U.S. Just Made It a Lot Less Difficult to Sue Nursing Homes

Elizabeth Barrow case

The federal agency that controls more than $1 trillion in Medicare and Medicaid funding has moved to prevent nursing homes from forcing claims of elder abuse, sexual harassment and even wrongful death into the private system of justice known as arbitration.

An agency within the Health and Human Services Department on Wednesday issued a rule that bars any nursing home that receives federal funding from requiring that its residents resolve any disputes in arbitration, instead of court.

The rule, which would affect nursing homes with 1.5 million residents, promises to deliver major new protections.

Clauses embedded in the fine print of nursing home admissions contracts have pushed disputes about safety and the quality of care out of public view.

The system has helped the nursing home industry reduce its legal costs, but it has stymied the families of nursing home residents from getting justice, even in the case of murder.

A case involving a 100-year-old woman who was found murdered in a nursing home, strangled by her roommate, was initially blocked from court. So was a case brought by the family of a 94-year-old woman who died at a nursing home in Murrysville, Pa., from a head wound. The cases were the subject of a front-page article in The New York Times last November.

“The sad reality is that today too many Americans must choose between forfeiting their legal rights and getting adequate medical care,” Senator Patrick Leahy, a Democrat of Vermont, said in a statement on Wednesday.

The nursing home industry reacted strongly against the change. Mark Parkinson, the president and chief executive of the American Health Care Association, a trade group, said in a statement on Wednesday that the change on arbitration “clearly exceeds” the agency’s statutory authority and was “wholly unnecessary to protect residents’ health and safety.”

The new rule on arbitration came after officials in 16 states and the District of Columbia urged the government to cut off funding to nursing homes that use the clauses, arguing that arbitration kept patterns of wrongdoing hidden from prospective residents and their families.

With its decision, the Centers for Medicare and Medicaid Services, an agency under Health and Human Services, has restored a fundamental right of millions of elderly Americans across the country: their day in court.

It is the most significant overhaul of the agency’s rules governing federal funding of long-term care facilities in more than two decades.

And the new rule is the latest effort by the Obama administration to rein in arbitration’s parallel system of justice that was quietly built over more than a decade.

In May, the Consumer Financial Protection Bureau, the nation’s consumer watchdog, unveiled the draft of a rule that would prevent credit card companies and other financial firms from using arbitration clauses that bar consumers from banding together in a class-action lawsuit.

While Democrats, including Mr. Leahy, have tried to get rid of arbitration through legislation, their efforts have met resistance from various industry groups. The efforts by the consumer agency and now Health and Human Services do not require congressional approval.

Like other rules put forth by the administration, the rule on nursing homes that receive federal funding could be challenged in court. But absent those challenges, the rule is scheduled to go into effect by November. Only future admissions would fall under the new rule.

The nursing home industry has said that arbitration offers a less costly alternative to court. Allowing more lawsuits, the industry has said, could drive up costs and force some homes to close.

But some government officials and elder care lawyers see a different rationale. For corporations, they say, arbitration also potentially keeps embarrassing practices under wraps.

The nursing home rule, which was first proposed in July 2015, was aimed at improving disclosure. The agency began to re-examine the rule after a chorus of patient groups raised concerns about the widespread use of arbitration.

The final version of the rule went a step further than the draft, cutting off funding to facilities that require arbitration clauses as a condition of admission.

Lawyers who work with the elderly say that people are being admitted to nursing homes at one of the most stressful moments of their lives. Distraught and often desperate for a room, prospective residents do not fully grasp what they are signing, the lawyers say.

Sometimes, that does not matter. Judges are bound by a pair of Supreme Court decisions, in 2011 and 2013, that blessed the widespread use of arbitration clauses. Those decisions have made it virtually impossible to overturn clauses, even those signed by the most vulnerable nursing home residents.

An appeals court refused to throw out an arbitration clause signed by a man who could not read or sign his name, reasoning that “illiteracy alone is not a sufficient basis for the invalidation of an arbitration agreement.”

In the last decade, arbitration clauses have affected things like cellphone contracts, employment agreements and student loans.

But even as the use of arbitration clauses spread, little was known about what happened to those who took their chances there. Companies argued that arbitration offered a simpler, swifter and less expensive alternative to court, without the headaches and delays.

Those claims, though, were largely anecdotal because arbitrations are confidential and there is no federal database that records their outcomes.

In a yearlong investigation, The Times tried to pierce the veil, getting inside the secretive proceedings. To do that, The Times examined records from more than 25,000 arbitrations between 2010 and 2014 and interviewed hundreds of lawyers, arbitrators, plaintiffs and judges in 35 states.

The proceedings bear little resemblance to court. They have been conducted in the offices of lawyers who represent the companies accused of wrongdoing.

In the case of nursing homes, The Times found many troubling examples where issues of abuse and potential neglect never made it into the public light because they were blocked from court.

In May 2014, for example, a woman with Alzheimer’s was sexually assaulted two times in two days by residents at a nursing home in Lemon Grove, Calif. A subsequent investigation by the state’s department of public health found the nursing home “failed to protect” the woman.

But when her family tried to hold the nursing home accountable in court, their case was scuttled because of an arbitration clause. Ultimately, they gave up and settled with the nursing home.

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U.S. Just Made It a Lot Less Difficult to Sue Nursing Homes

More older adults spending ‘golden years’ in homelessness

After a lifetime of working hard, Linda Boamah thought she was setting herself up for a comfortable retirement.

But the former optical-lab worker became ill with multiple chronic conditions in 2014 and in less than two years lost everything, including her house, life savings and pride.

"I couldn't work anymore because I got congestive heart failure, COPD (chronic obstructive pulmonary disease) and am diabetic," said the 62-year-old East Side resident. "The money I had saved up was quickly depleted, and I was terrified."

Thankfully, a friend stepped in and offered Boamah a room to sleep in, sparing her from becoming part of the growing population of seniors living on the streets and in shelters.

About half of the homeless in the United States are people 50 or older, studies show. The number of older homeless adults is projected to increase by 33 percent in the next decade and double by 2050.

"We're at the beginning of the wave and have an opportunity to not only improve the quality of life of these homeless and formerly homeless elders, but also extend their lives," said Katrina Van Valkenburgh, central region managing director for CSH, also known as the Corporation for Supportive Housing.

The average life expectancy for a homeless older adult is 63 years, compared with 80 for someone who always has had stable housing, she said.

Leaders from across the Midwest are meeting in Columbus this week to talk about helping this aging homeless population get into and keep affordable housing. The two-day event is hosted by CSH and National Church Residences, which specializes in low-income and affordable senior housing.

