Monday, September 19, 2022

Register Now-Webinar on Guardianship Systems & Practices

The National Center on Law & Elder Rights has announced a webinar on Thursday September 22, 2022 at 3 eastern on Strengthening Rights & Ensuring Accountability in Guardianship Systems & Practice.   Here's a description

Improvements to state court adult guardianship systems can include the promotion of less restrictive options, strengthening rights, and ensuring accountability. Making significant changes in practice and systems requires the commitment of many parties, including courts and the legal, aging, and disability communities.

Join us for Part 1 of this training series to learn about models and promising practices to reform guardianship being implemented by three “highest state court” recipients of the ACL Elder Justice Innovations Guardianship Improvement grant program (Maryland, Minnesota, and Oregon).

This training will also preview Part Two of this series, which will focus on strategies for legal advocacy for proposed protected persons and protected persons.  

Presenters will share strategies they are implementing to:

  1. Address diversion from, alternatives to, and revocation of guardianship;
  2. Redress occurrence and risk of abuse, neglect, and exploitation in guardianship; and
  3. Enhance the fairness, effectiveness, timeliness, safety, and integrity of adult guardianship or conservatorship proceedings.

Speakers:

  • Hilary Dalin, Office of Elder Justice and Adult Protective Services, Administration on Aging Administration for Community Living
  • Nisa C. Subasinghe, Maryland Judiciary
  • Jamie Majerus, Minnesota Judicial Branch
  • Christian Hale, Oregon Judicial Department
  • Jeffrey Petty, Oregon Judicial Department
  • Jessica Brock, Indiana Legal Services

Closed captioning will be available on this webcast. A link with access to the captions will be shared through GoToWebinar’s chat box shortly before the webcast start time.

This training will be presented in a WEBCAST format to accommodate more participants. Due to the high volume of participants, computer audio will be the only option to listen to the presentation. No telephone call-in number will be provided. Please plan accordingly. Thank you. 

This webcast will be recorded and available on our website shortly after the presentation. The recording and training materials will also be emailed to all registrants within a few days after the training.

The webcast will take place on Thursday, September 22, 2022, at 12:00 p.m. P.T./3:00 p.m. ET and will run for 75 minutes.

To register, click here.

September 19, 2022 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, State Statutes/Regulations, Webinars | Permalink | Comments (0)

Monday, September 12, 2022

A Few Interesting Articles

I'm a bit behind and in an effort to catch up, in this post I just wanted to point out to you a few interesting articles that you hmay want to read.

1.  A robot that will catch an older person who is falling:  This robot catches grandma before she falls.

2. Probiotics and arthritis: Rheumatoid arthritis could be treated by eating probiotic bacteria.

3. Advance detection of Alzheimer's before symptoms manifest:  New Device Can Detect Alzheimer’s 17 Years in Advance

(Thanks to my dear friend Professor Feeley for sending me the links to the last two).

September 12, 2022 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Other | Permalink

Sunday, August 21, 2022

Hearing Loss, Cataracts, and Dementia

There seem to be a lot of articles in the media currently discussing the statistical relationship between hearing loss and dementia.  Of course, we need to remember the axiom that "correlation does not necessarily mean causation."  Still, recent studies and informed observations are intriguing.  For example one study underway is looking at whether treating hearing loss can reduce the risk of cognitive decline.  

Johns Hopkins is leading a large National Institute on Aging study to see if hearing aids can safeguard seniors’ mental processes. The study has multiple locations and has recruited nearly 1,000 people ages 70–84 with hearing loss. One group is provided hearing aids, while another group receives aging education. By early 2023, the study should provide definitive results on whether treating hearing loss will reduce the risk of cognitive decline. In essence, we’ll know whether the use of hearing aids can potentially reduce brain aging and the risk of dementia.

Some of this research is going beyond examining the potential for common causes for the two processes (such as poor diet and inadequate exercise, as well as uncontrolled blood pressure or weight).  Researchers are asking whether a failure to hear clearly can actually damage the brain's function.  NPR's Sunday Edition (8.21.2022) includes  a five minute interview with Dr. Frank Lin, at John Hopkins Bloomberg School of Public Health, who addresses three "major brain mechanisms" that may be affected by untreated hearing impairments: (1) the potential impact of the load on a brain from having to work harder; (2) the potential for hearing loss to actually affect the integrity of the brain's structure  because of atrophy of an essential function, and (3) the potential for loss of hearing to contribute to social isolation, further reducing engagement that keeps people (and their brains) interacting with the world around them. 

