Thursday, August 31, 2017
USA Today ran a story, Can this eye scan detect Alzheimer's years in advance? This short article explains that according to scientists "early indicators of Alzheimer's disease exist within our eyes, meaning a non-invasive eye scan could tip us off to Alzheimer's years before symptoms occur... It turns out the disease affects the retina — the back of the eye — similarly to how it affects the brain, notes neuroscience investigators at Cedars-Sinai Medical Center in California. Through a high-definition eye scan, the researchers found they could see buildup of toxic proteins, which are indicative of Alzheimer's." The study on which this article is based was published in the Journal of Clinic Investigation. Retinal amyloid pathology and proof-of-concept imaging trial in Alzheimer’s disease is downloadable as a pdf by clicking here. The 19 page article offers this intriguing statement. "Such retinal amyloid imaging technology, capable of detecting discrete deposits at high resolution in the CNS, may present a sensitive yet inexpensive tool for screening populations at risk for AD, assessing disease progression, and monitoring response to therapy." (Warning-there are a lot of detailed photos of eyes in this article).
Wednesday, August 30, 2017
Kaiser Health News ran this story, Elder Abuse: ERs Learn How To Protect A Vulnerable Population, a few days ago.
Because visits to the emergency room may be the only time an older adult leaves the house, staff in the ER can be a first line of defense, said Tony Rosen, founder and lead investigator of the Vulnerable Elder Protection Team (VEPT), a program launched in April at the New York-Presbyterian Hospital/Weill Cornell Medical Center ER.
The most common kinds of elder abuse are emotional and financial, Rosen said, and usually when one form of abuse exists, so do others. According to a New York study, as few as 1 in 24 cases of abuse against residents age 60 and older were reported to authorities.
The project consists of a team of doctors and social workers who rotate being on call, with backup from other professionals when the case so requires. The team trains the entire ER staff about identifying elder abuse. "A doctor interviews the patient and conducts a head-to-toe physical exam looking for bruises, lacerations, abrasions, areas of pain and tenderness. Additional testing is ordered if the doctor suspects abuse."
The team looks for specific injuries. For example, radiographic images show old and new fractures, which suggest a pattern of multiple traumatic events. Specific types of fractures may indicate abuse, such as midshaft fractures in the ulna, a forearm bone that can break when an older adult holds his arm in front of his face to protect himself.
When signs of abuse are found but the elder is not interested in cooperating with finding a safe place or getting help, a psychiatrist is asked to determine if that elder has decision-making capacity. The team offers resources but can do little more if the patient isn’t interested. They would have to allow the patient to return to the potentially unsafe situation.
Patients who are in immediate danger and want help or are found not to have capacity may be admitted to the hospital and placed in the care of a geriatrician until a solution can be found. Unlike with children and Child Protective Services, Adult Protective Services won’t become involved until a patient has been discharged, so hospitalization can play an important role in keeping older adults safe.
There have been a number of cases of suspected abuse identified by the team with a fair percentage of those confirmed as abuse cases. Ultimately, the team wants "to optimize acute care for these vulnerable victims and ensure their safety. They plan to work at continually tweaking VEPT to improve the program and to connect to emergency medical, law enforcement and criminal justice services. Eventually, they hope to help other emergency departments set up similar programs."
Tuesday, August 29, 2017
There was a lot of sad news this past week, especially the news about the damage that Hurricane Harvey has brought to Texas. I read a story about SNF residents in waist-high water awaiting evacuation. This brought back memories of Katrina and stranded residents then. The New York Times article, Behind the Photo of the Older Women in Waist-High Water in Texas, notes that there was some back and forth regarding the authenticity of the photo as the photo went viral. Ultimately, the residents were evacuated, as the article explains
On Sunday afternoon ... An evacuation was underway and the residents — more than a dozen — were being relocated... [A] Galveston County commissioner, confirmed on Sunday that the residents had been rescued, though he could not say for sure how many... He said the furor over the photo was not what brought emergency responders to the scene...“We knew about it before it hit social media,” he said. “We were working on a solution for the nursing home, and it was in progress, so social media can sometimes leave one with the wrong impression.”