It kicked off on Tuesday with a tour of two supportive housing properties owned by National Church Residences. Today, housing experts from across the country are meeting.

Aging adults who have been homeless experience chronic illnesses and geriatric conditions 15 to 20 years earlier than the general population, said Dr. Margot Kushel, a professor of medicine at the University of California-San Francisco who followed 350 homeless people in Oakland, California.

Although the median age of the participants was 58, they had more trouble bathing, dressing and eating than many in their 70s, 80s and 90s, Kushel said. They also had a harder time using transportation, taking medication, managing money, applying for benefits and arranging job interviews.

One answer is creating more affordable and supportive housing — the theme of today's gathering. Supportive housing complexes provide tenants with tailored services such as life-skills training, alcohol and drug abuse programs and case management so they can have more stable, productive lives.

After six months of living with her friend, Boamah was able to secure an apartment in June at National Church Residences' Commons at Third near Grandview Heights.

"I was so worried before about what was going to happen to me that I was making myself even more sick," she said. "I love my new home. It's peaceful and quiet."

Though supportive housing has been available for people who have been homeless or have struggled with addiction or mental illness for decades, they need to be adapted to the unique needs of older residents, Kushel said. Rooms, for instance, need good lighting and grab bars in the bathroom. Many residents also could use personal-care attendants to help them bathe and get dressed.

Leon Williams, 63, of the North Side, said if it weren't for the supportive services at Commons at Third, he'd probably still be living in a nursing home, where he landed in 2009 after falling and dislocating his shoulder. He remained there for six years because of prostate cancer, a knee replacement and a spinal condition that forced him into a wheelchair.

"Unlike the nursing home, I can come and go when I please," he said, adding that he enjoys eating at the many restaurants near his new home.

After two bouts of homelessness, mostly recently in 2005 after a difficult divorce that led to substance-abuse problems, Jerome Johnson, 47, of the West Side, said he's glad to have found permanent supportive housing at another National Church Residences property, Commons at Buckingham, while he is still relatively young and healthy.

"It took me a lot of work and paperwork to get here, and I'm never leaving if I can help it," he said.

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More older adults spending ‘golden years’ in homelessness

The Loneliest Patients: When They Can't Make Decisions, Who Will?

The elderly man hadn’t sought medical care in 20 years when he collapsed on his way to the grocery store. At the hospital, he was diagnosed with a bloodstream infection, dementia and tuberculosis. Doctors suspected he had bladder cancer.

He’d been abusive, and estranged family members refused to help in his health care decisions. The man didn’t want any treatment, or even to be evaluated medically. But his dementia deprived him of the mental capacity to make his own decisions. Doctors kept him in acute care and treated him for TB, as public health law required, but nothing else.

Three months later, on the day his guardianship hearing was scheduled, the man died from infections. 

Could his infections, acquired in the hospital, have been treated with antibiotics? Or was there a decision not to treat the infections, to let them run their course? Either way, who decided?

Chances are, the doctor in charge did. Chances are, the decision was made “off the radar,” and did not follow hospital policy — if the hospital even had a policy. Chances are, the decision was right, but arrived at through a process that would not look good on a newspaper's front page.

The patient lived and died in Colorado, but aspects of his story are increasingly familiar in critical and acute care wards in Boston and elsewhere.

These patients go by many names: conserved, unknown and unrepresented, unbefriended, incapacitated and alone, to name a few. The sad irony is, they answer to none of them, and cannot inform their own care.

For decades, public guardians — court-appointed decision-making advocates for patients who need them — have been held up as the ideal for such cases, but funding and other support have been inadequate. And in some places, Massachusetts included, there is no public guardianship. Here, how such decisions are made varies from hospital to hospital. Some rely on private guardians; some have learned to avoid guardians.

This hardly inspires trust in the system, and the need for a process that is ethical, legal and serves the patient’s best interest is only becoming more urgent.

Why the urgency? Growing roughly commensurately with the doubling of America's senior population, the ranks of the unbefriended are set to rise from about 35 million in 2000 to a projected 72 million in 2030. In Massachusetts, people 65 and older are projected to grow in number from 860,000 in 2000 to 1.5 million in 2030.

Decisions about medical care ideally combine medical expertise about what’s wrong and what’s possible with the patient’s own wishes and values. But with the unbefriended, those wishes and values cannot be known.

In a medical system where patient autonomy rules, these patients have none.

About a half million Americans die in critical care each year, including a significant majority after a decision has been made to limit life support. How many are unbefriended is difficult to say, but the low estimate is nearly 6 percent, or about 30,000. It may be closer to twice that. In one urban hospital studied, one in four ICU patients who died was unbefriended.

In Colorado, concern over elder abuse prompted the study of this patient population. Similar studies going back three decades have been conducted by the Markkula Center in Northern California, by the American Bar Association, and the Conference of State Court Administrators, among others. Each saw a growing wave of incapacitated patients and a court system unprepared to deal with it. And each study recommended significant improvements and funding for public guardianship, but response has never met the need.

It simply costs too much, and unbefriended patients, by definition, have no constituency.

The public clearly understands the harm of hastening death, with possible exceptions for terminally ill patients suffering unbearably. But prolonging dying is often considered a lesser harm.

That is one source of the unbefriended dilemma, which pits civil rights protections against patients' best interests. And in a society that treasures individual choice so highly, a dying patient incapable of making a choice creates a profound life-and-death quandary.

Douglas White, a critical care physician and bioethicist from the University of Pittsburgh, has studied unbefriended patients closely and says, “Process is most necessary for a patient who will never leave the hospital.”

I believe hospitals need a clear, transparent process for decisions to be made internally. Any such process will spark concerns over abuse or physician bias. And yet, already there are models that are ethical, legal and worthy of public trust.

Both New York State and the Department of Veterans Affairs (the former by statute, the latter by federal policy) keep the courts and guardianship as options but give attending physicians full authority for medical decisions.

Safeguards are in place to ensure it is not the physician’s recommendation alone. Both New York and the VA require second opinions and review by a committee within the institution. Ultimately, the hospital is responsible.

Research into these patients is growing but limited. Many suffer dementia, mental illness or addiction. Some are homeless. Some have scared off loved ones; others have simply outlived them.

One small study revealed this troubling fact: Unbefriended patients continued to receive life-sustaining treatments such as feeding tubes, ventilators and antibiotics for pneumonia significantly longer than comparable patients who had decision-making surrogates.

Some patients receive too much treatment and others, too little. For many, death is prolonged. Their caregivers suffer conflict, moral distress and burnout.