Dr. Lin is also pleased about the FDA finally opening access for Americans to purchase over-the-counter hearing aids, a change he's worked on and supported for some eight years.  He points out that currently only some 15 to 20% of Americans who could benefit from hearing assistance are getting the help they need, probably because of high costs and reluctance to see doctors. Dr. Lin says that any theoretical risks from over-the-counter sales (such as over- or under-amplification) is significantly outweighed by the benefits. 

Oh, and while I'm at this, the research suggesting that older people who have cataracts removed may be "nearly 30% less likely to develop dementia" is also interesting.

August 21, 2022 in Cognitive Impairment, Consumer Information, Dementia/Alzheimer’s, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare, Statistics | Permalink | Comments (0)

Hearing Loss, Cataracts, and Dementia

There seem to be a lot of articles in the media currently discussing the statistical relationship between hearing loss and dementia.  Of course, we need to remember the axiom that "correlation does not necessarily mean causation."  Still, recent studies and informed observations are intriguing.  For example one study underway is looking at whether treating hearing loss can reduce the risk of cognitive decline.  

Johns Hopkins is leading a large National Institute on Aging study to see if hearing aids can safeguard seniors’ mental processes. The study has multiple locations and has recruited nearly 1,000 people ages 70–84 with hearing loss. One group is provided hearing aids, while another group receives aging education. By early 2023, the study should provide definitive results on whether treating hearing loss will reduce the risk of cognitive decline. In essence, we’ll know whether the use of hearing aids can potentially reduce brain aging and the risk of dementia.

Some of this research is going beyond examining the potential for common causes for the two processes (such as poor diet and inadequate exercise, as well as uncontrolled blood pressure or weight).  Researchers are asking whether a failure to hear clearly can actually damage the brain's function.  NPR's Sunday Edition (8.21.2022) includes  a five minute interview with Dr. Frank Lin, at John Hopkins Bloomberg School of Public Health, who addresses three "major brain mechanisms" that may be affected by untreated hearing impairments: (1) the potential impact of the load on a brain from having to work harder; (2) the potential for hearing loss to actually affect the integrity of the brain's structure  because of atrophy of an essential function, and (3) the potential for loss of hearing to contribute to social isolation, further reducing engagement that keeps people (and their brains) interacting with the world around them. 

Dr. Lin is also pleased about the FDA finally opening access for Americans to purchase over-the-counter hearing aids, a change he's worked on and supported for some eight years.  He points out that currently only some 15 to 20% of Americans who could benefit from hearing assistance are getting the help they need, probably because of high costs and reluctance to see doctors. Dr. Lin says that any theoretical risks from over-the-counter sales (such as over- or under-amplification) is significantly outweighed by the benefits. 

Oh, and while I'm at this, the research suggesting that older people who have cataracts removed may be "nearly 30% less likely to develop dementia" is also interesting.

August 21, 2022 in Cognitive Impairment, Consumer Information, Dementia/Alzheimer’s, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare, Statistics | Permalink | Comments (0)

Sunday, August 14, 2022

Upcoming in November before USSC: Do Residents have Private Rights of Action for Violations of Federal Nursing Home Reform Act?

For those teaching Elder Law, Health Law, and Disability Law Courses this semester, there is a unique opportunity for students to hear relevant oral arguments before the United States Supreme Court.  One of the important federal laws that arguably changed -- for the better -- the standards for care in nursing homes was the Federal Nursing Home Reform Amendment of 1987 (FNHRA, adopted as part of OBRA '87).  But a long-festering central issue for the provisions known as the "Residents' Bill of Rights" is whether the law provides residents a privately enforceable right of action for alleged violations of the standards.  On November 8, 2022, the United States Supreme Court is scheduled to hear oral argument on two key concerns:

  1. Whether in light of historical cases to the contrary, the Court should reexamine its holding that Spending Clause-related legislation confers a implied right to privately enforceable rights under 42 U.S.C. Section 1983; and
  2. Whether, assuming Spending Clause statutes ever give rise to enforceable private rights under Section 1983, there are private rights of action for alleged violations of the Federal Nursing Home Reform Act's transfer and medication rules.

The case in question is Health & Hospital Corp. v. Talevski, originally filed in the United States District Court (Northern District) of Indiana.  Mr. Talevski, who has dementia, through his wife, alleges that while living in a nursing facility, he was prescribed powerful medications despite his family's objections, which functioned as prohibited "chemical restraints imposed for purposes of discipline or convenience rather than treatment." Further, he alleges he was improperly transferred over their objections away from the local care facility to a different, more distant facility.  Federal spending laws are at issue because the state's long-term care facilities are eligible for federal dollars and the state receives federal funding, including Medicaid funding, for such nursing care.  In this case, the District Court held that there was no private right of action. 

