at tweets about people with Alzheimer’s disease and found ridicule, stigma and stereotypes.
In the December article, the author, reporting on the Gerontological Society of America's annual scientific meeting in November, was in attendance as a Journalist in Aging Fellowship. After generally reviewing topics covered in the conference, the author notes that the Boomers wish to age in place, yet many may not be physically able to do so and blame themselves for their own inability to do so. Enter negative thoughts about aging:
Meanwhile, society does its best to accent the negative.
Asked to characterize the aging, some people recorded during on-the-street interviews dredged up cliches about spry retirees on vacation, but most talked about decline, disease, dependency.
“Society isn’t betting on them,” said one man.
These interviews were done as a result of a project with 8 of the national aging organizations, who were looking for metaphors for aging because how we look at something is crucial to how we apply information about it. The article concludes
[T]he way information is framed has an impact on how people use the information, which should come as no surprise to those who reframed cultural norms about race, gender, sex, the environment and entertainment.
The baby boomers have a lot at stake, and that includes [the author] me. I’m no fan of euphemisms, but I’m all for promoting a fine-wine view of life. It should get better with age. We should feel better about aging.
If some creative wordsmithing and mass marketing helps our society recognize that aging doesn’t diminish value or humanity, it would be a real contribution to our collective understanding of who we boomers are.
Turning to the researchers at Oregon State U who did the analysis of tweets, their article, Portrayal of Alzheimer's Disease on Twitter is available in volume 55 of the Gerontologist, the publication of the Gerontological Society of America.
Tuesday, January 12, 2016
We all know how important it is to get the appropriate amount of sleep. But it may be more important than we realize. According to an NPR story on January 4, 2016, Lack Of Deep Sleep May Set The Stage For Alzheimer's, we need that deep sleep to help us fend off Alzheimer's. The story focuses on the work of the Oregon Health & Science University scientists. One of the scientists explains why this deep sleep is so important to us: "[t]he brain appears to clear out toxins linked to Alzheimer's during sleep, [the scientist] explains. And, at least among research animals that don't get enough solid shut-eye, those toxins can build up and damage the brain." The story notes that there is definitely a link between sleep and Alzheimer's since many of those with Alzheimer's have some kind of sleep disorder. The OHSU scientists are about to start a study of "that should clarify the link between sleep problems and Alzheimer's disease in humans." The study described is fascinating (let's just say it involves sleeping in an MRI) and will be so important. Read more about the study here. Now, take a nap!
Monday, January 11, 2016
It's time for the new semester!!! Always such an exciting time for all of us. I wanted to see if anyone is doing anything new or innovative in your classes that you wanted to share. Are you assigning any movies or books (other than law school books) to your students? One of the books I'm considering suggesting is On Pluto: Inside the Mind of Alzheimer's. I'm also thinking of an assignment where the students research various technologies that are designed to help an elder age in place or stay safe. I'm happy to share results with those of you interested. Let us know your ideas and suggestions!
Friday, January 8, 2016
I've been intrigued by Hillary Clinton's December 2015 campaign announcement of a plan to focus on prevention, treatment and a cure for Alzheimer's disease if elected President. Certainly there is plenty of data to document the need for such a plan. Her announcement seems to be attracting attention -- support? -- as demonstrated in this piece from Lois Bowers, Senior Editor at McKnight's Senior Living, an industry-focused publication.
Thursday, January 7, 2016
NPR ran an interesting story on December 22, 2015 on how our internal clocks may begin to lose time, but we have backup clocks ready to start ticking! As Aging Brain's Internal Clock Fades, A New Timekeeper May Kick In notes that
We all have a set of so-called clock genes that keep us on a 24-hour cycle. In the morning they wind us up, and at night they help us wind down. A study out Monday in Proceedings of the National Academy of Sciences found that those genes might beat to a different rhythm in older folks.
One of the authors of the study refers to the genes as the conductors of a person's orchestra and somehow for elders, "[t]heir orchestras seem to go off the beat, but it isn't known why." Before worrying about being "out of tune", take heart that the study found that elders have a back-up clock that starts keeping time when the main internal clock begins to get out of tune. The researchers are particularly interested in how this affects individuals who sundown because of dementia. The NPR story includes an audio version of the story in addition to the print version.
Wednesday, January 6, 2016
Runner's World magazine ran the story, Outrunning the Demons on December 15, 2015. We all know about sundowning. But have you ever heard it described so eloquently:
I could hear their screeching howls through the canopy of oak and red maple trees that enshroud Lower Road in Brewster, Massachusetts, on the Lower Cape. They were gaining, ready to pounce—I had to sprint to avoid capture at sundown. I felt them closing in as the spring afternoon gave way to dusk and a spectral fog crept over me, first in misty sprays that tingled, then in thick blankets that rose slowly from the base of my neck to my forehead, penetrating my mind and disorienting my senses. Alone, I was soon enveloped in fear and paranoia.