In New York, for legal legitimacy, a decision to withdraw treatment with the intent of allowing death to occur must meet these criteria: the patient’s condition is incurable or irreversible; the patient is permanently unconscious and expected to die within six months; and treatment is causing unacceptable, even inhumane, suffering.

The VA policy has a curious requirement. The physician must explain to a patient that they have been determined to lack capacity. If the patient cannot understand, why require a explanation?

One reason: Capacity is not constant; for some patients, it comes and goes. More significantly, I think, the VA has created a ritual by which the physician must see the patient as a person, not an incapacitated set of symptoms.

And so it was notable in summer 2015 when a California judge ruled as unconstitutional a state law that allowed nursing home physicians to make all decisions for incapacitated patients — because the law did not require that patients be told and given a chance to object.

The ruling did not solve the problem of over-treatment and under-treatment of vulnerable patients. That problem continues, and not only in California.

But the ruling did underscore the need for an efficient and fair process that respects the patient’s best interests and civil rights. Massachusetts should protect its most isolated patients by writing this kind of policy into law. Thanks to New York and the VA, it won’t require starting from scratch.

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The Loneliest Patients: When They Can't Make Decisions, Who Will?

Protect clients and caregivers against claims of senior financial fraud

As the American population keeps growing grayer, senior financial fraud has become a hot-button issue for politicians and regulators.

Three bills designed to protect seniors from financial fraud are moving through the Senate Judiciary Committee with bi-partisan sponsorship and support.

A new model state law adopted by the North American Securities Administrators Association (NASAA) requires financial advisors and firms to report suspected financial exploitation of seniors to regulators and adult protective services offices.

NASAA also has proposed model state legislation that would allow financial institutions to place a 10-day hold on disbursements whenever firms or advisors believe harm may result to an investor age 60 or older. FINRA has requested comments on a proposed rule that would do the same for accounts of people age 65 and older.

Stronger legal protections are: 1) expanding and clarifying the definition of senior financial fraud; and 2) expanding the audience of potential victims to include anyone above a certain age (e.g., 60 or 65). In the past, some statutes have focused only on fraud against mentally impaired seniors or those living in institutions.

Claims of financial fraud often are made against family members, including those closely involved in senior caretaking.  Consider these situations, and ask yourself whether they involve senior fraud:

• A husband is caring for his 66-year-old wife, who is temporarily incapacitated following a stroke. The husband wants to liquidate funds from the wife’s checking account, in her sole name, to pay for care. He writes and dates the check and guides the pen in her hand as she signs. Several weeks later, their daughter files a charge against him, claiming forgery.
  
• A son is caring for his 85-year-old father in an assisted-living facility. The father does not have access to a computer, but does have an online account at MySocialSecurity.com. The son goes to the site, verifies the father’s identity, and logs on with the father’s username and password. The son then changes the bank account for receiving the father’s Social Security benefits, so the son can access benefits to pay for the care facility. Weeks later, a family member sees this change, asks the father if he authorized it, and files a claim of senior financial abuse against the son.
  

These are possible cases of senior financial abuse – even though the caregiver has good intentions – and both situations could have been avoided with planning. Here's how: (Click to Continue)

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Protect clients and caregivers against claims of senior financial fraud

Nursing Home Group Sues U.S. Government Over New Lawsuit Rule

The American Health Care Association, an industry group that represents most nursing homes in the U.S., has filed a lawsuit against the federal government over a new rule that protects the right of patients and their families to sue nursing homes in court.

The new rule, which is part of a set of regulatory reforms set to take effect on Nov. 28, bans so-called pre-dispute binding arbitration clauses in nursing home contracts, which require patients and their families to settle any dispute over care outside the court system via arbitration.

As The Two-Way has reported, "The rule applies to facilities that receive money from Medicare or Medicaid — which is nearly all of them."

The lawsuit filed Monday in Mississippi by the American Health Care Association calls the arbitration clause ban "arbitrary and capricious" and contests the authority of the Centers for Medicare & Medicaid Services, which drafted the rule, to regulate how nursing homes handle disputes. The suit asks a federal court at least to delay the ban from taking effect when the rest of the rules become law in November, while the court considers the industry group's challenge.

The lawsuit also echoes comments made to NPR by an American Health Care Association spokesman in arguing that arbitration is "an equally fair — yet far simpler and less costly — means of seeking redress as compared to the complicated and slow-moving court system."

The American Bar Association noted in 2014 that "arbitration has a number of elements that lend to its reputation for efficiency and expediency, including traditionally faster timelines and therefore lower costs for case resolution." A 2009 study commissioned by the American Health Care Association found the average awards after arbitration in nursing home cases were 35 percent lower than if the plaintiff had gone to court.

"Long-term care facilities and their residents and residents' families should not be deprived of the ability to choose arbitration, a valuable form of dispute resolution," the suit states.

As we reported when the new rule was announced in September, it does not prevent patients and their families from pursuing arbitration if both sides agree to it.

The heads of the Department of Health and Human Services and Centers for Medicare & Medicaid Services, who are both named as plaintiffs, have not commented on the case since the lawsuit was filed.

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Nursing Home Group Sues U.S. Government Over New Lawsuit Rule

NJ: Brick lawyer stole $1.2 million from elderly

A Brick attorney who has long served as an advocate for the elderly and held himself out as an expert on elder law has been charged with stealing more than $1.2 million from elderly clients, authorities say.

Robert Novy, 65, whose office is in Manchester, was arrested on charges of first-degree money laundering, second-degree theft by unlawful taking, and second-degree misapplication of entrusted property, according to a statement from the Office of Attorney General Christopher Porrino. He was taken to Ocean County jail with bail set at $500,000.

“While Novy held himself out as a leading legal advocate for the elderly, we allege that he corruptly used his reputation and his law license to prey on vulnerable seniors, taking control of their finances and stealing more than $1 million from their life savings.” Porrino said in the statement. “In his greed, Novy not only betrayed his oath as a lawyer to uphold the law, he betrayed all standards of decency.”

Many of the victims were people without close relatives or were of diminished capacity, Porrino's office said.

Gerald Krovatin, Novy's attorney, said his client had done nothing wrong.

"Bob Novy has had a distinguished career as an attorney and has helped many people over his 40 years in practice in elder law,"Krovatin said. "He denies these charges and he will fight them with every bone in his body.”