The U.S. Court of Appeals for the 7th Circuit reversed, at 6 F.4th 713 on July 27, 2021, finding that in the Act, "Congress spoke of resident rights, not merely steps the facilities were required to take.  This shows an intent to benefit nursing home residents directly." (emphasis in the original).  In reaching this decision, the 7th Circuit joined rulings by the 9th (2019) and 3rd (2009) Circuits directly confirming private rights of action under FNHRA. 

The Petitioner Nursing Facility seems to be playing to the newest justices on the Court, arguing that a long line of Spending Clause cases willing to recognize a cause of action under Section 1983, including Blessing  v. Freestone, 520 U.S. 329 (1997), are incorrectly decided or too generous in their willingness to recognize or infer fact-specific, private rights of action.  The Petitioner's argument is supported by an amicus brief, including one submitted on behalf of twenty-two states, resisting the financial implications of accountability asserted by individual patients.   The United States has submitted an amicus brief that expresses general support for individual actions, but argues against such a cause of action for nursing home residents. 

But, as one legal studies student observed in 2013 about what happens when minimum standards are not adequately enforced by authorities: 

Even though conditions in nursing homes have improved since the passing of the Federal Nursing Home Reform Amendment of 1987, the existence of substandard care in nursing homes, which Congress attempted to correct with the statute, still exists today. . . . [A case such as Grammer v. John J. Kane Reg'l Ctrs-Glen Hazel, 570 F.3d 520 (3d Cir. 2009) recognizing the right of residents to bring private actions under 1983] does open the door for state-run nursing homes to be held accountable for abuse and substandard care. . . . Considering that most of us at some point in our future will live the nursing-home experience first-hand, we should keep this topic on our radar.

Susan J. Kennedy, "Conflict in the Courts: The Federal Nursing Home Reform Amendment and Section 1983 Causes of Action,"  3 Law Journal for Social Justice 195, 209 (2013).  Some ten years later, the resident's case before the Supreme Court appears to have strong amici support, with amici briefs due in mid-September, arguing that without residents' ability to enforce their legal rights, "they will lose a powerful weapon for their protection.  This puts them at risk of harm and even death, as abuse, neglect and poor care are rampant in many facilities." Id. 

August 14, 2022 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Discrimination, Ethical Issues, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare, Social Security | Permalink | Comments (0)

Friday, August 5, 2022

Horse Therapy Provides Boost to Elders with Dementia

Ending the week on happy note due to this Washington Post article, A ‘magical’ treatment for seniors with dementia: Horse therapy.

Painting [on the horses] is not mandatory in this equine-assisted learning program, but it is one of the many ways participants are taught to engage with horses, with the goal of stimulating their minds and bodies. Since 2017, Simple Changes Therapeutic Riding Center in Mason Neck, Va., has teamed up with Goodwin Living, a senior living and health-care facility in Alexandria, to introduce residents with cognitive impairment and anxiety to the residents of its barn.

Up to six people at a time participate in the four-week sessions, which include horse identification, grooming, feeding, leading, discussing equine literature, poetry and haiku writing, and making horse treats. The collaboration began when Barbara Bolin, a social worker at Goodwin House Alexandria and a lifelong rider and horse owner, reached out to Corliss Wallingford, the nonprofit equine therapy organization’s executive director.

Read the article and look at the accompanying photos. Doing so will end your week with a smile.

August 5, 2022 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Other | Permalink | Comments (0)

Thursday, August 4, 2022

Questions Arise About Validity of 2006 Alzheimer's Study?

Last month, Science magazine published an article, BLOTS ON A FIELD? A neuroscience image sleuth finds signs of fabrication in scores of Alzheimer’s articles, threatening a reigning theory of the disease.   One researcher recently noted that there were concerns about the 2006 study, including concerns about "image tampering"  There is no smoking gun and the article explains how this one expert became concerned. The article has technical materials in it, so read it and form your own opinion.

August 4, 2022 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Statistics | Permalink | Comments (0)

Tuesday, July 26, 2022

7th World Congress on Adult Capacity 2022

I have heard that the 7th World Congress on Adult Capacity 2022 was quite successful. I was excited to see that the conference organizers have published a link to download the various presentations.  The link is available here and then choose the presentations you wish to download.

July 26, 2022 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, International | Permalink | Comments (0)

Tuesday, July 19, 2022

When Was the Last Time You Had Your Eyes Checked?