A follow-up article in the Times, Houston’s Hospitals Treat Storm Victims and Become Victims Themselves discusses the impact on the "medically vulnerable" and what lessons were learned from Katrina. A number of improvements were made, as the article notes, but "[w]hile some vulnerable hospitals and nursing homes opted to move their patients out of the region in the hours before the storm, ... others “did not know to necessarily expect this level of chaos.” A large coalition of medical providers had drilled and planned regularly for catastrophes ... 'but honestly, not at this epic level.'" The article notes a change in the federal rule after Katrina has helped; it "requires a wide range of health providers to establish emergency plans —[which has] ... led to significantly better preparedness among nursing homes."
Federal health officials also analyzed Medicare claims to provide Texas officials with the likely addresses of homebound people who rely on power-dependent ventilators, oxygen concentrators and electric wheelchairs, among other needs. Responders also used the state’s voluntary registry to locate them and offer assistance.
So this is a good time to remind everyone about having an disaster plan. There are a number of resources on the web providing guidance on how to create a plan and to have an evacuation "go box" ready. It also is good to know what the SNF's plan is and under what circumstances do they evacuate residents or shelter in place. The stakes are too high not to ask about the plan.
I suspect that we will be posting more entries about the aftermath of Harvey for a while. Stay tuned.
I suspect many of our readers have been thinking the same thing: "How can I help Texas residents in the wake of Hurricane Harvey?" I was particularly struck by the images of residents of an assisted living center in Dickinson, Texas, waist deep in the flood waters. It is frustrating to feel you have nothing to contribute as lawyers. In our official capacity, we are rarely needed as first-line responders, although certainly free and low-cost legal services can be critical in the many months to come.
Of course, members of the legal community can and do donate needed items and money. The challenge is sometimes how "best" to make those donations effective, especially if you want to help a specific group or population of folks. With that in mind, I was interested to hear an NPR radio report on the Texas Diaper Bank today. It was an example of a targeted program, that has been around long enough to have an established network for providing relief in Texas, and the story focused on "working to get supplies to evacuating families with young children."
I wondered, "What about seniors?" Sure enough, when I went to the website for the Texas Diaper Bank, I learned that the nonprofit organization's mission is to address "the diaper gap and its impact on individuals in crisis," including providing "incontinence supplies" to adults. Cute photos of babies may be the key to recruiting volunteers and donations, but I was pleased to read that the "Bank" mission specifically includes helping "seniors" to "live healthier" through provision of "essential items, education, and more." It turns out that Texas' Diaper Bank program is part of a "National Diaper Bank Network."
So, if you aren't too embarrassed to talk about "adult diapers," here is an organization you can share with those who want to help seniors "too." Maybe a short note with your donation is appropriate, saying you want your contribution to help seniors.
Perhaps NPR will do a follow-up story on how the "diaper bank network" programs serve the elderly?
Monday, August 28, 2017
The Consumer Financial Protection Bureau has released three resources on reverse mortgages:
1. https://s3.amazonaws.com/files.consumerfinance.gov/f/documents/201708_cfpb_costs-and-risks-of-using-reverse-mortgage-to-delay-collecting-ss.pdf on using a reverse mortgage to delay taking SSA retirement. The issue brief, The costs and risks of using a reverse mortgage to delay collecting Social Security runs 27 pages and is downloadable as a pdf. As the conclusion explains
We find that borrowing a reverse mortgage loan to get an increased Social Security benefit carries significant costs that generally exceed the additional lifetime amount gained from delaying Social Security. In addition, the amount that a consumer will need to borrow from a reverse mortgage loan to delay claiming Social Security benefits could negatively affect the consumer’s ability to move or use their home equity to meet a large expense later in life.
For consumers who have the option, working past age 62 is usually a less costly way to increase their monthly Social Security benefit than borrowing from a reverse mortgage.40 The extra years of work often provide people more time to save for retirement and pay off debts. The extra years of work may also result in an increase in Social Security benefits—separate from the increase that arises from deferring the start of benefits—by replacing years with low or no earnings from the person’s earnings record.41 Consumers may also consider other options to increase their Social Security benefit, such as coordinating their claiming decision with their spouses.
As consumers consider borrowing a reverse mortgage loan in order to delay claiming Social Security benefits or defer withdrawing funds from retirement savings, it is important for them to be aware of the risks and costs associated with this strategy. This is especially true for consumers whose primary source of income is Social Security and whose main asset is their home. For those consumers, the costs of a reverse mortgage loan will likely exceed the lifetime amount of money gained from an increased Social Security benefit, which in turn may threaten their financial security later in life.
The second resource is a discussion guide on reverse mortgages a twenty-four page pdf that provides "an overview of many key concepts of reverse mortgages." The guide is organized by the requirements for a reverse mortgage and includes illustrations and graphics for each. This is a very helpful tool!
