Friday, October 9, 2020

Court Called Upon to Prevent Misuse of Law to Penalize Homeless People

As many of our regular readers know, I grew up in Phoenix, Arizona.  One of the developments I have followed over the years is the number of homeless residents of Phoenix.  I'm a cyclist in my spare time and one of my regular downtown bike routes in Phoenix takes me past an ever-growing encampment.  In addition, a large park near my parents' home now serves as a daytime gathering spot for many.  In the scorching heat of the summer, and the desert cold of the winter, there are more and more people without adequate shelter.  The New York Times recently pointed out that in contrast to historical statistics suggesting that nationwide, "elderly" persons make up a small percentage of the homeless population, in the last few years we are seeing a surge among older adults.  See Elderly and Homeless: America's Next Housing Crisis, a feature article published on September 30, 2020, that, in part, profiles the issues in Arizona.  


Stryker PhotoSo, it was with great interest that I read a report on a federal appellate decision, limiting the ability of municipalities to use criminal laws to penalize individuals, in an attempt to discourage or remove people who are living on the streets.  The report is by one of  Dickinson Law's third year law students, Jacqueline Stryker.  She writes in part:  

"The city of Boise, Idaho attempted to fight homelessness in the community through a combination of its public camping ordinance and its disorderly conduct ordinance.  In Martin v. City of Boise, 920 F.3d 584 (9th Cir. 2019), the 9th Circuit Court of Appeals considered whether the Eighth Amendment’s prohibition on cruel and unusual punishment bars a city from criminally prosecuting people for sleeping outside on public property when those people have no shelter.  The Court concluded that it does.  A municipality cannot criminalize people who sleep outside when no sleeping space is practically available in any shelter. "

Ms. Stryker observes in her conclusion, "Whether the decision of the Ninth Circuit in Martin will gain traction a local governments grapple with the growing problem of homelessness and homeless encampments is yet to be seen."

For more of Ms. Stryker's timely, concise case analysis, see:  Municipal Efforts to Combat Homelessness.

October 9, 2020 in Crimes, Current Affairs, Discrimination, Ethical Issues, Federal Cases, Housing, Property Management, Statistics | Permalink

Thursday, July 16, 2020

NYT: Boom(er?) Time for Planning where Death Triggers Next Events

The New York Times has an article that might be particularly useful for faculty members teaching Wills, Trusts & Estates or Elder Law courses in the Fall.  

From the article, titled "Boom Time for Death Planning:"

The coronavirus pandemic has drawn new buiness to startups that provide end-of-life services, from estate planning to a final tweet. . . . 

Before the pandemic, end-of-life start-ups — companies that help clients plan funerals, dispose of remains and process grief — had experienced steady to moderate growth. Their founders were mostly women who hoped a mix of technology, customization and fresh thinking could take on the fusty and predominantly male funeral and estate-planning industries.

Still, selling death to people in their 20s and 30s wasn’t easy. Cake’s team sometimes received emails from young adults, wondering if the site wasn’t a tad morbid. Since Covid-19, this has changed. Millennials are newly anxious about their mortality, increasingly comfortable talking about it and more likely to be grieving or know someone who is.

July 16, 2020 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Estates and Trusts, Ethical Issues | Permalink | Comments (0)

Thursday, July 9, 2020

Are Older Adults Now the Proverbial Canaries in the Global Mines?

During an AALS-sponsored online "hang-out" session this week, the featured host, Syracuse Law Professor Nina Kohn, helped faculty think about better ways to conduct online courses, including Elder Law.  We also talked about our research projects for the summer.  Nina commented that she has never before had "so much to write about and so little time to do so," which I suspect has something to do with her wonderfully active children!  But, I also think that most of us in the AALS Section on Law and Aging are feeling the same way.  It is as if our client base -- older persons -- are at the epicenter of so much tragedy.  Sadly, the COVID-19 illness has hugely impacted older persons, as documented frequently on this Blog.  

And now the news that in Japan, seasonal rains that have become steadily worse over the years for reasons associated with climate change, have triggered extraordinary flooding, resulting in the drowning deaths of many elders in their nursing homes or while trying to shelter at home.  From the New York Times article, Japan's Deadly Combination: Climate Change and an Aging Society:yAlthough the Japanese gird every June and July for the rainy season — known as tsuyu — this year the rainfall has set records in Kyushu, with more rain expected to blanket central Japan by the end of this week.

 

Older residents accustomed to year after year of summer rains may believe they know how to ride out the downpours at home. Yet they may not understand the growing severity of the rains or the increased dangers of flooding.

 

“Under the emerging impact of global warming, there is an increasing risk or potential that rainfall amounts could be at a level that we haven’t experienced in the past,” Professor Nakamura said. “So I think that citizens must realize that their previous experience may no longer work. We have to act even earlier or faster than what we have experienced in the past.”

 

Evacuation itself can pose a risk to the elderly. Conditions in evacuation centers inevitably fall short of those in nursing homes designed for old-age care. For the frailest patients, the moves can cause injury or destabilize long-term care plans....

 

In the case of the Senjuen nursing home, Aki Goto, its director, told The Kumamoto Nichinichi Shimbun, a local newspaper, that she had been more concerned about mudslides than flooding. When the waters came, she added, the caregivers could not move quickly enough to move all the residents upstairs.

 

Six of the workers were on call the night of the floods last weekend, the newspaper reported. That still left each caregiver in charge of more than 10 aging residents, some of whom were unable to walk without help. Even with the aid of local volunteers, they could not bring everyone to safety upstairs as the floodwaters rapidly rose and deluged the ground floor.