You may be thinking to yourself, what does that have to do with elder law?  Well, read this article from the New York Times,  New Dementia Prevention Method May Be Behavioral, Not Prescribed. Here's the crux of the article: "[p]ublic health experts and researchers argue that it is past time to turn our attention to a different approach — focusing on eliminating a dozen or so already known risk factors, like untreated high blood pressure, hearing loss and smoking, rather than on an exorbitantly priced, whiz-bang new drug."  So now, about getting your eyes checked....

The latest modifiable risk factor was identified in a study of vision impairment in the United States that was published recently in JAMA Neurology. Using data from the Health and Retirement Study, the researchers estimated that about 62 percent of current dementia cases could have been prevented across risk factors and that 1.8 percent — about 100,000 cases — could have been prevented through healthy vision.

What other risk factors should we conside?

The influential Lancet Commission began leading the modifiable risk factor movement in 2017. A panel of doctors, epidemiologists and public health experts reviewed and analyzed hundreds of high-quality studies to identify nine risk factors accounting for much of the world’s dementia: high blood pressure, lower education levels, impaired hearing, smoking, obesity, depression, physical inactivity, diabetes and low levels of social contact.

In 2020, the commission added three more: excessive alcohol consumption, traumatic brain injuries and air pollution. The commission calculated that 40 percent of dementia cases worldwide could theoretically be prevented or delayed if those factors were eliminated.

So let me add to my initial question: when was the last time you had you had your vision and hearing checked?  No time like the present...

July 19, 2022 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care | Permalink | Comments (1)

Saturday, April 9, 2022

What's A Neighbor to Do? When friends need assistance....

This tends to happen in waves, but I've been receiving a lot of calls lately from people who are concerned about an aging neighbor or a casual friend. 

For example, in one communication, the caller was worried about a neighbor lady in her 80s who had stopped her on the sidewalk recently to ask for a recommendation for an attorney to come to her house.  She seemed to want help "working out a proper arrangement" for a younger person to live in her house on a rent-to-own type of contract.  The older neighbor didn't seem to have money to maintain the house.  A complication -- more than a solution -- was the fact the woman had adult children, but didn't want to "bother" them and they lived out-of-town.

In the second situation, it was an early morning text, asking for help for a friend, where an agent, operating under a "new" Power of Attorney, was denying permission for the live-in Significant Other to visit the friend now that she was in assisted living.  Apparently the SO was raising objections about  the quality of care (or maybe just the lack of appropriate care) in AL.  Suddenly a POA surfaced, purporting to give authority for an out-of-state relative to direct the AL to deny the SO's visits because they were disturbing the patient.   

Red flags everywhere in these fact patterns.

Both of these fact patterns are variations on a theme.   Protective service units (if they have sufficient staffing) and long-time Elder Law attorneys can often respond effectively.  But one of the biggest changes I've found since the pandemic is finding "live" people who might be available and willing to help. Shortages of staff, overworked solo attorneys, budget cutbacks -- all play a part of the challenges to find effective services to assist older adults.

All of this puts a premium on advance planning -- for more than "just" wills or trusts.

When we wait until we are already seriously ill or until we are in our 80s, we are running a huge risk that we won't get the advice and counsel we need to make sound, effective choices.  We need to make these plans while we still "clearly" have capacity.  If the person with cancer had added instructions and her preferences about visitors before surgery, it would be less likely she is denied time with someone who cares enough to seek better care.  

 

April 9, 2022 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Estates and Trusts, Ethical Issues, Health Care/Long Term Care | Permalink | Comments (0)

What's A Neighbor to Do? When friends need assistance....

This tends to happen in waves, but I've been receiving a lot of calls lately from people who are concerned about an aging neighbor or a casual friend. 

For example, in one communication, the caller was worried about a neighbor lady in her 80s who had stopped her on the sidewalk recently to ask for a recommendation for an attorney to come to her house.  She seemed to want help "working out a proper arrangement" for a younger person to live in her house on a rent-to-own type of contract.  The older neighbor didn't seem to have money to maintain the house.  A complication -- more than a solution -- was the fact the woman had adult children, but didn't want to "bother" them and they lived out-of-town.

In the second situation, it was an early morning text, asking for help for a friend, where an agent, operating under a "new" Power of Attorney, was denying permission for the live-in Significant Other to visit the friend now that she was in assisted living.  Apparently the SO was raising objections about  the quality of care (or maybe just the lack of appropriate care) in AL.  Suddenly a POA surfaced, purporting to give authority for an out-of-state relative to direct the AL to deny the SO's visits because they were disturbing the patient.   