The agency's blog also discusses this new resources. Add these to your collection of resources!
From Oregon, known for its "death with dignity" laws, the dilemma facing a couple who are learning the limits of the laws:
Bill Harris is blunt: For more than a year, he has been trying to help his wife die.
The 75-year-old retired tech worker says it’s his duty to Nora Harris, his spouse of nearly four decades, who was diagnosed with early-onset Alzheimer’s disease in 2009.
“Let me be honest: Yes. It’s what she wanted,” he said. “I want her to pass. I want her to end her suffering.”
Nora Harris, 64, a former librarian, signed an advance directive after her diagnosis to prevent her life from being prolonged when her disease got worse. Now, her husband said, she’s being kept alive with assisted eating and drinking against her stated wishes.
For more of the story, read "Despite Advance Directive, Dementia Patient Denied Last Wish, Says Spouse."
August 28, 2017 in Advance Directives/End-of-Life, Cognitive Impairment, Dementia/Alzheimer’s, Ethical Issues, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (0)
Tuesday, August 22, 2017
Mark your calendars for September 6, 2017 at 2:00 p.m. edt. DOJ's Elder Justice Initiative will be hosting another in its series of webinars on elder abuse. More information and registration for Financial Exploitation in the Context of Guardianships and Other Legal Arrangements will be available soon.
Update 8/28/2017: registration is now open!
August 22, 2017 in Cognitive Impairment, Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Programs/CLEs, State Statutes/Regulations, Webinars | Permalink | Comments (0)
Monday, August 21, 2017
A new publication is available from the National Academies Press. Developing Affordable and Accessible Community-Based Housing for Vulnerable Adults: PROCEEDINGS OF A WORKSHOP is available for download as a pdf or for purchase as a print copy. Here is an excerpt from the introduction
Accessible and affordable housing can enable community living,2 maximize independence, and promote health for vulnerable populations. However, the United States faces a shortage of affordable and accessible housing for vulnerable low-income older adults and individuals living with disabilities. This shortage is expected to grow over the coming years given the population shifts leading to greater numbers of older adults and of individuals living with disabilities.
Housing is a social determinant of health and has direct effects on health outcomes, but this relationship has not been thoroughly investigated. To better understand the importance of affordable and accessible housing for older adults and people with disabilities, the barriers to providing this housing, the design principles for making housing accessible for these individuals, and the features of programs and policies that successfully provide affordable and accessible housing that supports community living for older adults and people with disabilities ....
The forum meets to discuss how to support independence and community living for people with disabilities and older adults. The roundtable promotes health equity and the elimination of health disparities by advancing the visibility and understanding of the inequities in health and health care among racial and ethnic populations; by amplifying research, policy, and community-centered programs; and by catalyzing the emergence of new leaders, partners, and stakeholders.
The book runs 108 pages and the pdf is a free download.
Sunday, August 20, 2017
The Centers for Medicare & Medicaid Services (CMS) is working diligently to make healthcare quality information more transparent and understandable for consumers in all stages of life to empower them to take ownership of their healthcare choices. This includes decisions about end-of-life care, when consumers in a time of vulnerability need transparent, digestible information to make the best choice for their care or the care of their loved ones.
We at CMS understand that there are many difficult decisions that come with a terminal illness—including deciding if hospice is right for you and which hospice to choose—which is why we have launched Hospice Compare. This new website will help empower you by allowing you to easily and quickly compare hospice providers on various aspects of care and assess the quality of care that potential hospices provide.
Hospice Compare provides information on hospices across the nation and allows patients, family members, caregivers, and healthcare providers to compare hospice providers based on some key quality metrics, like what percentage of a hospice provider’s patients were screened for pain or difficult or uncomfortable breathing and if their patients’ preferences are being met. Specifically, the quality measures look at the percentages of patients who received recommended treatment, for example:
- Patients or caregivers who were invited to discuss treatment preferences, like hospitalization and resuscitation, at the beginning of hospice care;
- Patients or caregivers who were invited to discuss beliefs and values at the beginning of hospice care;
- Patients who were checked for pain at the beginning of hospice care;
- Patients who received a timely and thorough pain assessment when pain was identified as a problem;
- Patients who were checked for shortness of breath at the beginning of hospice care;
- Patients who got timely treatment for shortness of breath; and
- Patients taking opioid pain medication who were offered care for constipation.
