Elder Law Prof Blog

Senate Special Committee on Aging-Guardianship Hearing

Earlier I had blogged about the upcoming hearing on guardianships scheduled for the Senate Special Committee on Aging The hearing was held on November 28, 2018, and a report as well as the video of the hearing are now available.  You can also access the witness statements here.

Senate Special Committee on Aging

The  Senate Special Committee on Aging is holding its next hearing tomorrow, November 28, on guardianships.  “Ensuring Trust: Strengthening State Efforts to Overhaul the Guardianship Process and Protect Older Americans.” is scheduled for 2:30 p.m. and will feature 4 witnesses. Testimony and remarks will be posted to the website after the hearing.

The Latest Robot Caregiver

With Thanksgiving 2018 behind us and family on our minds, it seemed timely that the New York Times ran an article about the newest entry into robot caregivers.  Meet Zora, the Robot Caregiver explains that this small robot, perhaps "more cute toy than futuristic marvel ...  is at the center of an experiment in France to change care for elderly patients." The nursing home using Zora found that residents, with dementia or needing 24 hour care,forrmed emotional attachments to it. A nurse, out of sight of residents, controls the robot via a laptop, giving it commands to speak and do activities such as exercises and games. 

The article focuses as well on the shortcomings of any robotic caregivers-that is, they aren't human.  Regardless, we all know about the looming caregiver shortage. Will robot caregivers fill that shortage? 

The experience at Jouarre provides a window into a future when we will rely more on robots to help care for loved ones as they age.

Zora Bots, the Belgium-based provider of the robot at Jouarre, says it has sold over 1,000 of the robots to health care facilities around the world, including in the United States, Asia and Middle East. It is part of a growing emphasis on robotics focused on care. A robot dog made by Sony has been marketed as a companion for older adults.

France, the article explains faces ongoing and serious issues regarding health care

[H]ospitals have been facing a national crisis, with health care professionals striking and protesting budget cuts and staff shortages. A rise of suicides of nurses and doctors has made national headlines, and France’s health minister acknowledged that the hospital system was “running out of steam.”

The challenge will be creating machines capable of doing more complex jobs. Lifting a patient’s mood with a song is different from providing health care. The French hospital, which bought the robot with the help of a charitable grant, brings out Zora just a few times a month.

In Australia, a hospital using a Zora robot studied the effects on patients and staff. The researchers found that it improved the mood of some patients, and got them more involved in activities, but required significant technical support.

The experience of the French hospital staff has been similar.

However, these robot caregivers are not health care providers-at least not yet. What the research has shown is that the residents can feel emotional bonds with the robots and they can help residents feel happier, or even, as the article notes, confide things in the robots that they won't tell human caregivers.

Stay tuned....

Caregivers need to save for retirement

We all know that caregiving can be a 24/7/365 job.  And many caregivers are working full time and caregiving part-time, while others leave their jobs to caregive. In those situations, it is no less important for caregivers to save for their own retirement, no matter how hard that may seem to be.  US News ran a story, Caregivers Should Save for Retirement which focuses on caregiving for someone with special needs. The article highlights the issues

ADVANCES IN MEDICINE and technology are allowing Americans – including those with special needs and disabilities – to enjoy longer, fuller lives. Still, as a caregiver, the emotional, physical and financial toll can be draining and could potentially prevent you from being able to plan for your own future. Research shows 30 percent of caregivers are not saving and investing for their own retirement because of the time and cost required for caring for those with special needs.

The article suggests the following for the caregiver: check out the available programs and benefits, continue savings and don't forget to invest, consider the implications of your financial situation on the individual with special needs who is applying for means-tested assistance, be aware of the impact of well-meaning relatives making a testamentary gift for the individual, and housing options and their various levels of care to name a few. The article also discusses special needs trusts and ends with this:

The key takeaway is that planning for your financial future, while at the same time ensuring continuity of care for a loved one, can be extremely complex, but you don't have to do this alone. Leveraging professional resources and revisiting your plan periodically can help keep you on track as your needs, and the needs of your family, continue to evolve.

