Monday, December 2, 2013
Marshall B. Kapp, J.D., M.P.H. (Director, Florida State University Center for Innovative Collaboration in Medicine & Law) recently published an article entitled, The Nursing Home as Part of the Polst Paradigm, 36 Hamline L. Rev. 151 (Spring 2013). Provided below is the introduction to his article:
Improving the quality of care and quality of life for individuals with advanced, irreversible illness is a paramount goal from the perspectives of both ethics and public health. One aspect of achieving such improvement entails assuring that the care those individuals receive is consistent with their important, authentic, personal values and wishes. The physician and other professional members of the health care team are the experts on medical means to achieve specific outcomes, but the individual patient is the best expert about his or her own values, goals, and preferences. The quality of care and quality of life challenge is exacerbated by the fact that, as the medical and social ramifications of advanced illness unfold over time, many people receive care within several different settings, often moving back and forth among settings as their immediate needs and resources change. Consequently, it is imperative that the mechanisms we develop for the purpose of enforcing persons' personal care values and preferences follow individuals across and throughout the care continuum.
Many people with advanced, irreversible illness reach a point at which they need to receive most of their care in a nursing home, and a large proportion of those individuals ultimately die in that venue after receiving various forms of medical care there. The care actually provided to nursing home residents during the period prior to their deaths too frequently deviates from that which they, on the basis of their own values, really want. This article discusses one initiative-the Physician Orders for Life-Sustaining Treatment (POLST) paradigm-that holds the promise of improving the quality of care and quality of life for nursing home residents with advanced, irreversible illness by more closely reconciling the details of the actual care they receive at the most crucial juncture of their lives with their desired care in that context.
The next section of this article provides background on the intersection of nursing homes and the care of people with advanced, irreversible illness. First, it outlines the importance of nursing homes within the contemporary American health care enterprise and then describes the ways in which medical care decisions are made today in this context and identifies some of the major shortcomings of the status quo. The ensuing section proposes the POLST paradigm as a viable alternative to the status quo, laying a foundation by setting forth information on the nomenclature, definition, and legal status of the POLST concept and then specifically exploring the adaptability of the POLST paradigm to the nursing home setting. The advantages of this mechanism as compared with conventional Advance Directives (ADs) are highlighted. The article concludes that POLST can and should be an integral facet of ideal nursing home care for all willing and appropriate residents.
Sunday, December 1, 2013
Social media allows for private pain to become public in a matter of seconds. Here are three fundamental guidelines for the nation’s 65 million caregivers and their friends to consider when it comes to using social media.
First, remember you are not just speaking for yourself, you are also speaking for the person you are caring for. Consider their comfort level with sharing their personal lives before you start posting.
Second, consider the reason you are sharing before you share. Before posting revealing information about someone’s situation, ask yourself if this news makes you feel superior to the person you are referring to, and then ask yourself if you are using the information to better your own social standing. If either answer is yes, then you’re not displaying the empathy of a supportive caregiver and should probably not share the information.
Third, remember social media is a double-edged sword. Sharing experiences with other caregivers online can help cope with stress, but seeing online posts of other people’s good times can add to frustration. Be sure to invite people into your network who bring you peace and support.
See Sherri Snelling, Social Media Dangers for the Modern Caregiver, Forbes, Nov. 21, 2013.
Special thanks to Naomi Cahn (John Theodore Fey Research Professor of Law, George Washington University School of Law) for bringing this article to my attention.
Thursday, November 28, 2013
According to a recent study from Bank of America Merrill Lynch, many adults with over $250,000 in investable assets were not discussing important financial planning concerns with their families.
The study found more than half of respondents had not discussed issues such as wills and health directives with their children and almost a third had not discussed these issues with their spouse.
The main reasons for avoiding these discussions was avoiding family conflict and avoiding the discomfort. However, the study concludes that advisers should encourage families to have these discussions so they’ll be prepared in the event of a family emergency.
See Mason Braswell, Families Don’t Talk to Each Other About Money, Says Merrill Study, On Wall Street, Nov. 18, 2013.
Special thanks to Jim Hillhouse (Professional Legal Marketing (PLM, Inc.)) for bringing this article to my attention.
Tuesday, November 26, 2013
ElderLaw Answers is sponsoring the 8th Annual Academy of Special Needs Planners (ASNP) National Meeting in Denver, Colorado, on March 27-29, 2014.