The information on Hospice Compare can be used along with other information you gather about hospice providers in your area. In addition to reviewing the information on Hospice Compare, you’re encouraged to talk to your doctor, social worker, other healthcare providers, and other community resources when choosing the best hospice for care for you or your loved one.
In addition to Hospice Compare, Medicare also offers a number of other websites that can help you select providers and facilities to meet a wide range of care needs, including Inpatient Rehabilitation Facility Compare; Long-Term Care Hospital Compare; Hospital Compare; Physician Compare; Nursing Home Compare; Medicare Plan Finder; Dialysis Compare; and Home Health Compare.
Hospice Compare is available here
Friday, August 18, 2017
Every once in a while, I find something so well written, that even if not strictly speaking an "elder law" related piece, I have to share it here.
Here's one such example. Of course, under the right combination of circumstances, given the secrets people hold to their last hours, there certainly could be legal consequences of the mysteries discussed by Hospice Chaplain Kerry Egan in her piece for the New York Times, "Married to a Mystery Man."
I'm sure all of us have seen ads about fighting aging, or a product that is promoted as "anti-aging." I always am puzzled; it seems that we are in a battle against aging. So an article in Huffington Post caught my eye. Allure Just Banned The Term ‘Anti-Aging’ And Everyone Else Should, Too explains the company "will no longer use the term “anti-aging,” acknowledging that growing older is something that should be embraced and appreciated rather than resisted or talked about as if it’s a condition that drains away beauty." The article explains that the "anti" label reinforces a negative message about aging being something that is to be fought. The magazine's statement, "Allure Magazine Will No Longer Use the Term 'Anti-Aging'" is available here.
Thursday, August 17, 2017
The federal right to try law's next stop is the House of Representatives. The article in Kaiser Health News, House Expected To Hold Hearings On ‘Right-To-Try’ Bill That Senator Tied To FDA Funding provides this background
The Senate quickly passed the bill that would allow dying patients access to experimental drugs after Sen. Ron Johnson (R-Wis.) had threatened to slow down consideration of a separate bill to renew the FDA’s fee-collection authority. In other drug industry news, the FDA is implementing new rules about hiring foreign scientists, industry tightens controls to keep out counterfeit drugs, cancer trials are low on patients and costs of old drugs rising quickly for Medicaid.
Although given priority by the Senate, the bill isn't expected to get the same treatment by the House. According to an article in Roll Call, ‘Right to Try’ Bill Could Face Slower Action in House if the House committee changes the bill from the Senate version, things will slow down. Here's a bit of an overview from the article:
Currently, when a patient seeks access to an experimental drug, his or her physician must work with the drug company, the FDA and an institutional review board that signs off on drug testing to approve the treatment’s use. When originally introduced in January, Johnson’s bill would have taken the FDA and other government entities out of that process. It would have let the states define “terminal illness,” potentially leading to dozens of different standards across the country about who would qualify for access. It also would have prevented the FDA from using outcomes associated with the experimental use when considering the drug’s application.
The new bill, instead of leaving the definition of terminal illness to the states, says that eligible patients should have a “life-threatening disease or condition” as defined by current federal law. It also gives the FDA the right to use outcome data if the administration determines that it is critical to assessing the drug’s safety — or if the drug company wants the outcomes used.
The drug companies would also have to provide the FDA with information about the experimental uses. Like the original bill, the new version shields companies against liability, but extends that protection to manufacturers who chose not to grant access to treatments. The bill would also limit the drugs that can be provided to those that have already completed the first phase of formal clinical trials, which are conducted to assess drug safety.
Tuesday, August 15, 2017
Professor Marshall Kapp has recently had an article published in 33 Ga. State Law Review 869. Distinctive Factors Affecting the Legal Context of End-Of-Life Medical Care For Older Persons is the lead article in a symposium volume on end of life issues. Here is the abstract for this article
Current legal regulation of medical care for individuals approaching the end of life in the United States is predicated essentially on a factual model emanating from a series of high-profile judicial opinions concerning the rights of adults who become either permanently unconscious or are clearly going to die soon with or without aggressive attempts of curative therapy.
The need for a flexible, adaptable approach to medically treating people approaching the end of their lives, and a similar openness to possible modification of the legal framework within which treatment choices are made and implemented, are particularly important when older individuals are involved. Of the approximately 2.5 million people who die each year in the U.S., about three-quarters of deaths occur among persons aged sixty-five and older. As stated succinctly by historian Jill Lepore, “[t]he longer we live, the longer we die.”