Whether it is hurricanes in the Carribean and US, wildfires in western US states, extraordinary storms or unique diseases around the world, our elderly are often seeming to take the heaviest blows.  Isolated and with inadequate protective equipment or assistance, the pattern of "unexpected" deaths continue.  Unexpected?  

 

July 9, 2020 in Current Affairs, Ethical Issues, Health Care/Long Term Care, Housing, International | Permalink | Comments (0)

Tuesday, July 7, 2020

Upcoming in July: AALS/CLEA Virtual Clinical Conference to include Pandemic-Impact Speakers on Clinics that Serve Older Adults

AALS's Clinical Section and CLEA are hosting a free Virtual Clinical Conference that begins Tuesday, July 21, running through Thursday, July 23.  The conference offers two plenary sessions, a webinar, asynchronous videos, large group discussions, small group discussions focued on specific topics or within affinity groups, very timely programs sponsored by Clinicians of Color, and a final community building session.

Jam-packed! -- but also easy to navigate through the virtual platform.  Here's the link to the full schedule.  The sessions will begin each day at noon, Eastern Daylight Savings Time. Register for the Conference here.  

And did I mention it is FREE?!

Elder Law/Disability Law Clinical gurus Martha Mannix (University of Pittsburgh) and Mary Helen McNeal (Syracuse) will be facilitators for three afternoon sessions on "Student Representation of Elderly and Special Needs Clients in Virtual and COVID World" and the brainstorming topics include: 

    1. Discussion on how we might reimagine our encounters with our elderly clientss or clients with disabilities through communications technology or creative reconfiguring of in-person client meetings.

    2. Discussion on the role of students.  Does the COVID-19 emergency require us to restructure or reimagine the role of the clinic student and our supervision of them in light of the challenges presented by remote learning and representation and institutional desires to shield student from risk?

    3. Discussion on whether we might consider altering the nature of our legal work in clinical settings: Is this the moment best met by continuing individual representation or should we turn our ckubucak efforts to addressing systemic issues or engagement in policy advocacy?  

And to add to the intrigue -- the final session of the three-day program includes a Dance Party!  Let your inner "Hairspray" shine! 

July 7, 2020 in Current Affairs, Discrimination, Ethical Issues, Legal Practice/Practice Management, Programs/CLEs, Webinars | Permalink | Comments (0)

Monday, July 6, 2020

What Does It Mean to Do Contact Tracing for Communicable Diseases, Especially for Air Travelers?

Last month I made my first roundtrip, domestic airline flight following 90+ days of lockdown and gradual easing of travel restrictions.  I scheduled this quick trip cautiously, for family-related reasons, and with a goal of returning to my Pennsylvania home well in advance of any return to work with students in my law school. I'm not a timid flyer, but I did my best to try to minimize risk factors, including selection of an airline that advertised "vacant" middle seats, masking requirements, and updated standards for cleaning the airplane and social distancing. I am writing here because an individual on the return leg of my flight in my same row (but across the aisle) became seriously ill during the flight. This post is about my growing concern about what it means to respond to the potential for a communicable illness while traveling, especially but not exclusively in the time of COVID-19. 

When the individual became ill (seeming to lose consciousness and vomiting-- more ill than what I associate with "mere" air sickness), the flight attendants responded to his needs with plastic bags and napkins.  On the positive side, they kept everything low key and talked to the individual softly.  I think it was another, closer passenger who summoned them and everyone tried to respect the privacy of the individual.  Eventually, the ill passenger was moved to the rear of the plane.  Shortly after that, all passengers were informed the seatbelt signs had been activated and everyone should stay in their seats for the remainder of the flight.   There were no further announcements and nothing said about the ill passenger specifically. When the flight arrived at its regular destination, I did not see the individual leave the plane.

What does it mean for any state health department or CDC program official to say they will follow a plan for contact tracing?  Each step of the process needs clarity, including that first step of identifying the ill traveler and other potentially affected travelers, right?   

I received a traditional customer satisfaction "survey" form from the airline the morning of my return via email, asking me to describe the flight. This made me realize that I should be talking directly to the airline about this specific incident.  Was the individual in question experiencing a communicable illness, especially COVID-19?  I made a short, emailed report to the airline less than 12 hours after the end of the flight, and made a follow up inquiry and a second report by telephone and email.   The most I have learned is that the airline is "researching" whether there is any record of the incident or illness on board that flight.  Taking a week (or more?) to determine whether the crew made a report is not reassuring. At a minimum, shouldn't there be a record of that plane being taken out of service for some period of time for cleaning?  

The Pennsylvania governor, for reasons unrelated to my account above, has recently asked all residents returning from the departure state in question (and certain other states experiencing surges in COVID-19) to self-quarantine for 14 days. That makes sense.  Even though I had been exceptionally careful during my time out-of-state, the airline incident was a stark reminder that travel, even with the lessons learned during the last several months, involves factors that are completly outside the control of any of the passengers.  "Being careful" on an individual basis may not be enough and when something happens that involves risk to others, we need clear lines  for any investigation and communication.    

Everyday we are learning new things about how to deal with communicable illnesses, including ones that may be life-threatening. I think what I'm realizing is that as individuals and consumers, we cannot be passive about these steps.

I contacted the CDC and was told there is a process for "contact investigations" by the CDC, but that triggering such an investigation cannot be done easily, at least not if you are a mere passenger.  They recommended I contact the health department in the state where my plane landed.  Here is what CDC sent me by email:  https://www.cdc.gov/quarantine/contact-investigation.html

Weaknesses clearly exist in the protocols. The airline and CDC have been quick to warn me that they cannot give any information about the "patient."  I'm not asking to know the patient's identity in any way. But shouldn't any potentially affected traveler be entitled to know:

a. Whether there was a report of the illness made by the crew to the airline and/or other authorities.

b. The result of any investigation, especially in terms of public health implications.

c.  Whether a specific, communicable illness or disease was identified.

d.  Whether there are specific steps that should be taken by passengers in light of the history.