- The Latest and Greatest on Special Needs Planning and the Affordable Care Act
- Special Needs Planning, DOMA and Other Marriage-Related Issues
- SNT Distribution Planning for Housing, Food Assistance, Employment and Others
- Latest SSI Updates and Understanding and Using SSI Regional Counsel Opinions
Monday, November 25, 2013
As I have previously discussed, Casey Kasem’s family and friends are trying desperately to see the ailing radio legend, saying his wife Jean is preventing them access.
Kasem’s daughter was seeking a temporary conservatorship, but Superior Court Judge Lesley Green has rejected that effort, citing reports by investigators and doctors that Kasem is receiving good medical care. However, Judge Green is urging the parties to come to an agreement for visitation by Kasem’s children. Attorneys for both sides hope to negotiate a visitation agreement before the court hearing set for December 20.
See Anthony McCartney, Judge Rejects Conservatorship for Casey Kasem, San Jose Mercury News, Nov. 19, 2013.
Tuesday, November 19, 2013
- Not Living life for yourself
- Working too much, enjoy life with people you love, make them the priority
- Failing to be honest about your feelings
- Not Keeping in touch with good friends
- Refusing to choose to be happy
Ware suggests do not wait till you are on your deathbed to live the way you want.
See Bonnie Ware, Top 5 Regrets of the Dying, AARP, Feb. 1, 2012.
Tuesday, November 12, 2013
As I have previously discussed, UCLA recently discovered how to identify chronic traumatic encephalopathy (CTE) in living players.
After undergoing treatment at UCLA during the past three months, Pro Football Hall of Famers Tony Dorsett and Joe DeLamielleure as well as former NFL All-Pro Leonard Marshall have now been added to the list of living players diagnosed as having signs of CTE.
Dorsett decided to seek testing after experiencing symptoms of memory loss, depression, and thoughts of suicide. Dorsett admits suffering numerous concussions during his famed career and wanted to know if playing football is the reason why his quality of living is quickly deteriorating.
DeLamielleure and Marshall experienced similar symptoms and hope that their recent diagnosis will lead to an eventual cure.
See William Weinbaum & Steve Delsohn, Dorsett, Others Show Signs of CTE, ESPN, Nov. 7, 2013.
Special thanks to David S. Luber (Florida Probate Attorney) for bringing this article to my attention.
Friday, November 1, 2013
A new study by the Congressional Budget Office shows increasing the age of Medicare eligibility would hardly lower entitlement spending.
The study dramatically reduced the projection of deficit savings if the eligibility age were to be raised to 67. This new projection provides even less incentive to institute this already politically risky option.
Last year, the nonpartisan CBO projected $113 billion in savings over ten years. This new estimate predicts the federal budget deficit would be reduced by just $19 billion.
See Brett Logiurato, The CBO Just Shredded the Idea of Raising the Medicare Eligibility Age, Business Insider, Oct. 25, 2013.
Tuesday, October 29, 2013
A USA Today investigation found that over 100 cases of theft from nursing home trust funds have been prosecuted since 2010. In many cases, the nursing home bookkeepers and office managers tasked with handling trust funds and managing expenses were the main culprits.
The investigation discovered just how easy it is for administrators to get away with this crime. Most states have no audit requirements or criminal background checks.
Mandatory background checks could help solve this problem, but for now, the loved ones of nursing home residents should monitor monthly statements from the facility and check actual receipts for purchases made.
See Jeff Rossen & Josh Davis, Rossen Reports: Thieves Target Seniors at Nursing Homes, Today News, Oct. 25, 2013.
Friday, October 25, 2013
The Minnesota Supreme Court will soon determine whether guardians can make the call to disconnect their wards from life support without a judge’s signoff.
The court announced it will review In re the Guardianship of Jeffers J. Tschumy. Tschumy was a mentally disabled man who choked on food at age 57 and could not be revived. The district judge authorized the termination of life support, but denied the guardian’s request to make that decision himself. He reasoned that although state law grants guardians the power to allow or withhold medical care, it does not specifically allow the termination of life support.
The Minnesota Court of Appeals disagreed, reasoning that final authority does lie with guardians and the court should not dictate end-of-life decisions. The Supreme Court ruling will be issued within three months.
See Abby Simons, Minnesota Supreme Court Will Decide Whether Guardians Can Make the Call on Life Support, Star Tribune, Oct. 18, 2013.