Long-Distance Caregiving

With November being National Caregiver Month, the National Institute on Aging offers tips on long distance caregiving

These tips include splitting caregiving responsibilities and providing respite for the local caregiver. When deciding how to split responsibilities, the article suggests the long distance caregiver identify her strengths and limitations. Recognizing that the long-distance caregiver isn't providing day to day hands on care, the long-distance caregiver can still provide emotional support for the local caregiver, make arrangements with local organizations and do the online tasks and other items that can be done remotely.

Remember all caregivers are heroes, whether local or long-distance caregivers!

Stan Lee has died

Stan Lee has died at age 95.  Many will recognize him as the creator of many famous superheroes in the Marvel comic universe.  Movies based on his superheroes have been blockbusters and his cameos were one of the highlights of the films. More recently though, he has been in the news because of an issue familiar to elder law attorneys.  As the New York Times reported in his obituary, 

In Mr. Lee’s final years, after the death of his wife, the circumstances of his business affairs and contentious financial relationship with his surviving daughter attracted attention in the news media. In 2018, Mr. Lee was embroiled in disputes with POW!, and The Daily Beast and The Hollywood Reporter ran accounts of fierce infighting among Mr. Lee’s daughter, household staff and business advisers. The Hollywood Reporter claimed “elder abuse.”

In February 2018, Mr. Lee signed a notarized document declaring that three men — a lawyer, a caretaker of Mr. Lee’s and a dealer in memorabilia — had “insinuated themselves into relationships with J. C. for an ulterior motive and purpose,” to “gain control over my assets, property and money.” He later withdrew his claim, but longtime aides of his — an assistant, an accountant and a housekeeper — were either dismissed or greatly limited in their contact with him.

In a profile in The New York Times in April, a cheerful Mr. Lee said, “I’m the luckiest guy in the world,” adding that “my daughter has been a great help to me” and that “life is pretty good” — although he admitted in that same interview, “I’ve been very careless with money.”

Famous Faces of Dementia

Soon after Justice O'Connor's announcement, the New York Times ran an article, Dementia Is Getting Some Very Public Faces.

Focusing on the issue of stigma that accompanies the disease, the article notes the impact of Justice O'Connor going public about her condition.  Dementia and specifically Alzheimer's can strike any one, regardless of fame or fortune. As the article notes

Justice O’Connor had joined a growing but still tiny group: public figures who choose to share a dementia diagnosis. ...  The breakthrough came in 1994, when Ronald and Nancy Reagan released a handwritten letter disclosing his Alzheimer’s disease.

“In opening our hearts, we hope this might promote greater awareness of this condition,” the former president wrote. “Perhaps it will encourage a clearer understanding of the individuals and families who are affected by it.”

Musician Glen Campbell and his family reached a similar decision in 2011, announcing his Alzheimer’s diagnosis, and several farewell concerts, in a magazine interview. The concerts became a 15-month tour and an intimate, unflinching documentary.

The famous folks also include Pat Summit and Gene Wilder.  So what is the value of famous folks going public with their diagnosis? We already know that a large number of folks are diagnosed with dementia and that Alzheimer's disease in particular is horrible disease in my opinion.

It’s hardly an obscure condition. About 5.7 million Americans have Alzheimer’s disease, the Alzheimer’s Association estimates. That represents just 60 to 80 percent of people with dementia, which takes multiple forms.

Though dementia rate seems to be declining, possibly because of rising education levels and better treatment for conditions like hypertension, both of which seem to help prevent dementia. But the number of Americans affected will continue to grow as the population grows and ages.

Already, Alzheimer’s has become the fifth leading cause of death for those aged 65 and older — and the only one for which medicine can’t yet offer prevention or treatment.

The article explains the value of famous folks going public with their diagnosis lessens the stigma others may feel from that diagnosis. Plus it may lead to earlier diagnosis for others and although there is no cure, it gives the patient and families more time to plan.