Novy spoke about elder law on “Inside the Law,” a radio program on WOBM-AM – the station’s website shows he covered topics such as estate planning, wills, powers of attorney, Medicaid, real estate settlements and asset protection. In an episode in May 2015, Novy interviewed a sergeant with the Ocean County Prosecutor's Office about scams targeting seniors. (Click to Continue)

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NJ: Brick lawyer stole $1.2 million from elderly

Judge retires after discipline for racially insensitive comments

Judge Michael Creedon is retiring with a six-figure pension after being disciplined for insensitive comments.
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Judge retires after discipline for racially insensitive comments

Financial Help Proposed for PA Elder Homeowners

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KINGSTON, LUZERNE COUNTY (WBRE/WYOU) -- Pennsylvania seniors looking for some help to pay for their home renovations may be in luck. A state senate bill was just introduced to provide older homeowners a tax credit worth thousands of dollars.

Of the hundreds of senior citizens attending this year's Luzerne County Senior Expo at the Kingston Armory on Thursday, many are concerned about the financial pinch they and others in their age bracket feel. "You know, people are on a fixed income. A lot of people don't have a lot of money," said Nancy Beach of Berwick. The last thing older homeowners need is a costly repair they cannot afford. 83-year-old homeowner Bob Stiff of Jackson Township said, "Got to replace a furnace, eight or $9,000. A roof." Retiree Bonnie Dunnigan owns a home in Carverton. "I'm gonna need some repairs but I'm not giving it up. I'm not going into any kind of senior living yet," she said.

State Senator John Yudichak (D) 14th District reflected on the situation facing many older Pennsylvanians. "Now, because of maintenance conditions, they're forced to go into their pocket, it becomes very difficult." Enter the Aging in Place bill. It's a measure introduced in the state senate in September. Senate Bill 1382, which Sen. Yudichak co-sponsored, would establish the Livable Home Tax Credit. Under the legislation, eligible homeowners would receive a tax credit up to $2,000 to renovate their homes to meet accessibility needs. The credit would expand to up to $5,000 in its second year allowing more older Pennsylvanians to stay in their homes. "That's where we should have folks living out their days, their golden years. They've built this country. They've build Pennsylvania. They've made their contribution," said Sen. Yudichak.

State Senator Lisa Baker (R) 20th District serves on the State Senate Aging & Youth Committee. "If we can do some minor things and keep people in their own home with some supports, it's where people would like to be if they don't need that higher level of care."

Sen. Yudichak said he hopes the Aging in Place bill will go the Senate Aging & Youth Committee to push for a hearing and put it to a floor vote by the end of the year.

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Financial Help Proposed for PA Elder Homeowners

Signs of Nursing Home Neglect, Abuse

There may come a time when some of us face the painful decision of putting our parents or grandparents in a nursing home because they need full-time professional healthcare.

If you or a loved one does have family in a nursing home, you should be aware of a new rule that the Centers for Medicare and Medicaid Services (CMS) says will, for the first time, allow consumers to sue nursing homes for neglect. Before now, most long-term care facilities have included arbitration clauses in the contracts that would block the family from suing over alleged neglect. According to the ABA Journal, healthcare industry lawyers say a challenge to the new rule is likely.

Ginalisa Monterroso, CEO of the Medicaid Advisory Group Opens a New Window. , who has spent more than 25 years in the healthcare industry, discussed with FOXBusiness.com what the new ruling means for nursing home residents and what you can do to ensure your loved one is placed in a safe environment for long-term care. Here is what you need to know.

Boomer: What rights do consumers and families now have under this new rule?

Monterroso: The new ruling, allows nursing home residents and families to take residential facilities to court and pursue justice for wrongful care. This decision is long overdue and a victory for all families and former nursing home residents, who, were unable to sue their nursing homes even when they were negligent. Before this ruling, families and patients were forced into arbitration where they frequently did not have the justice system by their side. In most cases, the public never got to hear about these cases of abuse because the dispute was discussed behind closed doors where the media and others couldn’t hear the allegations. And worse, when the arbitrator ruled against the nursing home and forced a ruling, no one got to hear the end result, or even the initial claim.

Boomer: What steps should family members take in researching nursing homes – before signing a contract?

Monterroso: Most important, don’t ever feel rushed to pick a facility because a hospital is pushing a discharge. The hospital is aware you are allowed to view facilities and make the appropriate choice for your loved one.

When making a decision to admit a sick loved one into a long-term care facility, never act on impulse, or even take a quick recommendation from the treating health professionals (who may recommend any facility to quickly discharge the patient). Medicaid Advisory Group recommends scheduling a tour of the facility before being admitted. Everyone has a right to pick and visit a facility. Medicaid Advisory Group urges everyone to visit the exact floor and room the potential resident may be admitted. You can also research the nursing home on this government website: https://www.medicare.gov/nursinghomecompare/search.html Opens a New Window. .

That Medicare website is star rated - one star being the lowest score and five being the highest and most recommended facility.

Think of a nursing home admission as picking a babysitter for your child. We as consumers forget our elderly, sick and disabled need all the essentials our children require when making a placement.
Google the facility and click news to see if the facility has had any negative press. Check references and ask to speak to any residents or families at the facility. You should also check online with the State Department of Health to see if the facility was ever sanctioned or fined. Most of all go with your gut feeling. If something doesn't feel comfortable, believe your instinct.

Boomer: How can family members detect if their loved ones are at risk of abuse?

Monterroso: When visiting their loved ones in long-term care facilities, if you see your loved one suddenly change in behavior and they seem agitated, irritable and being aggressive, that’s an indication something is not right. Many patients who have dementia are the ones who are being abused due to the fact everyone thinks they are forgetful or making things up. If a loved tells you, someone, physically or verbally abused them -- investigate the allegation. Speak with the nursing station, ask questions. Report the concern to the facilities administration, never ignore the resident. 90% of the time there has been some mistreatment, whether they were being yelled at, shoved or ignored that would make that resident tell you about an incident.

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Signs of Nursing Home Neglect, Abuse

Prosecutors drop fraud charges against Stuarts Draft lawyer

Attorney Frankie Coyner & his attorney John Zwerling

STAUNTON — A special prosecutor on Monday dropped the case against a Stuarts Draft attorney accused of insurance fraud, agreeing that a main witness in the case lacked credibility and had submitted false documents.

The decision came nine months after the public announcement that an Augusta County grand jury had indicted attorney Frankie Coyner  on a charge of obtaining money by false pretenses. Coyner represented the potential main witness and one other person in an insurance claim.

But on Monday, special prosecutor Amanda Clymer told Judge Edward Hogshire that the main witness had falsified documents. Clymer requested nolle prosequi — Latin for "not to be prosecuted" — of the charge against Coyner. The request is a legal term that, for all intents and purposes, means the case is being dismissed, either because of a lack of evidence, a major flaw in the prosecution's case or because the prosecutor believes the accused is actually innocent. The judge granted the request.