This article outlines a few of the most salient clinical and social factors that distinguish the large and growing cohort of older persons, in potentially legally and policy relevant ways, from other population groups for whom end-of-life medical treatment choices may come into play. Some practice and policy implications are alluded to briefly.
Thanks to Professor Kapp for letting me know about his article!
Monday, August 14, 2017
According to recent stories about Medicare observation status, poor elders may be harder hit by this than those with more affluence. Medicare’s Observation Care Policy More Likely To Affect Low-Income Seniors makes note of "[a] new study finds that low-income patients are more likely to be kept in the hospital under observation, and the higher out-of-pocket spending that accompanies not being officially admitted is a bigger burden for them." The study referenced is published in the American Journal of Medicine. The article's abstract explains:
Medicare beneficiaries hospitalized under observation status are subject to cost-sharing with no spending limit under Medicare Part B. Since low-income status is associated with increased hospital utilization, there is concern that such beneficiaries may be at increased risk for high utilization and out-of-pocket costs related to observation care. Our objective was to determine whether low-income Medicare beneficiaries are at risk for high utilization and high financial liability for observation care compared to higher-income beneficiaries.
A subscription is required to access the full article.
The ABA Journal this month has a short piece especially relevant today, August 14, 2017. Today is the 82nd anniversary of the signing of the Social Security Act in 1935. Frances Perkins is highlighted in the article as "The Woman Behind America's Social Safety Net."
By late 1934, Roosevelt was facing conservative resistance to his New Deal programs in Congress and the courts. Moreover, it would take years before those who had immediate needs would see any benefit from the social security [Secretary of Labor Frances] Perkins favored. Roosevelt confided to others that the timing might not be right for old-age insurance.
Perkins was furious and confronted him, arguing that the nation’s dire condition might provide the political opportunity for a bold initiative. When Roosevelt gave her a Christmas deadline, Perkins invited the committee to her home, placed a bottle of scotch on a parlor table, and told them they were not to leave until they had framed a legislative proposal....
Okay -- admit it -- how many of us first came to know the name of Frances Perkins in the movie Dirty Dancing?
Kaiser Health News recently ran a story about the end of life consultations now covered by Medicare. End-Of-Life Advice: More Than 500,000 Chat On Medicare’s Dime offers some interesting statistics on the number of consults. "In 2016, the first year health care providers were allowed to bill for the service, nearly 575,000 Medicare beneficiaries took part in the conversations, new federal data obtained by Kaiser Health News show." In fact, that number is almost double of what the AMA projected for 2016. Although those numbers are good news for the proponents of the law, when compared to the numbers of Medicare beneficiaries overall, the percentage is quite low.
[O]nly a fraction of eligible Medicare providers — and patients — have used the benefit, which pays about $86 for the first 30-minute office visit and about $75 for additional sessions.... Nationwide, slightly more than 1 percent of the more than 56 million Medicare beneficiaries enrolled at the end of 2016 received advance-care planning talks, according to calculations by health policy analysts at Duke University....
The article explores some explanations for these numbers, including lack of knowledge of the benefit by doctors and lingering concerns over the "death panels" controversy.
Friday, August 11, 2017
Here is another tragic news story for a man, age 82, "who had begun showing signs of dementia and would become 'disoriented at times.'"
On Aug. 2, nearly a month after he went missing, maintenance workers reported to fire authorities a discovery: a decomposed body in an elevator car in the parking garage. The body was soon identified as Komisarchik’s. . . .
At some point on or before July 6, Komisarchik stepped inside the parking garage elevator. For reasons that remain unclear, he struggled to get out.
So in an attempt to seek help, Komisarchik pushed the elevator’s emergency button — twice over the course of eight minutes, a Denver Fire Department spokesman told the Denver Post. But no one responded.
Electronic records show that the elevator’s emergency alarm was pressed at 9:09 p.m. and 9:17 p.m. on July 6, the day after Komisarchik was last spotted, according to KUSA. Pushing this emergency button should trigger an alert to an elevator monitoring group or the fire department. But during the time Komisarchik was in the elevator, the fire department received no emergency calls from that car, the Denver Post reported.
“Something is not right,” Capt. Greg Pixley, a Denver Fire Department spokesman, told the Denver Post.