Shouldn't the CDC want to know whether others on that plane have experienced similar symptoms? (Thankfully, I have not, but although I was in the line of sight of his seat, there were others between us, and in front and behind him, who were much closer.)  I have realized that short of contacting every passenger on the plane, it might be difficult  for some airlines to help with "contact" tracing. They may be relying on a manifest rather than a chart for assigned seats.  Certainly, no one asked me or other, closer passengers on the flight for contact information. I hope the ill individual has recovered fully and quickly, and that for his sake this was a temporary illness.  I'm being calm, even as I'm frustrated.  I'm frustrated not just for myself, but for the larger public.  The  passengers on this plane included all ages, including older individuals.  Earlier during my trip, I overheard one older traveler say to another, "I just want to live long enough to see my grandchildren again."

July 6, 2020 in Consumer Information, Ethical Issues, Health Care/Long Term Care, Science, Statistics, Travel | Permalink | Comments (0)

Thursday, July 2, 2020

Topics and Speakers Announced for AALS January 2021 Program on Intersectionality, Aging and the Law

Hard to believe we are scheduling for January 2021, isn't it!  Here's the scheduled speakers and topics for the co-hosted program during the AALS Annual Meeting in San Francisco on "Intersectionality, Aging and the Law:"

July 2, 2020 in Advance Directives/End-of-Life, Cognitive Impairment, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, International, Programs/CLEs, Statistics | Permalink | Comments (0)

Wednesday, July 1, 2020

Using Advanced Age as a Factor in Rationing Health Care? Consider the Arizona COVID-19 Crisis Plan

I've recently returned from a week in Arizona with family.  I managed to arrive in Phoenix just in time for a surge in COVID-19 cases, traffic headaches connected to President Trump's campaign visits, a couple of new wildfires, and a few more degrees up the summer temperature gauge.  Probably the most newsworthy part of the trip was the announcement by Arizona authorities that the state was activating a COVID-19 crisis plan that involves triage -- or "rationing" as some  people interpreting the plan are calling it.  One component of the Arizona plan involves "protocols for scarce resource allocation."  An Arizona public statement describing the protocols attempts to reassure the public (emphasis provided with blue color):

If resources are sufficient, all patients who can potentially benefit from therapies will be offered therapies. If resources are insufficient, all patients will be individually assessed. No one will be categorically denied care based on stereotypes, assumptions about any person’s quality of life, or judgement about a person’s “worth” based on the presence or absence of disabilities.


All patients, regardless of resource availability, will be treated with respect, care, and compassion. Triage decisions will be made without regard to basis of race, ethnicity, color, national origin, religion, sex, disability, veteran status, age, genetic information, sexual orientation, gender identity, quality of life, or any other ethically irrelevant criteria.

When resources become inadequate -- implicit in the Governor's recent news conferences -- triage involves a color-coded system of triage "priority scores."  According to the statement, "All patients will be eligible to receive critical care beds and services regardless of their triage score, but available critical care resources will be allocated according to priority score, such that the availability of these services will determine how many patients will receive critical care."

The guidelines indicate health care providers must make an active assessment of the "patient's goals of care and treatment preferences.  It is imperative to know whether aggressive interventions such as hospitalization, ICU admission or mechnical ventilation are consistent with a patient's preferences.... All hospitalized patients should be asked about advance care planning documents, goals of care, and are strongly encouraged to appoint a proxy decision-maker (e.g., medical durable power of attorney... or health care agent) if not previously in place.  Patients in nursing homes, skilled nursing facilities, other long-term care settings, and outpatient care settings should also be asked about their goals of care and advanced care planning documents.... If advance clare planning documents are in place and available the healthcare provider should verify the patient's goals of care and treatment preferences remain the same....."

Will the patient's age, especially an advanced age, be relevant to a Arizona's Covid-19 crisis plan?  On the one hand, the guidelines indicate "age" is  expressly "removed ... as a specific factor for Triage Priority scores or Triage Color Groups."  On the other hand, when determining the Triage Priority Score, points assessed must reflect an evaluation of whether the patient is "expected to live more than 5 years if patient survives the acute illness [zero points added]" or whether death is "expected wtihin 5 years despite successful treatment of acute illness [2 points added]." If "death [is] expected within 1 year regardless of successful treatment of the acute illness," 4 points are added.  The patient's prioritization for critical care resources is best with a low score (1 to 3 total points), while priority is reduced to "intermediate" (4 to 5 points) or "lowest," if they are assessed with more than 6 total points.  Further, "age" is implicitly involved as the prioritization process somehow examines the specific patient's "opportunty to experience life stages (childhood, young adulthood, middle years, and older years)."

These are obviously tough calls in any health care assessment contect, but especially so in the middle of a pandemic.  Public health professionals have experience with these kinds of assessements. I suspect that many families also have engaged in a type of informal assessment when serving as a loved one's health care spokesperson or agent. 

My sister and I were thinking about last summer as I visited this summer.  Last summer, the two of us talked about similar factors when making the call on whether our mother would have hip-surgery at age 93 following a fall-related fracture.  The doctor said that without the surgery our mother was unlikely to walk again because of pain; with the surgery there was a significant chance she would be able to walk without pain.  She ended up sailing through the surgery -- and began taking steps again the same day.  Ironically, probably because of her increasing dementia, she had no fear of falling nor any memory of the surgey and thus was soon fully ambulatory (although she did sometimes substitute a walker for her occasional cane) and remained so for all but the last few days if the next six months of life.  That took her into the summer of 2019 in Arizona.