Technically, a nolle prosequi could be withdrawn, but such an reversal is extremely rare and highly unlikely in this case.

Defense Lawyer John Zwerling of Alexandria said the prosecution witness had multiple fraud convictions, adding that she had misled Coyner about the amount of money she and a partner were making in a dog grooming business.

The basis for the insurance claim was damage to a mobile home the two were using for the dog grooming business. Zwerling said the charge against Coyner was brought despite the Virginia State Police never having contacted the attorney until his arrest.

"They never questioned him or his assistant,'' Zwerling said.

An insurance investigator became suspicious of the claim because of checks submitted to show a stream of income. The investigator determined the checks were in the same exact sequence, despite being weeks or months apart, Zwerling said. In reality, the dog grooming business was a cash business.

Zwerling said the witness might have had to invoke the Fifth Amendment if she had testified on Monday. The defense attorney said that beyond the facts, Coyner would never have risked his legal career for a $15,000 insurance settlement.

"For a personal injury lawyer, that is small potatoes. It's not worth putting his career on the line,'' Zwerling said.

Coyner, who has practiced law for decades in Waynesboro, Staunton and Augusta County, had only one comment on Monday.

"I wouldn't be standing where I am today if I didn't have the best lawyer there is,'' he said.

Coyner has continued to work while waiting for the case to be tried, and said he would be busy with court cases on Tuesday.

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Prosecutors drop fraud charges against Stuarts Draft lawyer

CAPITOL REPORT

This is a status report provided by the New Jersey State Bar Association on recently passed and pending legislation, regulations, gubernatorial nominations and/or appointments of interest to lawyers, as well as the involvement of the NJSBA as amicus in appellate court matters. To learn more, visit njsba.com.

NJSBA Urges Supreme Court Not To Adopt Standardized Guardianship Forms 

The association urged flexibility in the use of required forms for guardianship of incapacitated adults in response to the report and recommendations of the Supreme Court Civil Practice Committee on the proposed revised and new model forms. Citing the complexity and unique nature of guardianship matters, the NJSBA expressed concerns that the model forms do not appear to collect enough information required to meet the guardianship standards established by court rule.

As an alternative, the association suggested it should be acceptable practice to supplement the forms to alleviate potential confusion and delays in guardianship actions to the detriment of the incapacitated person. The association pointed out that there is no standardized form of complaint and urged references to Rule 4:86-1 be included within the package of forms so that applicants know where to find the requirements applicable to a verified complaint.

The report and recommendations of the committee proposed the following model forms:

A newly drafted adult guardianship case information statement;

A newly drafted certification of assets;

A newly drafted certification of physician or psychologist;

A revised order fixing guardianship hearing date and appointing attorney for alleged incapacitated person; (Click to Continue)

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CAPITOL REPORT

Indiana nursing home company’s ex-CEO indicted for fraud

American Senior Living Communities headquarters

INDIANAPOLIS (AP/WLFI) — A grand jury has indicted the former CEO of a company that operates dozens of Indiana nursing homes, accusing him and three others in a kickback scheme.

Federal prosecutors in Indianapolis released the indictment Wednesday morning. It charges former American Senior Communities CEO James Burkhart with mail and wire fraud and money laundering. American Senior Communities fired Burkhart last September, three days after federal agents searched his home and the company’s Indianapolis headquarters.

Specifically, prosecutors say the defendants used shell companies to falsify and inflate costs of goods and services to steal discounts and rebates and conceal kickbacks in a scheme worth hundreds of thousands of dollars.

Burkhart’s defense attorney, Larry Mackey, had no comment. American Senior Communities did not immediately respond to email and phone messages seeking comment.

ASC manages dozens of properties in Indiana, including two in Lafayette — Rosewalk Village on Union Street and Aster Place on Park East Boulevard.

The company issued a press statement Wednesday that read:

American Senior Communities is grateful to the United States Attorney’s Office and the federal agencies whose hard work and dedication resulted in today’s indictment. ASC has actively cooperated in this investigation and will continue to cooperate until the prosecutions are concluded. ASC was the victim of a betrayal of trust by two of its former officers.

ASC continues its strong tradition of providing excellent care, which has made ASC a valued and respected provider of senior care in Indiana. Nothing in the investigation or this prosecution involves resident care. ASC’s primary focus continues to be exceptional resident care.

ASC appreciates the commitment of its employees and continued support of its families.

ASC has emerged from this process a stronger, more vital organization. ASC has implemented many safeguards, and strengthened the organization with new leadership under the direction of CEO Donna Kelsey. ASC skilled nursing and residential facilities continue to enjoy quality ratings that exceed state and national averages.

Full Article & Source:
Indiana nursing home company’s ex-CEO indicted for fraud

What is a public guardian?

Q: What do you do as the public guardian?

A: I do guardianships on the vulnerable that the court has found that probably needs guardianships, because there is nobody else to be their advocate, take care of their possessions, take care of them, and to make sure that they have a quality of life that they most deserve. I am a last resort as the public guardian. If we can get family or somebody else to do those guardianships, of course that’s sometimes always better, if there’s accountability there.

Q: How many guardianships do you take on at one time?

A: I have a county ordinance that says I can only do 25.

Q: How do you aid in promoting quality of life?

A: I have, I think 18, at the Highland Manor … Mainly because it’s convenient for me and most of my people have lived in this community all of their life. This is where their family is. This is where a lot of them grew up or they worked their whole lives. So, this is where I feel they should be as long as they’re being taken care of. Some of them I do have in different facilities, but it’s only because their family might live in that town or they need a specialized type of care. I’m probably at the Manor four or five times a week. Yes, I do outings with them.

I make sure they have Christmas. I make sure that their birthdays are taken care of. ... They're taken care of but they still enjoy some of the ... things in life that make their life still enjoyable. I have a gentleman that used to like to fish, and he can't anymore, but when me and my husband go fishing, and then we cook a bunch of fish, I always take a bunch to him so he can have a nice fish dinner.

It’s just those little type of things. Some people say you’re not supposed to get connected with them or feel those type of things, but sometimes you can’t help but have that feeling for them, and with some of them I’m very, very connected.

... Sometimes, it’s just the little things that make a big difference. Sometimes it’s just a hug that makes a difference to them. I have a little Yorkie that sometimes I’ll take into the Manor and I have one lady that just loves her, and sometimes, when she’s not feeling very good or something, I’ll take the Yorkie in there and just let her hug her.