For more details, read "He pushed an elevator's alarm button but no one came. . . ." from the Washington Post
Thursday, August 10, 2017
The GAO has issued a report that examines various federal programs for low-income individuals. Federal Low-Income Programs: Eligibility and Benefits Differ for Selected Programs Due to Complex and Varied Rules offers the following findings
Six key federally funded programs for low-income people vary significantly with regard to who is eligible, how income is counted and the maximum income applicants may have to be eligible, and the benefits provided. In fiscal year 2015, the most current data available, the federal government spent nearly $540 billion on benefits for these six programs—the Earned Income Tax Credit (EITC), Medicaid, the Housing Choice Voucher program, Supplemental Nutrition Assistance Program (SNAP), Supplemental Security Income (SSI), and Temporary Assistance for Needy Families (TANF). The target population for each of these programs differs, for example, people who are elderly or disabled or who have dependent children. Further, some programs have conditions for continued eligibility, such as participation in work activities under TANF. The six programs also vary in what income is and is not counted when determining an applicant's eligibility. For example, certain programs, such as SNAP, disregard a portion of earned income, while others do not. The maximum amount of income an applicant may have and still be eligible for benefits, which is determined for some programs at the federal level and for others at the state or local level, also differs significantly. As of December 2016, this amount ranged from $5,359 per month for one state's Medicaid program to $0 per month in one state for TANF cash assistance, for a single parent with two children. Benefit levels also differed across the six selected programs, with average monthly benefits for these programs ranging in fiscal year 2015 from $258 for SNAP to $626 for Housing Choice Vouchers, and four of the six programs adjust benefits annually.Legal, administrative, and financial constraints pose challenges to efforts to streamline varying eligibility rules for federal low-income programs, according to GAO's current and previous work. A key challenge is that the programs are authorized by different federal statutes enacted at different times in response to differing circumstances. Other laws, such as appropriations laws, can also have an impact on federal programs and their rules. As a result, streamlining eligibility rules would require changing many laws and coordination among a broad set of lawmakers and congressional committees. A further challenge is that a different federal agency or office administers each program GAO reviewed. For some of these programs, such as TANF, state governments also establish some program rules, making it more difficult to streamline rules at the federal level within or across these programs. Finally, financial constraints may also affect efforts to streamline program rules. For example, if rule changes raise the income eligibility limit in a program, more people may become eligible and that program's costs may increase. Despite these challenges, Congress, federal agencies, and states have taken some steps to streamline program administration and rules, such as by making greater use of data-sharing where permitted by federal law and aligning programs' applications and eligibility determination processes. For example, SSI recipients in most states are automatically eligible for Medicaid, and GAO previously reported that some states have integrated the SNAP eligibility process with other low-income programs, such as through combined applications and common eligibility workers.
Wednesday, August 9, 2017
The Florida State U. Center for Innovative Collaboration in Medicine & Law along with the Florida Bioethics Network will hold the annual Medicine-Law Conference on Monday, January 22, 2018 at the Florida State University Alumni Center in Tallahassee. The 2018 conference theme is Health Professional/Attorney Collaboration on Behalf of Patients and Clients. More info will be available from the Center for Innovative Collaboration in Medicine & Law.
The Washington Post carried a recent story by Samantha Schmidt on the tragedy that befell the Tarnowski family in Minnesota when Mary, age 78, and Ron, age 81, somehow wound up stranded with their car on a remote rural trail. Sadly, they both perished, with heat and dehydration likely factors in their deaths.
One element of the story has attracted a lot of reader attention -- the report that Ron Tarnowski, who had been his wife's primary caregiver for more than 35 years, was "showing signs of early-stage dementia" in recent years. Implications from this label raise questions for many.
From the article, a facebook page, and the obituary, it is apparent that the couple's two sons were very caring and attentive. One son had built them a home "adjacent to his own so he could keep an eye on them." That son's wife had given his mother a bath and cooked breakfast for the couple earlier on the day they went missing, and the fact that they were missing was reported the very same day. Despite the sons' attentiveness, and the all-out efforts of authorities and volunteers to locate the missing couple, the search lasted eight days.
I read with interest the comments to the story posted on-line at the Washington Post website. I expected there would be "flamers" and shaming, so typical of many on-line comment websites. But for the most part, the readers showed kindness and empathy, especially as they told their own stories of struggles to balance protection with respect, attempting to preserve autonomy of beloved family members who are aging.
Significantly, many readers addressed the potential for modern technology in the form of automated trackers on cars and cell phones to help avoid, if not completely prevent such a tragedy.