If the cornonavirus pandemic had occurred in the summer of 2019, and if safe access to hospitals and surgery were the issues, my best guess is Mom would probably have had a "high" score on any health care triage assessment -- in other words, not good news.  We are glad we never confronted decisions about respirators or ventilators.  We do know that our very elderly mother had a much better quality of life with major surgery than she would have had without it. Just one case, of course.  Again, tough calls (and yes, expensive calls for Medicare) with or without a pandemic to complicate the decision process.  

July 1, 2020 in Advance Directives/End-of-Life, Cognitive Impairment, Current Affairs, Ethical Issues, Health Care/Long Term Care, Medicare | Permalink | Comments (2)

Thursday, June 18, 2020

Upcoming Webinar: Extreme Home Takeovers - Dealing with "Concerned" Relatives

On Monday, June 22, 2020, I'm joining the 3rd Annual Memorial Elder Abuse Sympsium hosted by Legal Aid Services of Oklahoma and being delivered as a webinar over the course of several sessions.  On Monday, the first set of speakers includes deeply experienced professionals in banking and securities, both potential avenues for elder fraud, as well as Judge Scott Roland of the Oklahoma Court of Criminal Appeals.  I follow them with the topic "Extreme Home Takeovers - Dealing with Concerned Relatives" -- the clever title supplied by our hosts!  

I'll be offering comparative statutory and common law approaches for recovering a house. including my own experiences while supervising Dickinson Law's Elder Protection Clinic.  The need is usually triggered by a transaction often tied to the worries of the older person, hoping or believeing that a family member, friend or new "befriender" would be more likely to save them from the dreaded nursing home if they give the hoped-for-caregiver "the house."  I'll be using cases from Ireland, Pennsylvania, Oklahoma (of course) and beyond for strategies, and discussing everything from filial support laws, to improvident tranaction laws, to the common law concept of failure of consideration in "support deeds." 

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June 18, 2020 in Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Housing, International, State Cases, State Statutes/Regulations | Permalink | Comments (0)

More Reasons for a Serious Bi-Partisan Commitment to Citizenship for DACA Health & Long-Term Care Workers

Shared by my colleague, Professor Medha Makhlouf, who heads Dickinson Law's Medical-Legal Partnership Clinic, this thoughtful article explaining the importance of DACA-recipient health care workers in the United States, especially now:    

The Covid-19 pandemic is stretching our public health system to its limits and challenging our ability to meet the urgent and critical medical needs of the country as never before. As executives responsible for the legal affairs of major hospitals and lawyers working in Covid-19 hot spots, we know how crucial it is to have every available front-line medical worker fighting this pandemic. . . . 

 

New data from the Center for American Progress reveals that the DACA-recipient health care work force includes more than 6,000 diagnosing and treating practitioners, including respiratory therapists, physicians assistants and nurses; some 8,000 health aides, including nursing assistants and orderlies; more than 7,000 other health care support workers; and some 5,500 health technologists and technicians.

 

The Association of American Medical Colleges told the Supreme Court that nearly 200 physicians, medical students and residents depend on DACA for their ability to practice medicine and serve their communities. Those 200 trainees and physicians alone would care for hundreds of thousands of patients per year in normal times — the association estimates as many as 4,600 patients per year, per person. Under the demands of the Covid-19 pandemic, those numbers will be much higher.

 

The Center for Migration Studies found that 43,500 DACA recipients work in the health care and social-assistance industries, including more than 10,000 in hospitals....

The decision on the DACA case is expected this week.  "If the Supreme Court upholds the decision to terminate DACA, nearly 700,000 people — including those health care workers — will lose their ability to work and live in the United States."  For more, ready the full NYT article, There's Only One Thing Stopping Trump From Deporting Health Care Workers.  

For once, the members of Congress from both sides of the aisle should be ready with emergency legislation for citizenship (or at a minimum, permanent residency status) for these essential workers.  It is the least we can do for people who are doing the most. And it is vital for the best interests of public health across the nation.  A win-win, if we can just focus on what's important.  

WOW!  Moments after I posted the above, I see the news flash that Supreme Court Rules Against Trump Administration Attempt to End DACA, A Win for Undocumented Immigrants Brought to U.S. As Children.  

After reading the opinion(s), it is clear that while DACA recipients have a temporary reprieve, the real need is serious consideration of true relief from fear of deportation.  Must they really wait until after the election?  

June 18, 2020 in Consumer Information, Current Affairs, Discrimination, Ethical Issues, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, International | Permalink | Comments (0)

Wednesday, June 17, 2020

This "Should" Be Easy: Support DACA Workers in Health Care and Long-Term Care

The Supreme Court 's ruling on the fate of DACA-residents and workers in the U.S. could be issued this week.  Regardless of the outcome on the case itself, everyone who cares about quality of health care, including long-term care, should also care about the United States' need to be honest about how much health care depends on the hard work and commitment to care provided by temporary-status and undocumented-status  workers in health and personal care jobs.  I've seen DACA workers in action in elder care, and I've seen their families ripped apart by harsh immigration rulings.

NPR's Morning Edition had a short and yet deeply important segment today on Health Care Workers Who Are Awaiting Supreme Court DACA Decision.   Do listen to the podcast replay --  it is just 4 minutes -- and think about whether this is a key opportunity for a true, bipartisan solution for DACA-children (families) who so often are working in some of the most challenging (and dangerous) U.S. jobs during the COVID-19 pandemic.  Let's do the right thing.  