Q: Do you think there needs to be a call for more people in Elko County to step up to be accountable, to take care of their family member?

A: Yes, and I’ve seen probably within the last four or five years that. Mainly because our population is getting older. We have more elderly people in our county that’s not getting the medical care that they should be getting, because, right now, quite frankly, our medical care isn’t that great. Some of them are struggling to get by every month on their incomes. Some of them are even outliving their family members, unfortunately. Some of our family members are into the drugs, and so, their elderly family members aren’t being taken care of. Our mental health (care) in the State is not that great. A lot of our family members need to step up. However, that’s not always the best answer because that’s why some of us are having to step in as guardians, public guardians, because that’s not working.

Q: Are you court mandated? How does your process begin?

A: I’m appointed as the public guardian for Elko County. Every county has to have a public guardian. Therefore, how I get appointed is I start with a referral process and I usually get those referral processes from either the hospital, Division of Aging (Nevada Aging and Disability Services Division), it could be from law enforcement, it could be from another family member. It could come from anybody that thinks that there’s a person that needs a guardianship or needs help. From there I do an investigation, and what I consider when I do an investigation is, are there other alternatives.

Are there least restrictive alternatives? Because you always want to give that person the benefit to get help without going through the process of a guardianship. If that has not been either successful or it has not been tried as a least restrictive type resource, then I would, for sure, try to make sure that’s implemented with another resource that we have here in Elko County. Or, at least, try to get a family member involved to help this person. If that isn’t successful, then I will go through with a guardianship. … The person the guardianship is being sought on always has the right to have an attorney, that’s their due process.

Q: How do you find recent changes in Nevada concerning guardianship beneficial?

A: I’ve been a guardian for 15 years. So, I’ve kind of worked in the business where every year there has always been a little bit. We started out with a little bit of guardianship laws and then grown to every legislature year to try to get a little bit better, but it’s never quite gotten that way. So, I think the commission for reform has really been kind of a godsend to Nevada as far as the family guardians, the professional guardians, private professionals. As far as accountability, there wasn’t much accountability in our courts as far as that.

Q: How has Elko County’s implementation to promote accountability in guardianship helped?

A: My courtrooms are usually in Judge (Nancy) Porter’s. … As far as adult guardianships, I think that Judge Porter is very diligent, very careful, very sincere on the guardianships and she is the one that makes us accountable as guardians. ... For her to be there, it’s been a job for her to get that in place, her and her staff, but I think it’s been very good for our county mainly as far as family guardianships.

Q: How has that helped you in particular?

A: … My job, I’m very sincere in my job. I’ve been here for 15 years and I’ve seen a lot of guardianship abuse within a family, because I’ve had to take the guardianship over because a family has been abusive or exploiting, or that type thing. ... I like to be accountable for taking care of my people. ...You have to be a very sincere person to that person’s everyday life issues and what goes on in their everyday life as far as giving them a quality of life. It isn’t all banking and it isn’t all money and manager, and doctors and physicians. It’s also about caring. When you’re doing your job as a guardian, all of that comes into play, eventually, in the court.

Full Article & Source:
What is a public guardian?

Attorneys at Tucson Court Night to give free legal information

The public is invited to attend free legal information sessions presented by attorneys at Court Night.

Topics include divorce, child support, probate and landlord/tenant issues.

The first session of the Oct. 18 event begins at 4 p.m. at Flowing Wells Community Center, 1660 W. Ruthrauff Road. The second session starts at 5:45 p.m.

Both sessions are hosted by Pima County Superior Court and the Pima County Bar Association.
Attorneys Michael Aaron, Angela Hurtado, Lisa McNorton and Juan Perez-Medrano will present sessions on divorce, child support, paternity and custody, according to a news release.

The topics of probate, guardianship and conservatorship will be presented by attorneys Thomas Curti and Carrie Rednour.

Sessions about debtor and creditor, and landlord and tenant will be offered by attorneys Beverly Parker and Steve Cox.

After each session, the attorneys will take questions from the audience, but they cannot give legal advice or discuss specific cases.

Representatives from the Arizona Attorney General’s Office, Division of Child Support Services, National Alliance on Mental Illness of Southern Arizona, and Casa de los Niños will also be available to answer questions and provide information, according to organizers.

Spanish-speaking interpreters will be available during the event.

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Attorneys at Tucson Court Night to give free legal information

The perils of probate court: Former judge with Alzheimer's could lose her life savings

Superior Court Judge Betty Lou Lamoreaux in 1988

Retired Orange County Superior Court Judge Betty Lou Lamoreaux was such a force in juvenile justice that the seven-story family court building bears her name.

Every day, hundreds of children and their parents stream through the doors of the Lamoreaux Juvenile Justice Center in Orange. Some are in trouble with the law, some are from fractured families. All are hoping for justice tempered with mercy.

Now Lamoreaux is in danger of being financially drained, in part by the very justice system to which she dedicated her life.

Lamoreaux, 92, has Alzheimer’s dementia, according to court records. Her family – mostly nieces and nephews, as Lamoreaux has no children – is trying to care for her and preserve her estate. But they’ve fought over how best to do that, and about who should be in charge of Lamoreaux’s money, and they’ve taken the fight to probate court.

The family dispute has grown to include no fewer than three judges and nine lawyers and related professionals, with more attorneys set to join the fracas.

Now, some in the family are afraid the trip to probate court could end with attorney fees swallowing up “Auntie Lou’s” nest egg, forcing her to sell her $1.8 million house in Newport Beach.

They argue that the particulars of probate court are problematic.

“The very court system she served, and was honored by, is now bilking her of her life savings,” says Duff McGrath, her 58-year-old nephew and her trustee.

“It wouldn’t happen to Betty Lou Lamoreaux if it wasn’t happening to a lot of other people. The system is flawed.”

McGrath’s frustrations are echoed by many in probate court – where the affairs of a loved one can be taken out of the hands of family members and turned over to experts who often are paid hundreds of dollars an hour. Every year, nearly 5,000 probate-guardianship cases grind their way through probate court in Orange County.

In theory, the work is done by sincere professionals trying to protect their clients.

But by nature, the process of turning one’s affairs over to lawyers and their subcontractors can get expensive, even when fees must be approved by the court.

Good work, some argue, takes time. And in probate court, time definitely is money.

“Even if you’re trying to do a good job (on behalf of the client), the longer it takes to do a good job, the more money you get,” said Kurt Eggert, director of the Alona Cortese Elder Law Center in Orange.

“There is the incentive to prolong the case.”