The demons kept advancing as the blazing red sun sank into Cape Cod Bay, doused like a candle. Faster and faster they chased, and faster and faster I ran. I was 61 that day, two years into my diagnosis, and with every ounce of my will, I made it home. But I knew the demons would be back—with a vengeance. My life, once a distance run, has become a race for survival. That’s the way it is with early onset Alzheimer’s. It’s like a death in slow motion, like having a sliver of your brain shaved every day. Alzheimer’s stole my maternal grandfather, my mother, and my paternal uncle. Now, at age 65, it’s coming for me.
This personalized account of one man's fight to hold on in face of a relentless disease is a compelling read. Photos of the author accompany the story. The author, Greg O'Brien, wrote On Pluto: Inside the Mind of Alzheimer's. Read the article. It's worth it.
Tuesday, December 29, 2015
An article in the Washington Post shortly before Christmas had me shaking my head at the cluelessness of some employees of nursing homes regarding resident privacy. Nursing home workers have been posting abusive photos of elderly on social media gave me one of those "you have got to be kidding me moments." Maybe it's an age-gap thing, but I just can't fathom why it would be appropriate to post intimate photos of individuals with whose care one is entrusted. The article indicates that this is not a geographically isolated problem:
Nursing home workers across the country are posting embarrassing and dehumanizing photos of elderly residents on social media networks such as Snapchat, violating their privacy, dignity and, sometimes, the law.
ProPublica has identified 35 instances since 2012 in which workers at nursing homes and assisted-living centers have surreptitiously shared photos or videos of residents, some of whom were partially or completely naked. At least 16 cases involved Snapchat, a social media service in which photos appear for a few seconds and then disappear with no lasting record.
The article offers some illustrations of these photos and the remedies available against the perpetrators. The article also notes that not only are those photos invading resident privacy, they serve as evidence of the violations.
The incidents illustrate the emerging threat that social media poses to patient privacy and, at the same time, its powerful potential for capturing transgressions that previously might have gone unrecorded. Abusive treatment is not new at nursing homes. Workers have been accused of sexually assaulting residents, sedating them with antipsychotic drugs and failing to change urine-soaked bedsheets. But the posting of explicit photos is a new type of mistreatment — one that sometimes leaves its own digital trail.
How often is this violation of resident privacy occurring? The article notes that "ProPublica identified incidents by searching government inspection reports, court cases and media reports. [A district attorney in Massachusetts] said she suspects such incidents are underreported, in part because many of the victims have dementia and do not realize what has happened." So far HHS' Office of Civil Rights hasn't sanctioned any nursing homes "for violations involving social media or issued any recommendations to health providers on the topic." The article notes that CMS, in the process of revising the regs dealing with nursing homes, plans to deal with the issue when revising the definitions of various types of elder abuse. Even one of the social media sites referenced in the article expressed concern about the actions of those nursing home employees.
The article summarizes some cases where charges have been filed. Read the story and assign it to your students.
December 29, 2015 in Consumer Information, Crimes, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Health Care/Long Term Care, Other | Permalink | Comments (0)
Tuesday, December 22, 2015
I was listening to NPR's Morning Edition recently while working on this Blog and that's how I learned about a great resource, a telephone-based screening test for hearing problems, that individuals can take at home. Offered by The National Hearing Test, the cost is $5 (free for AARP members) and the process was developed with the help of an NIH grant. What impressed me is it tests for the ability to hear words (numbers) against background noise, a very realistic screen for many people's concerns. After taking the test, you are offered guidance and resources for follow-up. The NPR story made the point that unlike vision problems, which are hard to blame on others, it is all too easy for those with hearing problems to assume the problem "is" background noise or a failure of younger people to "speak up." Further, evaluation of hearing can be an important marker for other health issues, including problems with cognition.
For most reliable results, the website encourages you to use a traditional wired-phone connection, not a cell phone.
According to operation's website (linked above):
The National Hearing Test is provided on a nonprofit basis. It has no financial connections with any hearing products or services. (Free tests are typically offered by organizations selling hearing aids or providing services for a fee.) The $5.00 fee helps defray the costs of making it widely available to the public and processing test data; any remaining money goes to support further research on hearing loss.
Perhaps "taking" the screening test is a holiday present we can give our families.
Thursday, December 17, 2015
Is a Court-Appointed Guardianship, Using Paid, Private Guardian, "Worse Than Prison"? Latest from Nevada
As we've reported several times over the course of the last year, concerns about cost, misuse of authority, and lack of appropriate oversight of court-appointed guardians for adults in Clark County (Las Vegas), Nevada, have lead to a state-wide inquiry into how better to protect the civil rights of alleged incapacitated persons. According to news reports recent proceedings before the Nevada Supreme Court Guardianship Commission, one judge described past neglect of the alleged incapacitated individual's rights as being "worse than being sent to prison."