June 17, 2020 in Consumer Information, Current Affairs, Ethical Issues, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, International, Medicaid, Medicare | Permalink | Comments (0)

Thursday, June 11, 2020

Nursing Homes and the Right to Visitors During a Pandemic

The seminal 1987 Nursing Home Reform Act requires all nursing facilities to care for their residents in a manner that that "will promote ,maintenance or enhancement of the quality of life of each resident." 12 USCA Section 1396r(b)(1)(A).  The same law, at Section 1396r(e)(3),  addresses "access and visitation rights:" 

A nursing facility must - ... 

(B) permit immediate access to a resident, subject to the resident's right to deny or withdraw consent at any time, by immediate family or other relatives of the resident;
 
(C) permit immediate access to a resident, subject to reasonable restrictions and the resident's right to deny or withdraw consent at any time, by others who are visiting with the consent of the resident;
(D) permit reasonable access to a resident by any entity or individual that provides health, social, legal, or other services to the resident, subject to the resident's right to deny or withdraw consent at any time .... 
During the pandemic lockdown, states prohibited most visitations, citing the risk of infection from the outside community that could endanger not just the visitor's loved one, but potentially all residents.  States are now beginning to lift or at least ease visitation restrictions, and families are beginning to talk more openly about the impact of the isolation on residents who have not contracted the virus.  
 
This week, NPR has begun airing stories about the challenge of balancing the risks of visitors against the benefits of not just family member visits, but family member involvement in care and socialization for residents.  From one story about Luann Thibodeau and her husband Jeff, who has multiple sclerosis:
 

It wasn't candlelight and soft music that made the 40th anniversary of Luann and Jeff Thibodeau so memorable. It was gazing at each other through the window of Jeff's nursing home in Texas and eating carryout from the Olive Garden. Just the two of them. And a nursing assistant.

 

"She fed him, and I ate mine, and that was it," Luann Thibodeau says. "So that was our 40th wedding anniversary."

 

Luann Thibodeau would bring her husband, Jeff, dinner every night, except Tuesdays, when she had Bible study. Since she's been unable to visit, she says that her husband has become increasingly disinterested in food as his multiple sclerosis has worsened.
 

The Thibodeaus have not been in the same room since mid-March. That's when visitors were banned from nursing homes to slow the spread of the coronavirus. But family members say that talking via FaceTime and holding up signs at windows are no substitute for the hands-on care and emotional support their visits provide.

 

Family members often are an integral part of the care residents in nursing homes receive. They make sure meals are being eaten, clothes are being changed. They also offer invaluable emotional support. . . . 

 

Luann Thibodeau has seen that decline in her husband. She used to bring dinner for him every night except Tuesdays when she goes to Bible Study. She says that as his multiple sclerosis has worsened, he's become increasingly disinterested in food. [She explains]. "I bully him into finishing a meal. And I'll say to him, 'Jeff, you know, this is what an adult man eats. So you need to eat this.' "

 

A staff member can't do what she does. Nursing home residents have rights. So if Jeff Thibodeau tells a nursing assistant that he's done eating after three bites, she has to abide by his wishes.

 

Without his wife's push, the results of her absence is striking.

For more, listen to the NPR podcast or read the parallel written narrative in "Banned From Nursing Homes, Families See Shocking Decline In Their Loved Ones." 

The federal Nursing Home Reform Act's Bill of Rights has never been an easily enforceable mandate, and particularly in a global crisis the needs of the many can override the rights of individuals.  But there does need to be a long-range plan on how better to facilitate visitation, recognizing it as an important part of any person's quality of life.  

 

June 11, 2020 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Medicare | Permalink | Comments (2)

Monday, June 8, 2020

Oklahoma Legal Aid Services Update: 3rd Annual Memorial Elder Abuse Symposium Goes Virtual, Starting June 15

This year, the Sonya L. Patterson Elder Abuse Symposium hosted annually by Legal Aid Services of Oklahoma, will take place over the course of several weeks, in bite-size programming, rather than in a single, all-day conference format.  In light of the online setting, the organizers are also able to open up registration and attendance to interested people outside of Oklahoma; however, there are limits on the number who can attend each session, so I recommend registering early. In past years, the symposium has drawn an audience of attorneys, law enforcement and social workers, with CLE credits available.

I'm very pleased for the opportunity to be a speaker this year. In addition to attorneys and judges, the speakers include health care professionals and bankers.  The program honors the life and advocacy of a young Oklahoma public interest attorney, Sonya L. Patterson, who passed away far too soon in 2015, as the result of an accident at the age of just 30. 

Here's the line up for the midday Symposium Webinar Series , with all sessions taking place on Central Daylight Savings Time:

Session 1: Monday, June 15th (11:00 am to 1:45 pm)

  1. The Psychic Effect on Victims of Elder Abuse by Family and/or Caregivers- Dr. Nancy Needell, M.D., Weill Cornell Medicine
  2. Attorney Responsibility to Client’s Ward or Principal- Rick Goralewicz, Staff Attorney, Legal Aid Services of Oklahoma

 

Session 2: Monday, June 22nd (11:00 am to 1:15 pm)

  1. Financial Exploitation of the Elderly- Justice Scott Roland, Oklahoma Court of Criminal Appeals with Elaine Dodd, Executive Vice President/ Fraud Division at Oklahoma Banker's Association and Jennifer Shaw, Oklahoma Securities Commission
  2. Extreme Home Takeover: Dealing with the “Concerned Relative”- Katherine C. Pearson, Professor of Law at Dickinson Law, Pennsylvania State University, Carlisle Pennsylvania