Red flags everywhere in these fact patterns.

Both of these fact patterns are variations on a theme.   Protective service units (if they have sufficient staffing) and long-time Elder Law attorneys can often respond effectively.  But one of the biggest changes I've found since the pandemic is finding "live" people who might be available and willing to help. Shortages of staff, overworked solo attorneys, budget cutbacks -- all play a part of the challenges to find effective services to assist older adults.

All of this puts a premium on advance planning -- for more than "just" wills or trusts.

When we wait until we are already seriously ill or until we are in our 80s, we are running a huge risk that we won't get the advice and counsel we need to make sound, effective choices.  We need to make these plans while we still "clearly" have capacity.  If the person with cancer had added instructions and her preferences about visitors before surgery, it would be less likely she is denied time with someone who cares enough to seek better care.  

 

April 9, 2022 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Estates and Trusts, Ethical Issues, Health Care/Long Term Care | Permalink | Comments (0)

Wednesday, March 30, 2022

Victoria Law Foundation Hosts International Access to Justice and Legal Services Forum in Australia March 30 through April 1

Victoria Law Foundation International Access to Justice and Legal Services Forum
I had the unique privilege of joining an interdisciplinary team of professionals discussing timely concerns about access to justice for older persons, not only in the host country of Australia but around the world.  Our session, entitled Legal Need, Empowerment and Older People, began with Susannah Sage Jacobson and Eileen Webb, academics from the University of South Australia, who addressed ageism and specific examples of abuse, followed by Frances Batchelor, Acting Director of the Australian National Ageing Research Institute, discussing new consumer-based research on quality of residential care.  The International Access to Justice Online Forum is hosted by the Victoria Law Foundation and the UCI Law Civil Justice Research Initiative, with panelists across the three days of programming from Australia, the U.S, Canada, New Zealand and the U.K.  There is still time -- depending on which side of the international date line you reside -- to catch more presentations as the event runs through April 1, 2022.

In addition, research papers and reports and video captures of the program are being posted online.  Take a good look!  

March 30, 2022 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Crimes, Current Affairs, Dementia/Alzheimer’s, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, International | Permalink | Comments (0)

Wednesday, March 2, 2022

Reconsidering the Implications of Togetherness As Couples Get Older

I have a fondness for California Rock & Roll from a certain era -- also known as my youth.  One of my favorites, Warren Zevon, is probably mostly remembered as a singer/songwriter, and he penned some great songs such as Hasten Down the Wind (performed by another favorite, Linda Ronstadt, who, like me was born next door to California in Arizona).  Some of his lyrics work equally well as poetry.  Right now I'm thinking to the opening lines to Reconsider Me, recorded and released by Zevon in 1987:   

If you're all alone

And you need someone

Call me up

And I'll come running

Reconsider me

Reconsider me

Those lines seem to echo in an article from the New York Times today, describing a trend among older singles -- they are willing to love again, but at least one half of the couple isn't willing to live together.  The article begins by describing a 78 year-old widow's friendship with a a widowed man that was turning romantic.   He wanted them to move into together.  She wasn't eager and she admits that his health woes were part of the concern.  She is quoted as saying "He was not in great shape."  Eventually, when he had surgery and needed recuperative care, she followed his directions and "using his funds, hired a live-in caregiver for him."  Once he recovered, they spent more time together.  

The NYT writer, Francine Russo, observes:

With greater longevity, the doubling of the divorce rate since the 1990s for people over 50 and evolving social norms, older people like Ms. Randall are increasingly re-partnering in various forms.  Cohabitation, for example, is more often replacing remarriage following divorce or widowhood, said Susan L. Brown, a sociologist at Bowling Green State University in Ohio.

 

These older adults are seeking (and finding) love, emotional support and an antidote to loneliness.  But many older women, in particular, fear that a romantic attachment in later life will shortly lead to full-time caregiving.

The New York Times article also echoes topics addressed in the article I linked to last week by Cahn, Huntingdon and Scott, Family Law for the One-Hundred Year Life.  For more from the Times, if you have a subscription, see Older Singles Have Found a New Wat to Partner Up:  Living Apart.  

 

 

March 2, 2022 in Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Housing, Retirement | Permalink | Comments (2)

Tuesday, February 22, 2022

2022 Adult Guardianship Guide

The National Association for Court Management announced the release of the updated Adult Guardianship Guide.