Living Life at the End of LIfe

Kaiser Health News ran a story recently on living with a terminal diagnosis. At Death’s Door, Shedding Light On How To Live explores the impact of such diagnosis on how one person decided to live the rest of her life and how she is coping with the diagnosis. The article lists the things she no longer does  (regular exercise) or finds concerning: "[N]o more worrying, even for a minute, what anyone thinks of her. As [she] wrote in a recent blog post, 'All kinds of things … fall away at just about the exact moment the doctor says, ‘There is no treatment.'"  She blogs about her situation and has found positive responses from readers yet the article notes others may not prefer to share their lives with strangers: "Other people may have very different perspectives as they take stock of their lives upon learning they have a terminal illness. Some may not want to share their innermost thoughts and feelings; others may do so willingly or if they feel other people really want to listen."

Call for Proposals-National Center for Victims of Crime

The National Center for Victims of Crime has released a call for proposals for its 2019 training institute. The website announcing the call for proposals explains:

The National Center is pleased to present the National Center for Victims of Crime 2019 National Training Institute. As in past years, this training will emphasize a multidisciplinary approach to sharing promising practices, current research, and effective programs and policies that are victim-centered, practice-based, and research-informed. Our National Training is a forum for law enforcement, victim service professionals, allied practitioners, policymakers, and researchers to share current developments and build new collaborations. Conference sessions will highlight practical information to better support services for the wide range of persons victimized by crimes of all types.

 Call for Workshop Proposals

The National Center for Victims of Crime is seeking presenters for its National Training Institute, to be held September 4-6, 2019, in Denver, Colorado. Workshops will address a wide range of topics organized into separate conference tracks. Workshops are scheduled for 90 minutes (1.5 hours) in length, unless otherwise specified in the proposal. Accepted presenters will be assigned day and presentation time by the Institute planning committee.

Click here  to submit a proposal.

8 Briefs-Financial Exploitation by Conservators

The National Center for State Courts project on  Elders & Courts, with other organizations have published  a series of 8 research briefs on Financial Exploitation by Conservators.  The topics include

• Examples of Conservator Exploitation: An Overview
• Conservator Exploitation in Minnesota: An Analysis of Judicial Response
• Detecting Exploitation by Conservators – Court Monitoring
• Detecting Exploitation by Conservators – Systemic Approach
• Court Actions Upon Detection of Exploitation
• Innovative Programs that Address Financial Exploitation by Conservators
• Data Quality Undermines Accountability in Conservatorship Cases
• Supporting Victims of Conservator Exploitation

as well as key resources for these cases.

The introduction explains the impetus for the work, the 8 briefs, definitions of common terms and the reason for the project

NCSC in 2016 estimated, based on projections, that there are approximately 1.3 million active adult guardianship or conservatorship cases in the United States and at least $50 billion in assets under conservatorships (see Data Quality Brief). Also in 2016, the U.S. Government Accountability Office (GAO) found that “the extent of elder abuse by guardians nationally is unknown due to limited data . . .” While many conservators are trustworthy, dedicated, and provide critically needed services, multiple media accounts over many years profile instances in which conservators have breached their fiduciary duty – taking advantage of those they were charged with protecting. (citations omitted)

 

A 22 Year Retrospective of Elder Abuse Prosecutions

Paul Greenwood, a rock star prosecutor known widely for his successes in elder abuse prosecution recently retired (huge loss for all of us).  He authored The Changing Landscape of Elder Abuse Prosecutions: A 22-Year Journey. He writes about the changes

Today prosecutors and law enforcement have an abundance of materials at their disposal to assist in the investigation and prosecution of criminal elder abuse cases. One such outstanding example is the newly released Elder Abuse Guide for Law Enforcement [EAGLE] operated by the National Center on Elder Abuse. Another great tool is the Elder Justice Initiative created by the Department of Justice.

The quandary that we face is not where to find the information but rather whether to make elder abuse prosecution a priority.

It is no exaggeration to say that elder justice is fast becoming a critical national issue. Demographics, availability of technology to seniors, the opioid epidemic, and the expanding number of dementia patients are just a few factors that have combined to create the perfect climate for predators. Elder abuse has been called the “crime of the 21st century”.