 

Session 3: Wednesday, June 24th (11:00 am to 1:15 pm)

  1. Elder Abuse General Topic- Stacey Morey, Oklahoma Attorney General’s Office, Chief of Consumer Protection Division
  2. Experts: Identifying and Utilizing in Elder Abuse Litigation- Kara Vincent, Attorney, Barber and Bartz

 

Session 4: Monday, June 29th (11:00 am to 1:15 pm)

  1. Domestic Violence and Seniors- Melissa Brooks, Staff Attorney at Legal Aid Services of Oklahoma and Gail Stricklin, Attorney at Law
  2. Abuse in Institutional Settings- William Whited, State Long Term Care Ombudsman and Nicole Snapp-Holloway, Attorney at Maples, Nix and Diesselhorst

 

Session 5: Wednesday, July 1st (11:00 am to 1:15 pm)

  1. Incompetency, Incapacity and Vulnerability- Mark Holmes, Attorney at Holmes, Holmes and Niesent, PLLC, Travis Smith, Attorney at Holmes, Holmes and Niesent, PLLC and Cathy Wood, Adult Protective Services
  2. Isolation and Loneliness- Laurel Dinkel, LCSW, Norman, Oklahoma

Click HERE for access to registration information for individual sessions or  the entire series. My thanks to Oklahoma Legal Aid Staff Attorney Rick Goralewicz for the invitation.  

June 8, 2020 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Crimes, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Housing, State Cases, State Statutes/Regulations, Statistics, Webinars | Permalink | Comments (0)

Sunday, June 7, 2020

Using Technology to Enhance Family Caregiving (and grieving)

The increasing use and sophistication of various  new technical products and remote platforms for monitoring patients and family members is profiled in this article from the New York Times I can remember when my very rudimentary way of checking daily on my Mom  was watching her yahoo email account to see whether there was a green oval to indicate she was typing!  Somewhere along the way, the ethical implications of monitoring other's online activity eliminated that option, and that makes sense. 

And speaking of technology, tomorrow is my first participation in an online memorial.  A Zoom send-off.  A another step in the brave new world of finding new ways to be together alone.  

 

 

 

June 7, 2020 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Health Care/Long Term Care, International, Web/Tech | Permalink | Comments (0)

Saturday, June 6, 2020

NYT: "Detecting" the Reasons for a Death in Nursing Home

From a sad, powerful story about one of many deaths at Isabella Geriatric Center, carried in the New York Times:

A little after 1 in the afternoon, Aida Pabey got the call from the nursing home: Her mother was not going to make it. It was April 6, nearly four weeks after the state had barred all visitors to nursing homes, and Aida and her sister, Haydee, had been struggling to get even the most basic information about their mother. Was she eating? Had the coronavirus reached her part of the home?

 

Now this dire call. Just the day before, the sisters had been assured by an aide that their mother was “fine.”

 

They were both detectives in the New York Police Department, 20-year veterans. They were used to getting information, even from people determined to withhold it. But the nursing home had been a black box.

 

They raced to the home. Haydee got there first and managed to get upstairs. Aida, arriving second, identified herself as a crime scene investigator and brought safety gear. “I had my face shield, my bootees, my mask, my gloves,” she said. The security guard refused to let her in. “No. It was, ‘No way.’”

For more read, When Their Mother Died at a Nursing Home, 2 Detectives Wanted Answer.  As one of our Blog's readers has commented recently, "we need to go a step deeper to the ROOT cause of these serious breaches of safe practices in care facilities."

June 6, 2020 in Cognitive Impairment, Consumer Information, Crimes, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Housing, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Friday, June 5, 2020

Must Any Public "Right to Know" the Covid-19 Infection Status of LTC Facilities Depend on Legislation?

Under the best of circumstances, it is difficult to make a decision about whether to place a fragile loved one in a care community.  With COVID-19, such a decision can be even more difficult,  as some states states (and some facilities) have resisted making public the names of long-term care facilities where residents or staff have been diagnosed with COVID-19.

In Arizona, a "right to inspect public records" suit was filed on May 5, 2020 by news organizations, seeking to review "public records" that show the number of COVID-19 positive residents at nursing care institutions, as well as the number of transfers made between such facilities and Arizona hospitals.  They were not requesting the identity of the residents; however, disclosing records containing the numbers would disclose the names of the facilities. That state's Governor has reportedly taken the position that not disclosing the COVID-19 infection history of facilities by name is "in the best interest of public health." 

On May 29, Maricopa County Superior Court Judge Christopher Coury ruled against the news organizations.  In the 23-page opinion in CV 2020-005385, Judge Coury concluded with these interesting paragraphs: 

72. Both Plaintiffs and Defendants have asserted legitimate positions in this action, particularly given that the underlying issues are important and weighty in the lives of Arizonans. It is beyond dispute that Arizonans who have parents, aunts, uncles, friends, neighbors, and loved ones living, or who may in the future be placed, in a Facility to care for them want, and justifiably deserve, to know how that Facility and its residents have fared during the Covid-19 public health emergency. As a son, nephew, friend, and neighbor, this judicial officer understands, respects, and empathizes with the need for Arizonans to have access to the information contained in the Records. Fortunately, this need of family and caregivers has been mitigated, if not eliminated, by EXECUTIVE ORDER 2020-35, which requires Facilities to provide Covid-19 information to residents, transferees, and applicants – and their guardians and next of kin – on a prompt basis.