The executive summary points out  the

Issues identified in this guide which are critical for planners to consider include: • Strengthening protections and enhancing rights of persons subject to guardianship • Identifying alternatives to guardianship including supported decision-making • Providing meaningful due process including access to counsel
• Identifying opportunities for modification, termination, and restoration of rights • Identifying, tracking, and documenting the number of guardianship cases and adoption of data standards • Implementing meaningful guardianship monitoring • Formalizing a process for bringing complaints or concerns to the attention of the court • Developing response protocols for abuse, neglect, or exploitation • Developing readily accessible materials for the public including clear, plain language forms and informational resources • Developing and institutionalizing training programs and materials for judges and court staff, judicial officers, managers, staff, and volunteers to include specialized training to recognize and identify abuse, neglect, and exploitation • Developing and institutionalizing training programs for guardians • Maintaining and strengthening relationships between the courts and the local probate bar while promoting the importance of court-community collaboration • Regularly evaluating guardianship processes and outcomes.

The guide includes several appendices and resources. The section on the future offers this "This Guide challenges court managers to make efforts that will lead to improvements in the way courts handle cases involving our most vulnerable adults. NACM underscores the need for prioritization and funding of the management of guardianship cases, while offering practices and models that can be implemented—some at little or no cost—to bring court practices in line with recommendations of the Fourth National Guardianship Summit and the NPCS."

If you go through the NACM website, although the guide is free, you may have to set up an account to download it. It will be posted on the National Center for State Courts website (I checked on 2/22/22 and the updated guide had not yet been posted).You can download the 76 page guide directly here.

 

On an unrelated note, University of Illinois College of Law is looking for a Dean of Students & Assistant Dean for Academic Administration.  For info about the position or to apply, "submit a resume, cover letter, and the names and contact information of three professional references at : https://jobs.illinois.edu/academic-job-board/job-details?jobID=159975&job=assistant-dean-for-student-services-dean-of-students-college-of-law-159975 by March 31, 2022. For assistance with the application system, please email rietz@illinois.edu."

The cool part of the job-you get to work with elder law Rockstar, Professor Richard Kaplan!

 

February 22, 2022 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, State Statutes/Regulations | Permalink | Comments (0)

Friday, January 21, 2022

Webinar Elder Justice Decision-Making Capacity Symposium

Register now for this important virtual symposium from DOJ's Elder Justice Initiative, scheduled for April 19th through April 21, from 1-5 eastern.  Here's a description about the Symposium.

Every day the lives of older adults are profoundly and negatively impacted in both the criminal and civil justice systems based on mistaken assumptions and inadequate assessments of their capacity to make decisions for themselves. In order to raise greater awareness of these issues and improve how elder justice professionals approach these issues, the Department of Justice will be hosting the Elder Justice Decision-Making Capacity Symposium, a three-day virtual conference on April 19-21.

The Symposium will highlight what we know today about the aging brain and its impact on decision-making, and discuss the protocols and tools available to assess decision-making capacity. The Symposium will then focus on the myriad of ways that perceptions of an older adult’s decision-making capacity can have profound implications on their treatment in criminal and civil proceedings. These may include elder abuse or fraud prosecutions not being pursued; unnecessary or inappropriate guardianships being imposed; and civil legal remedies being denied to older victims of elder abuse, neglect and financial exploitation.

By shedding light on the latest science as well as best clinical, legal and judicial practices, the Symposium aims to increase access to justice while promoting the autonomy of older adults.


Free Symposium provided by the Elder Justice Initiative, U.S. Department of Justice.

Click here to register.

January 21, 2022 in Cognitive Impairment, Consumer Information, Crimes, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Programs/CLEs, Web/Tech | Permalink | Comments (0)

Friday, January 14, 2022

Roundup of Articles Part 2

Saturday, January 8, 2022

Sad News: The Passing of Civil Rights Advocate Lani Guinier, Reportedly of Complications of Alzheimer's

I read the news late on Friday of the passing of Lani Guinier and it was especially sad to learn that family members reported her death, at just 71, was due to "complications of Alzheimer's disease."  That report made me realize that I hadn't heard from her on the important civil rights issues of the last few years -- and this history probably explains why.  Nonetheless, her teaching, her writing, her advocacy in court and in the field on behalf of civil rights, on voting rights, on student empowerment (often on behalf of women in law school classrooms, urging them them to speak out) will continue to impact the nation.  In her 2002 book, The Miner's Canary -- sitting nearby on my shelf --  cowritten with Gerald Torres, the conclusion resonates with equal strength in 2022:   

We credit the civil rights movement and the liberal legal model to the extent that each created a space for progressive politics and reduced racism as conventionally defined.  This tolerance model has made alliance possible that were once unthinkable.  But the civil rights movement too often seems to measure progress by looking backward; we want to shift the focus to where we are going, not how far we have come.  In the past, conventional ideas of race were deliberately tied to issues of social policy in order to make programs of general concern sound like special pleading.  Our response is to reclaim race in order to "complete" democracy."  