A frequent concern raised by family members has been the cost of court-appointed guardians, particularly for individuals or family members who disagree with either the need for a guardianship or the scope of the guardian's powers over the individual or the individual's assets. During the most recent proceedings addressing potential solutions, judges and others argued that a solution to some of the abuses was court-appointment of a lawyer at the outset of any guardianship proceeding to represent the interests of the individual. Thus, there is some irony, that an additional layer of potential costs -- the cost of the appointed counsel -- would be argued as part of the solution. On the other hand, limiting the amount of money such an attorney can charge (whether paid from the individual's estate or from public funds), can have the practical effect of what might be described as "de minimus" representation.
The Nevada proceedings have attracted considerable attention from media nationally -- and from family advocates challenging court-supervised guardianships in other states and who are sharing information about problems and potential solutions. My thanks to Rick Black for sharing news from Nevada.
December 17, 2015 in Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Legal Practice/Practice Management, State Statutes/Regulations | Permalink | Comments (4)
Friday, December 11, 2015
We all know how important caregivers are in the life of those elders. Two articles about caregiving caught my eye recently. First, a few days ago Kaiser Health News (KHN) ran a story on Who are America's Caregivers? Nearly a Quarter are Millennials. It's not just the Baby Boomers as caregivers; "almost a quarter of the adults who take care of older people – on top of their regular jobs and responsibilities – are between the ages of 18 and 34, according to research by AARP Policy Institute and the National Alliance for Caregiving." More attention is being devoted to the issue, and the article notes that the Institute of Medicine will be "putting out a report next year on the state of family caregiving, and a number of states have passed or are considering legislation that would help hospitals better communicate with and train an older person’s caregiver, especially after a hospitalization."
The New York Times ran a story on caregiving's impact on careers. Caregivers Sometimes Must Sacrifice Their Careers highlights one caregiver who used up all of her leave time before having to quit her job to be a fulltime caregiver. And once having left the workforce, rejoining the workforce later may not be that easy. There is no real comparison between child care and elder care-the two are quite different.
Elder care, however, takes life-altering turns without warning: the crippling fall, the massive stroke. An older person’s need for assistance generally rises; given increased life spans, some workers will care for their parents longer and more intensively than they did their children.
Moreover, “the emotional toll is different,” said Kenneth Matos, senior research director at the Families and Work Institute.
“Someone raising a child is headed for happier events” and greater independence. “Someone caring for an elder is headed for sadder experiences.”
Some states have stepped up to provide benefits for family caregiving. Also not to be overlooked, the financial impact on family caregivers who have to quit their jobs-now and in the future when they themselves retire.
Thursday, December 10, 2015
Court Rules Charter School Founder "Incompetent to Stand Trial" on Fraud Because of Alzheimer's/Dementia
In an extraordinarily detailed consideration of expert reports and testimony, the United States District Court for the Eastern District of Pennsylvania ruled on November 23, 2015 that a high-profile criminal defendant, Dorothy June Brown, was unable to stand for retrial on fraud charges, following her diagnosis of dementia of an Alzheimer's type. See United States v. Brown, 2015 WL 748490 (E.D. Pa. 2016).
Ms. Brown, age 78 at the time of the ruling, was accused in 2013 of multiple counts of federal wire fraud, conspiracy to obstruct justice, obstruction of justice and witness tampering, arising from her role in founding and operating two charter schools, with the alleged fraud totaling more than $6 million from federal funding sources. The charges were big news, with coverage often depicting Brown, a "career educator," as blond and fashionably dressed, and noting that she was married to a prominent attorney.
Wednesday, December 9, 2015
Last month Kaiser Health News ran a story about a global initiative on dementia. New Brain Institute Plans To Refocus Third World’s Attention On Dementia As ‘Societal Issue’ explains the launch of an institute between University of California, San Francisco and the University of Dublin that is "aimed at helping developing countries learn more about the disease and cope with the burden it places on patients, families and caregivers." Known as the Global Brain Health Institute, both universities will house the institute. Focusing initially on Latin America and parts of the Mediterranean, the goal is to train a wide variety of professionals to understand dementia including prevention and delay. The press release from UC San Francisco is available here.
Monday, December 7, 2015
Money Magazine's final article in the series on the costs of dementia focuses on the costs in the final stages of the disease. Coping With the Costs of Dementia: The Final Stage discusses the costs and the options for caring for an individual in the final stage of this disease.
In the final stages of dementia, which typically last four to five years, the need for care intensifies. [One's] spouse eventually will require around-the-clock assistance with most activities of daily living. [One's] toughest decision: whether to try to continue caregiving at home or move [one's] loved one to an assisted-living facility or a nursing home. [One] may feel guilty at the prospect of putting someone [one] love[s] in “a home”—that’s common and understandable—but a setting where professionals are providing the intense level of care needed at this point is often the best path, especially if they’re trained in the needs of dementia patients. That said, it’s also the most expensive care option by far.
The article urges caregivers to take proactive action, suggests caregivers pick a nursing home with a memory care unit, get advice on the order in which to spend assets and start planning for the caregiver's own future. "Caring for someone with dementia is emotionally exhausting and financially draining, but it comes with one particular satisfaction: knowing that you’ve done whatever you can to make the last years easier for someone you love."