 

73. It is not the position of the Judicial Branch to enact legislation or to create policy – that responsibility rests squarely with the other branches of government. The Legislature could consider the policy implications on all sides of this issue, and if desired, enact clarifying legislation and expressly protect records, or direct that records be released. If any frustration exists, it is that this has not happened. The Act – the legislation authorizing the actions at issue – lacks clarity. Rather than using model legislation with clearly defined terms, and rather than actually defining the terms used, the Legislature in 2002 created Arizona-specific legislation, apparently from whole cloth. Even though the subject matter of the Act relates to emergencies – instances when clear statutes are needed to permit critical, decisive and time-sensitive actions – the Act left critical terms undefined. Eighteen regular legislative sessions have passed, and the Act has not been amended or clarified. Perhaps this is the fortuitous result of not having to deal with a widespread health emergency during the intervening years. Nonetheless, if this decision illustrates nothing else, it highlights the need for the Legislature to revisit the Act and make it more workable for all concerned. In its present form, the ambiguous Act does a disservice to the media, to government leaders, to the courts, and to all Arizonans.

 

74. Arizona has been profoundly impacted by Covid-19. Lives have been lost. Women and men, old and young, have been sickened. The economy has been set back. Livelihoods of people have been compromised. Weddings and religious ceremonies have been delayed. Births and funerals have been isolated. Students have missed classes and graduations. Temptation exists to simply adopt jurisprudence that because Covid-19 has created such harm in our state and because Arizonans need information to battle Covid-19, sufficient justification exists to “look the other way” and require release of the Records. This judicial officer, however, will not and cannot do this. Indeed, were this judicial officer to ignore the law, Arizona’s Constitution – and its provisions of limited government and separation of powers – would be added to the list of Covid-19’s victims. The Court will neither countenance nor assist in this. Although difficult in the face of this devilish virus, fidelity to the Constitution and laws of the State of Arizona must prevail.

Therefore, Judge Coury entered judgment against the News Organizations as plaintiffs with respect to their request to produce records containing numerical information on COVID-19 infections at specific facilities, ruling that this was medical information that was "confidential and protected as a matter of law."  

The court found that a triable issue exists relating to other issues in the case, "specifically, Defendant's failure to produce  documents relating to information regarding the availability of PPE."  

Note:  I have not yet found a public website containing Judge Coury's decision, although it appears the order is not a restricted document.  If any of our readers come across such a site, feel free to let me know and I can amend this post to link to the full opinion.  

My thanks to Jon Dessaules, a  former Dickinson Law student, now a long-established Phoenix attorney, for assistance in tracking down information on this case.  

June 5, 2020 in Consumer Information, Current Affairs, Ethical Issues, Health Care/Long Term Care, Housing, Science, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Thursday, June 4, 2020

When Push Comes to Shove: Will Post Covid-19 Mean Better Government Support for In-Home Care?

Pittsburgh-based elder law attorneys Frank Petrich and Julian Gray write regular columns for the Pittsburgh Post-Gazette.  Recently they pulled out their crystal ball to gaze into the future, with the hope that positive change is possible if we pay heed to the lessons we are learning during the response to Covid-19.  In looking at long-term care, they write:

It has been difficult for families, as well as elder law attorneys, over the past few months to connect with clients in long-term care facilities. It’s understandable that restricting access to hospitals, nursing homes and other long-term care facilities saves lives and reduces exposure for all parties.

 

However, given the significant concentration of COVID-19 cases within nursing homes and the inability for families to be with loved ones in person, a radical shift in the delivery of long-term care services is on the horizon.

 

For now, this points toward more people wanting to receive assistance in their homes versus moving into a long-term care facility. Like many states, Pennsylvania has talked about developing programs to keep people in their homes since the Rendell administration.

 

Maybe now that push has come to shove and large stimulus packages are happening weekly, our government can truly live up to its promise of helping people stay in their homes while receiving their long-term care services and support.

 

For more, read Elder Law Guys: Long-term Care after COVID-19, posted May 25, 2020 for the Pittsburgh Post-Gazette.  

 

June 4, 2020 in Consumer Information, Current Affairs, Ethical Issues, Health Care/Long Term Care, Medicaid, Medicare | Permalink | Comments (0)

Wednesday, June 3, 2020

National Continuing Care Residents Association Joins Other Senior Living Advocates in Opposing COVID-19 Immunity

On June 1, 2020, the National Continuing Care Residents Association (NaCCRA) released its public statement detailing the organization's opposition to COVID-19 immunity or waivers of liability for nursing homes, adding to the growing chorus of opposition. They explain:  

CCRCs mainly provide three levels of care under one roof or on the same campus, normally comprised of independent living, assisted living, and skilled nursing care -- the latter two considered licensed long-term care facilities.  Our members can reside at various times in any of the three levels of care.  Fore example, one spouse can live independently while the other can live in assisted living or skilled nursing.  There are numerous variations of these living arrangements depending on the level of care required.

 

NaCCRA and its members are very sympathetic to the CCRC managers and front-line care/service workers as they labor during the coronavirus pandemic with its many challenges.  However, residents living and dying, many times alone, in nursing homes or assisted living apartments, should not be deprived of their legal rights or protections even in these most extraordinary times.

 

NaCCRA and its member residents living in continuing care settings are alarmed at the push to grant liability immunity to providers and operators of long-term care facilities in the face of the COVID019 epidemic.  Many states have acquiesced to provider association lobbyists at the expense of residents' legal protections.  NaCCRA believes that long term care providers must not be given a pass on negligence in any form simply due to a pandemic, which makes seniors in such congregate settings even more vulnerable.  