With grateful feelings, and remembering her as a role model for so many, we will miss her.  

January 8, 2022 in Books, Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Ethical Issues | Permalink | Comments (0)

Saturday, December 4, 2021

It is Time to Rethink "Waiting Rooms"

Today I read an interesting Washington Post article about a judge in a northern New Mexico town who has been willing to rethink criminal justice for drug-related offenses.  The approach this judge is taking goes beyond the "drug court model, once widely viewed as a progressive alternative to jail." As described in The Judge Who Keeps People Out of Jail Judge Jason Lidyard meets directly with participants in his program, outside the court house, to discuss progress one-on-one:  

He does not expect his clients to abstain from using -- in fact, he assumes the contrary. 'I don't care if you're high, so long as you show up here,' he tells one.  And informed by childhood memories of his own father's addiction, he categorically refuses to use jail as a sanction. 'Only two things will get you kicked out,' he explains. If you don't show up, or if you commit new crimes.

My own work doesn't focus on criminal justice.  But I am ever more intrigued by the willingness of some prosecutors, jurists and court systems to rethink solutions to different forms of problematic behaviors.

This article also intrigued me because I had recently spent an evening in an emergency room of a small town hospital. An older friend -- in her 90s -- had been waiting since early afternoon for diagnosis of symptoms of light-headedness, "waves" of confusion, and sudden inability to walk normally.  Her symptoms were serious.  After more than an hour at an urgent care facility, transfer by ambulance and 3 hours in the hospital's ER, some tests had been conducted.  But when I arrived the results were not available and she had yet to see a doctor.  Friends and then her daughter (driving several hours from her home in a large city) had been taking turns sitting with her and hoping to get some recommendation about how best to handle these worrisome symptoms. 

Over the last few years, as I suspect is also true for many of our readers,  I've done this same sort of "camping out" in ERs in multiple hospitals with aging friends and family members.

But that evening was startling in the intensity of what I was observing.  Every chair in this relatively new hospital was taken, and even more patients were sitting in wheelchairs.  There was only one person at the "intake desk" and it is an understatement to say that person was suffering from front-line burn out.  Rather, she was in full flame.  

At least a third of the patients I was seeing were "older."  Some of them had no family members with them.  One woman, with no family and clearly deeply affected by some form of dementia, was wrapped in a blanket, no shoes, and, I realized, no clothes on under the blanket. She was wandering, and moaning, very unstable on legs that appeared distorted by cellulitis.  Another patient was holding one of his legs in the air with his own hands, as he was in such pain that he couldn't stand to have his foot touch anything -- and no wonder, as I could see a large, weeping hole in the center of the foot.  I was moving in and out of that ER for about 4 hours.  Many of the patients that were sitting with agonized expressions on their faces when I first arrived at 6 p.m. were still in the same location when I left for the final time just after 11 p.m.  There were no hospital rooms available.  Period.  

My friend could not take the chance of going home to wait for the tests results, and it was clear that if she did so, no one would be available to talk with her by phone who could give an informed diagnosis and discuss options.

COVID-19 and certainly the recent variants, have exposed and intensified what has long been a problem for hospitals: the process of emergency admissions.  My father, years ago, summarized the problem accurately even while he was in the early stages of dementia.  "I would rather die on the steps than spend one more night in that place" -- referring to the ER.

But it isn't just emergency rooms at hospitals.  I've had to abandon waiting rooms in doctors' office, dentist offices, even the pharmacy, because whomever I was bringing in for help was panicking when they felt trapped in chairs that they were afraid to even touch. Post-Covid-personnel shortages at all levels of care are clearly making the problem of access to health care very problematic. But I suspect the problem pre-existed the pandemic.  (Inadequate, un-separated seating in airport lounges and transport buses? I'm thinking of you too!)

Solutions?  I'm not sure.  But certainly some creative minds could tackle this.  I know some care-sites ask patients, if possible, to wait in their cars to be called in for the actual appointment.  But that doesn't work for many older persons, especially in hot or cold weather, or where it is a very long walk to get to a bathroom.  

I do know that one source of help I stumbled across in one state was using the non-emergency number for the 911 responders in the area.  In that state, I discovered calling that number resulted in a "first available" non-emergency response by a team of trained professionals who could do high level assessments, and who could help prioritize any needed transport to the ER.  But that doesn't' seem to be a uniformly available alternative in all states.