He writes about the upcoming challenges and steps prosecutors are taking to face them. Those preparations include trainings for prosecutors, in-state collaborations between prosecutors and state attorney generals, and multi-disciplinary teams.  Paul writes that two areas present hurdles:

1. "Financial elder abuse is exploding and many of the perpetrators are able to hide in anonymity thanks to the proliferation of such internet ruses as romance, IRS, sweepstakes and grandma scams. Moreover, many exploiters are using nontraditional methods to steal from their elderly victim and then claiming that the transaction represents either a gift or a loan. We are having to find new ways to argue lack of consent aggressively and effectively and also educate ourselves as to the ways in which undue influence impacts this crime."
2. "Secondly, we are still figuring out how to uncover, investigate and prosecute crimes – particularly sexual abuse – that occur in long term care facilities. Prosecutors need to reach out to the various state agencies that oversee the issuance and revocation of facility licenses along with the Long Term Care Ombudsman programs."

Paul Greenwood has done amazing things in advancing the prosecution of elder abuse cases. We all should thank him and wish him well as he moves to his retirement. Thank you Paul!

 

10 Commandments of Capacity

The ABA Commission on Law & Aging published its September-October newsletter, BIOFOCAL. The lead article is on  The Ten Commandments of Mental "Capacity" and the Law.

Recognizing the evolving state on the issue of capacity, the article explains 

[R]ecent changes have called the legal term “capacity” into question. The U.N. Convention on the Rights of Persons with Disabilities in Article 12 recognizes that “persons with disabilities enjoy legal capacity on an equal basis with others in all aspects of life” and that governments must take measures to assist individuals in exercising their capacity. The emerging principle of supported decision-making focuses on providing the needed support to help people make decisions. Finally, the 2017 Uniform Guardianship, Conservatorship and Other Protective Arrangements Act (UGCOPAA), approved by the Uniform Law Commission for adoption by state legislatures, does not use the term “capacity” – rather, it guides courts in determining whether there is a “basis” for the appointment of a guardian, taking into account needed supports and supported decision-making.

The article goes on to offer Ten Commandments:

1. presume capacity, 2. talk alone to the client, 3. make efforts to increase the client's abilities, 4. recognize there is no one "universal standard for assessing capacity", 5. lawyers shouldn't administer the mini-mental status exam, 6. remember it's capacity to do a specific task, 7. remember to examine the big picture, 8. keep the client's wishes, goals, etc. in the forefront, 9. remember client confidentiality and autonomy, and 10. remember the importance of advance planning.

 

 

 

 

Disaster Recovery Resources

The National Consumer Law Center sent out an email listing resources for attorneys and others helping elders recover from natural disasters. The email described the situation:

Older adults living in communities hit by natural disasters disproportionately suffer emotional trauma and financial hardship after the event. Age-related changes, including decreases in mobility and cognitive abilities make it harder for older adults to navigate the recovery process and access resources to repair or rebuild their homes. Once the immediate danger has passed, older adults will need assistance from insurance, government, and nonprofit organizations or other aid agencies to rebuild their home and community support system. In the days and weeks after the disaster older adults are forced to deal with a wide variety of issues, including home repair, reconnecting utilities, and making payments, including mortgage, credit cards, and student loans. Unlike many others affected by disasters, older adults may have fewer private assets to aid in recovery making the process to rebuild financially more difficult. Here are some resources the National Consumer Law Center (NCLC) has compiled to help guide advocates in advising older adults.

The Disaster Relief & Consumer Protection Project  offers information and resources in several categories. For individuals who are older, the resources address the following:

• Issue Brief: Assisting Homeowners with Reverse Mortgages after a Natural Disaster: A Guide for Advocates, October 2018

• Webinar: Assisting Older Homeowners after a Natural Disaster (National Center on Law and Elder Rights), June 20, 2018:

  • Free Webcast: Assisting Older Homeowners After a Natural Disaster, June 2018

  • Issue Brief: Helping Older Homeowners Recover from Natural Disasters, June 2018

  • Presentation