 

Therefore, we strongly oppose the liability waivers for COVID-19 legislated by some states.  WE urge that these be repealed and advocate on immediate moratorium on any future waivers for providers/operators of CCRCs and long-term care facilities.  It is our position that existing laws and negligence standards are more than adequate to protect long term care facilities that are sued if they have followed the proper standards of care and protocols.

My thanks to Jim Haynes, the current president of NaCCRA, for keeping us advised on their position.  

June 3, 2020 in Consumer Information, Current Affairs, Ethical Issues, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Retirement, Science, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (2)

Tuesday, June 2, 2020

California Appellate Court Rules CCRC Residents Are Protected From Mandatory Arbitration

For more than ten years it is probably fair to say that the most ubiquitous appellate "elder law" cases are those involving attempts by nursing homes to compel arbitration, rather than court-based litigation, usually raised as a defense to personal injury suits brought by residents or family members of residents.  Admission contracts routinely include mandatory arbitration clauses.  Arbitration is often promoted by nursing homes to prospective customers as offering efficient, cost-effective resolution for any disputes; however, seasoned attorneys also know that limiting disputes to arbitration is a means by which care-providers avoid trials by jury, publicly reported trials, and most court-based rules on procedure, rights to discovery and admissibility of evidence.   

This month, a California appellate court (Second District, Division 6) ruled that residents of continuing care communities are protected because of California laws interpreted as prohibiting mandatory arbitration in "rental agreements."  From the June 1, 2020 opinion in Harris v. University Village Thousand Oaks, CCRC, LLC:

Civil Code section 1953, subdivision (a), states, “Any provision of a lease or rental agreement of a dwelling by which the lessee agrees to modify or waive any of the following rights shall be void as contrary to public policy: [¶] ... [¶] (4) [Their] procedural rights in litigation in any action involving [their] rights and obligations as a tenant.”

 

... The plain language of Civil Code sections 1940 and 1953 applies to the continuing care contracts here because the fees paid by appellants include payment for the right to live in a residence. Appellants are thus “persons who hire dwelling units.” (Civ. Code, § 1940, subd. (a).) Thus, the protections for “boarders” and “lodgers” (Civ. Code, § 1940, subd. (a)) apply to the “board, or lodging” portions of continuing care contracts (Health & Saf. Code, § 1771, subd. (m)(1)). Because the allegations in the complaint here include claimed violations of “rights and obligations as a tenant” (Civ. Code, § 1953, subd. (a)(4)), the arbitration agreements are void.

The court discussed the reasons legislatures enacted statutory laws to "protect the rights of tenants."  It continued:

Elders entering continuing care contracts are entitled to the same protection as mobile home owners. Both groups face significant economic barriers to relocating. The Legislature recognizes that “elderly residents often ... expend a significant portion of their savings in order to purchase care in a continuing care retirement community,” and that there is a need “to protect the rights of the elderly.” (Health & Saf. Code, §§ 1770, subd. (b)1776.)

The court acknowledged that CCRC residents also have some express statutory protections under state laws regulating CCRCs, but concluded that the lack of any bar on arbitration in that statutory scheme does not preclude protection for residents under landlord-tenant law.  

Moreover, the continuing care contract statutes “shall be liberally construed for the protection of persons attempting to obtain or receiving continuing care.” (Health & Saf. Code, § 1775, subd. (e). To deny residents of a continuing care retirement community the protection given others who contract for lodging would be inconsistent with this express policy. The legislative purposes of both the landlord-tenant laws and the continuing care contract laws are best served by applying the arbitration prohibition to the housing component of continuing care contracts.

The full opinion is currently available on Westlaw at 2020 WL 2831923.  

June 2, 2020 in Consumer Information, Current Affairs, Ethical Issues, Housing, Property Management, State Cases, State Statutes/Regulations | Permalink | Comments (2)

Friday, May 29, 2020

Filial Friday (sort of!)

On occasion, I have created what I call a "Filial Friday" post, where I write about attempts to use "filial support laws" to compel family members, usually adult children, to pay for the costs of nursing home care.  These cases sometimes arise in the U.S., or foreign countries, or in "reverse" circumstances, where the elderly parent is the target of a suit for long-term care of a disabled child.  Pennsylvania has played an important role in this episodic history, in part because of language added to Pennsylvania's colonial era statute that was interpreted by the courts as giving standing to nursing homes to bring direct suits against family members.

But, during the last few weeks of Covid-19-related lockdowns, I've noticed a sharp contrast with the troublesome filial support law cases. I've seen (and happily become part of) what I would call a "neighborhood movement."  For example, one of my neighbors, Marci, who, like many of us, is currently working full time from home, has more or less adopted one of our more elderly neighbors.  The elderly neighbor doesn't have children of her own and she's had some recent health issues.  Marci checks up on her regularly, does grocery shopping for her, prepares and delivers occasional meals, takes the cat to the vet, and more.  No one asked her to do this! 

I've seen other examples, including informal "teams" of neighbors organizing to help older individuals who don't have local family members to provide help. Its great to see -- and I know, I also feel more connected to my own distant family when I can help someone locally.  A "two-fer," as they say.

So, here's wishing you a very Happy Filial Friday -- of a different sort.  

May 29, 2020 in Consumer Information, Current Affairs, Ethical Issues, Health Care/Long Term Care, Housing | Permalink | Comments (0)

Thursday, May 28, 2020

The Most Important Coronavirus Death Statistic?

From Forbes, a deep dive into "The Most Important COVID-19 Statistic: 43% of U.S. Deaths Are From o.6% of the Population."  This will undoubtedly be an ongoing topic for examination for statisticians and analysts.  

May 28, 2020 in Consumer Information, Current Affairs, Ethical Issues, Federal Statutes/Regulations, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (1)