There is a saying, sometimes attributed to Winston Churchill (probably incorrectly) reminding us to "never let a good crisis go to waste."  Let's use the current crisis to rethink ways to more effectively access health care assessments.  Certainly that would be better for patients, but also for the front-line responders.  

December 4, 2021 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Health Care/Long Term Care | Permalink | Comments (1)

Tuesday, November 23, 2021

Is Guardianship Replaceable?

The most recent issue of BIFOCAL (the publication of the ABA Commission on Law & Aging) contains an article by David Godfrey, Replacing Guardianship / Conservatorship.  He identifies three areas where folks may need help: "health care decisions, personal care decisions and financial management" and notes that the assistance provided often comes from "family and concerned friends."  Mr. Godfrey analyzes each area and discusses the options to provide support.

For health care decisions, he note family consent statutes will work, except "when the person has no identifiable family or friends willing to assist, when there is conflict between family members, or when the person making the choice appears to be committing abuse. It is possible for laws to be structured so that state actors can select someone to have legal authority to consent to health care under those
circumstances." (citations omitted).  For Personal Care Decisions,  "[these choices often have a low risk of harm...  and  choices  simply need to be made to keep the person happy, safe, and with appropriate nutrition. Where there are challenges in personal care decisions, support by family and friends will most often replace guardianship." Noting the increase in disputes regarding visitation, he references a trend where  folks "are increasingly being advised to leave specific written directions on contact or visitation in the event of a decline in capacity, to replace the use of guardianship to resolve concerns about contact or visitation."  He notes that living arrangements is a hybrid of personal and legal issues. ". Powers of attorney, authorized signers on financial accounts, and trusts are planning tools that can replace guardianship. When those options are not available, laws can be created to allow courts to issue limited protective orders, to approve leases, sales, or purchases of property, or
approve occupancy or admissions agreements, and are limited in scope to just that one issue, with oversight by the court and accountability to the court." 

Finally, for financial decisions,  he discusses various devices that empower another to make financial decisions for a person and oversight mechanisms such financial management professionals or giving family members access to view the person's account statements online.  He discusses protective arrangements and the risk of elder abuse and offers this conclusion:

Successful planning and legal alternatives can replace many guardianships. In many states, laws and practices need to be changed to allow more alternatives. All of these can fail. No one tool is a guarantee of safety. Criminals have used every tool in the box to abuse and exploit. Everyone needs to be urged to plan for incapacity; we are all only one health care event away from needing help meeting our basic needs and protecting ourselves from harm. Currently, we fail to plan more often than plans fail. Guardianship becomes the replacement for failure to plan, or for plans that have failed. It is time to turn that on its head and replace guardianship.

 

November 23, 2021 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (0)

Monday, October 4, 2021

Breakthrough in Alzheimer's Research?

My dear friend and colleague, Professor Feeley, sent me a link to this recent article, Likely cause of Alzheimer’s identified in new study.

Here's a brief bit of info about the study

[S]cientists in Australia have recently discovered an additional factor that may be responsible for the development of this neurodegenerative condition.

Lead study author Dr. John Mamo, Ph.D. — distinguished professor and director of the Curtin Health Innovation Research Institute at Curtin University in Perth, Australia — explained to Medical News Today the conclusion from the new research...

“This study,” he added, “shows that exaggerated abundance in blood of potentially toxic fat-protein complexes can damage microscopic brain blood vessels called capillaries and, thereafter, leak into the brain, causing inflammation and brain cell death.”

The findings were published here. This is the abstract from the article

Several lines of study suggest that peripheral metabolism of amyloid beta (Aß) is associated with risk for Alzheimer disease (AD). In blood, greater than 90% of Aß is complexed as an apolipoprotein, raising the possibility of a lipoprotein-mediated axis for AD risk. In this study, we report that genetic modification of C57BL/6J mice engineered to synthesise human Aß only in liver (hepatocyte-specific human amyloid (HSHA) strain) has marked neurodegeneration concomitant with capillary dysfunction, parenchymal extravasation of lipoprotein-Aß, and neurovascular inflammation. Moreover, the HSHA mice showed impaired performance in the passive avoidance test, suggesting impairment in hippocampal-dependent learning. Transmission electron microscopy shows marked neurovascular disruption in HSHA mice. This study provides causal evidence of a lipoprotein-Aß /capillary axis for onset and progression of a neurodegenerative process.

October 4, 2021 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, International, Other, Science | Permalink