Until 2014, Lamoreaux shared her Newport Beach home with her 87-year-old sister, Shirley, and a niece. Over the years, as Lamoreaux’s dementia worsened, her house fell into disrepair, to the point of being unhealthy, according to court records.

McGrath and some family members went to probate court in 2015, hoping to get a court order that would give them the authority to separate Lamoreaux from those they felt would do her harm.

McGrath had moved Lamoreaux from her house to a senior living center in Corona del Mar while her home was undergoing repairs.

The court responded by appointing two people to the case, an attorney and a guardian – who also is an attorney – to represent Lamoreaux.

That’s when the legal wrangling began.

The court appointees, after speaking with Lamoreaux, believed she wants to move back home with her sister. A judge agreed and ordered McGrath to help Lamoreaux return home, a ruling McGrath has appealed.

McGrath hired his own legal team, who argued that Lamoreaux should stay at the center, which they noted has the expertise and facilities to care for her.

Along the way, the case picked up more professional consultants, a fiduciary and a few more lawyers, all charging from $200 to $450 an hour.

McGrath said the total, when everybody is working – including his attorneys – is about $3,000 an hour.

Experts hired in the case declined comment or did not return telephone messages.

Lamoreaux’s fate now is in the hands of Judge Kim R. Hubbard. A hearing is set for Tuesday to determine whether McGrath should be removed from his trustee position.

Lamoreaux’s physician has indicated that she should not be moved at this time, and she repeatedly tells friends that she wants to stay at the center, according to court records.

The attorney appointed by the court to represent Lamoreaux, Ernest Hayward, requested this week’s emergency hearing to determine whether McGrath should be thrown out as trustee and replaced with a professional. McGrath accuses Hayward of attempting to wrest more control over Lamoreaux’s affairs.

Regardless of who is right, finding the answer may get even more expensive than it’s been so far.

“We fell into a spiderweb,” said McGrath. “It’s been a year and a half of hell.”

Full Article & Source:
The perils of probate court: Former judge with Alzheimer's could lose her life savings

Nevada attorney general’s office receives grant to prevent elder abuse

By MAX MICHOR
LAS VEGAS REVIEW-JOURNAL

The Nevada attorney general’s office received a $925,000 grant to help prevent abuse and exploitation of the elderly.

The Justice Department’s office on violence against women awarded the grant to fund programs to help law enforcement serve elder victims of partner and caregiver violence, exploitation, stalking and neglect.

Three teams of trainers will be formed to serve Clark County, Washoe County and rural Nevada communities. A fourth team will serve the entire state and will consist of members from the Nevada Aging and Disability Service Division, the Inter-Tribal Council of Nevada, prosecutors and law enforcement.

These teams will work to train law enforcement officers across Nevada, along with judges, prosecutors and victim service providers. The teams also will work with the Nevada Network Against Domestic Violence.

“With the receipt of this competitive grant award, we aim to raise awareness about and improve the statewide law enforcement response to the abuse and exploitation of Nevada’s elders,” Nevada Attorney General Adam Laxalt said. “We look forward to working closely with our grant partners to assist local jurisdictions in addressing victim safety and perpetrator accountability.”

Full Article & Source:
Nevada attorney general’s office receives grant to prevent elder abuse

Tucson program finds innovative way to pair cats with seniors

Katherine Fitzpatrick and Eddie

After her husband died and the days became a bit long, Donna Pfeif’s doctor gave her an unusual prescription.

“Get a cat.”

Sadly, the first animal she adopted became sick — and costly — and eventually had to be euthanized.

Pfeif didn’t think another animal would be possible, but today she is enjoying the funny antics of a 12-year-old feline named Puddy, as in the famous Looney Tunes’ line, “I tawt I taw a puddy tat.”

Their friendship came by way of a local nonprofit that has started pairing older cats with older residents. Hearts That Purr Feline Guardians not only helps with the matches, but director Jeanmarie Schiller-McGinnis and her volunteers stay in touch regularly — and the organization maintains ownership of the cats.

The nonprofit got started in 2013, with Schiller-McGinnis taking in older cats that had outlived their owners, or who couldn’t stay home because of their owners’ failing heath. She got the senior foster program going a year ago and so far has placed about nine cats with senior companions.

“It’s not an adoption,” she said. “They are fostering the cat, but we retain legal ownership.”

Schiller-McGinnis helps out with the costs that sometimes prevent people from pursuing pet ownership: veterinary bills, food, ongoing care. Once a foster is in place, if the person can no longer take care of the cat for any reason, Schiller-McGinnis takes it back.

For Pfeif, that was key.

“I would never have taken in another animal if she weren’t taking on the vet bills,” she said. “I couldn’t afford it.”

The program has been underway for less than a year, and Schiller-McGinnis is looking for more volunteers to help her realize her vision. Eventually, she hopes to rescue more older cats from local shelters.

Shari Ronstadt said Hearts That Purr dramatically changed her mother’s life. Katherine Fitzpatrick, 93, lives at Villa Maria Assisted Living and, a couple months back, lost her longtime cat, Millie.

“I saw her outlook, her energy, her demeanor, everything start to slide,” she said. “She told me she hated to go back to her apartment because there’d be nobody to greet her at the door.”

Fitzpatrick was reluctant to get a new cat, but knowing she’d have help and support sealed it. She has been fostering Eddie, who is 10 and hails from Yuma.

“She is absolutely crazy about Eddie,” Ronstadt said. “She thinks he’s the smartest cat.”

Earlier this week, Fitzpatrick fell and is now hospitalized at Tucson Medical Center. Eddie, for the time being, is back with Schiller-McGinnis.

Ronstadt said her mother can’t wait to get home to Eddie, that caring for him gives her a sense of purpose and a reason to live.

Fitzpatrick’s doctor, Tucson geriatrician Elise Reinhard, said she’s recommended a number of her patients get in touch with Schiller-McGinnis.

“Hearts That Purr go out of their way to make it easy,” she said. “You’re not completely taking on the responsibility of caring for a pet.”

Reinhard said she asks every new patient if they have pets or grandchildren, and if they feel lonely in their day-to-day life. “I ask, ‘What keeps you going and what is important to you?’” she said.

“I think staying socially, mentally, physically active is so important for so many reasons,” she said.

“It’s so easy for people to become more isolated as they age, to lose those social connections.”

Often, she said, animals are a good fit for someone who wants more companionship. Exercising and caring for a dog fits for some, she said, while others are better suited to life with a cat.

“Cats like quiet environments and, while they need attention, they need minimal care and minimal activities,” she said. “For some, cats are ideal.”

Full Article & Source:
Tucson program finds innovative way to pair cats with seniors

Building Dementia Friendly Communities

By Michelle Seitzer

In Blue Island, Illinois, Tami Neumann is committed to a dementia friendly city—and dreams of taking the transformations further.

Most cities have limited financial resources for such an endeavor, but the fact remains: "More and more people will have to age in community," says Neumann, Chief Operations Officer at the Silver Dawn Training Institute. According to the Alzheimer's Association's 2016 Facts & Figures report, approximately 58 percent of older adults with Alzheimer's and other dementias live in the community. Of that number, 75 percent live with someone else; the remaining 25 percent live alone.

Creating sweeping change in communities may be difficult, but it's not impossible—and Neumann believes the "simple things" often make the biggest difference. And how do you build a sustainable dementia friendly community? By training others to carry that mission forward, which is at the heart of Neumann's work with partner Catherine Braxton, the Chief Education Officer at Silver Dawn.

Let's explore these elements of building a dementia friendly community.

1. Buildings. Design is critical, and there's a quick way to determine whether a building is dementia friendly. "If I'm lost in your building, that's the easiest litmus test," says Neumann. Buildings should also provide an entrance that doesn't include steps, because many individuals with dementia have a combination of depth perception, mobility, and balance issues.


2. Restaurants: "How do you take Mom out to eat without calamity?" Neumann asks. Training for restaurant staff would be tremendously helpful, but caregivers can take control by planning ahead. Use an app like OpenTable, Yelp, or Urbanspoon to make a reservation; a long wait can frustrate a person with dementia, or cause anxiety. Choose a restaurant that isn't crowded, busy, or loud—overstimulation can trigger feelings of anxiety, fear, or frustration too. Call in advance for specials or menu options, or pull up the menu on your phone or tablet. Discuss selections—perhaps even place your order—before you arrive. Besides the overwhelming process of choosing items from a large menu that may be difficult to read or interpret, it eliminates the need for communicating with the server, which can be incredibly stressful for the person with dementia who struggles with speech and language.


3. Businesses:The Purple Angel logo is quickly becoming a (global) sign of dementia friendliness, displayed in the window of gyms, grocery stores, and other community hot spots to indicate its employees are sensitive to the needs of patrons with dementia and prepared to assist in any way necessary. 


4. Schools: Neumann dreams of training children in schools to communicate better with grandparents or parents. Tools that work intergenerationally are ideal, says Neumann, and equipping the whole family to care for a person with dementia takes the burden off the primary caregiver.


5. First responders: When a person with dementia wanders and is found by a first responder, what happens next? Training for police officers and first responders is critical, because their ability to assess the person with dementia accurately may mean the difference between transporting the individual to a safe place (like a hospital) or getting them to the primary caregiver's place of employment, rather than returning them to the home the individual has wandered from already.

What can I do to build a dementia friendly community?
As Neumann says, everyone can contribute to "creating a community that can help." Here are a few ways to start.

First, be aware of people in your neighborhood and in the places you frequent who are living with Alzheimer's or caring for someone with dementia. If they live nearby, get to know them, and keep an eye out for unusual, concerning circumstances—for example, smoke coming from inside, which could indicate something was left on the stovetop, or a pet loose in the yard, which could indicate the person with dementia left a door open and perhaps even wandered from the home. Bring them a meal. Help them load groceries into their car. Guide them if they seem unable to find their destination.

Point them to online and community resources like support groups, caregiver podcasts, the Alzheimer's Association, or your local Area Agency on Aging.

Talk to your children and grandchildren about dementia. Encourage them to support classmates or friends who may be witnessing a dementia decline in their own home or family. Foster a brain-healthy lifestyle in your home, by exercising, doing crosswords, or enjoying brain-boosting foods together. (Check out this article for more advice on talking to your kids about caregiving.)

Use your influence to inspire change. Know someone who works for your city's Chamber of Commerce? Have connections to the local police department? Are you active in your school district's PTO or a member of the board? Talk to them about dementia friendliness; encourage them to provide training to key personnel.

Read more on our blog: What's Happening in Alzheimer's Policy and Why It Matters.

Full Article & Source:
Building Dementia Friendly Communities

Proper planning can avoid guardianship altogether

Over the last several weeks, we’ve written several articles about the obligations and responsibilities of guardians. We have written these articles to guardians to help give them an overview of the process, some practical tips, and to remind them they are not alone. This time I want to change gears a little and write to the potential ward.

A guardianship should be a last resort. It is court-ordered supervision over your life, your medical care, and your finances. I have great respect for the judges in our community, but no judge can ever know you, your wishes, or your family as well as you do now. You can put a plan into place so that you well cared for, and have the best quality of life, while you are alive but no longer capable of managing your own physical, medical, and financial matters.

In Nevada, a guardianship over you should not be necessary if you have a proper estate plan in place. An estate plan can seamlessly provide for that period of time when you are alive but not well. Your successor trustee and power of attorney can seamlessly step in to manage your assets and property without having to slog through the court system. Additionally, as your successor and agent, that person continues to have the high duties to manage your assets for your care – just like a guardian.

By creating an estate plan, you have the opportunity to pick your own successor – instead of leaving that decision to an unknown judge at some future date. You know who in your life is best with finances, knows your wishes, and will be there for you. You can hand-pick that person to step in to take care of your finances. You can talk to them now about what your wishes are, where you want to live, and how your assets are to be spent.

By creating a trust-centered estate plan, you can impose controls upon your agent that might not otherwise exist. For example, you can direct them to provide accountings to certain people that might not be entitled to them under state law (such as a long-term significant other, friend, or professional advisor). By creating a trust-centered estate plan, you can also give your agent the freedom to do certain things that would otherwise require court-approval, like: making gifts to your children or grand-children for education, medical, or other purposes; selling or renting your home; taking a loan out to cover your expenses; or even continuing the operation of your business.

Additionally, a proper estate plan would include the authority for your loved ones to deal with your health care. In addition to the health care power of attorney, which gives another the ability to make medical decisions if you cannot, a proper plan should address privacy releases. Such releases would allow a broader class of people to talk to the doctor, even if they cannot make medical decisions for you. A proper estate plan can also provide direction on long term care, pain management programs, and physical therapy.

No estate plan should ever be focused solely on what happens to your stuff after you pass away. Instead, a good estate plan should always provide for your care while you are alive but not well, even if you are getting better. It is key to seamlessly provide for your care, both physical and financial. If those pieces are in place, then you and your family may be able to entirely avoid the cost, delay, and the trauma of a court-ordered guardianship. You can put into place a plan that reflects what you want, and who you want, to care for you.

Full Article & Source:
Proper planning can avoid guardianship altogether