Saturday, December 17, 2016

Loneliness Can Be Deadly for Elders; Friends Are the Antidote

Credit Ken Orvidas
By Paula Span 

The circle shrinks. As the years pass, older people attend too many funerals. Friendships that sustained them for decades lapse when companions and confidants retire or move away or grow ill.

These days Sylvia Frank, who moved into an independent living residence in Lower Manhattan in 2014, can email or call one longtime friend in Florida. Another, in Queens, is slipping into dementia and will most likely exclaim, “I haven’t spoken to you in months!” when, in fact, they talked the day before.

But even at advanced ages, new relationships take root. Ms. Frank’s son kept telling her that a colleague’s cousin, Judy Sanderoff, was about to move into the same facility. They sought each other out.

Now, Mrs. Frank, 91, and Ms. Sanderoff, 96, eat breakfast together almost daily; they have dinner, à deux or with other friends, many evenings. Ms. Sanderoff spent Thanksgiving with Ms. Frank’s family in Brooklyn.

Together, they have signed up for bus trips to the Museum of Arts and Design, to historic sites in Harlem, to a Pennsylvania casino. With Ms. Frank speaking into her friend’s good ear, they talk about news, politics and their families.

When Ms. Frank didn’t come downstairs for breakfast one recent morning, Ms. Sanderoff was on the phone to ask why. For her part, Ms. Frank (sounding as if Neil Simon writes their dialogue) has been scrutinizing her friend’s diet.

Ms. Frank: What’s the point of taking blood pressure medication if you’re going to douse everything in salt?

Ms. Sanderoff: So don’t look.

But seriously. “At this age, it’s said you make acquaintances,” Ms. Sanderoff told me. “But I feel I’ve made a true friend in Sylvia.”

I’ve been talking, in this season of auld lang syne, with older people who have formed friendships late in life. Though they mourn their losses, they are grateful for the capacity to still find warmth, shared values and interests, understanding and trust from former strangers.

“The need we’ve had our entire lives — people who know us, value us, who bring us joy — that never goes away,” said Barbara Moscowitz, senior geriatric social worker at Massachusetts General Hospital.

The way we prioritize friendships may evolve. Laura Carstensen, a Stanford University psychologist, developed an influential theory called “socioemotional selectivity”: As people sense their remaining time growing brief, they shed superficial relationships to concentrate on those they find most meaningful.

“They invest more in their remaining connections,” said Gary Kennedy, director of geriatric psychiatry at Montefiore Medical Center. “They optimize friendships, rather than try to maximize them.”

A tide of recent research underscores the importance of such bonds. Social isolation and loneliness can take a serious toll on elders, psychologically and physically. (Over 75, almost a quarter of men and nearly 46 percent of women live alone, the Census Bureau reports.)

We can understand the risks of isolation and an underpopulated, disconnected life. “For a host of reasons, no one is addressing the individual’s daily needs — food, medication, medical appointments,” Ms. Moscowitz explains. “The refrigerator is empty, but there’s no one to call. People suffer despair, humiliation.”

They also suffer higher mortality rates and increased risk of depression, cognitive decline and illnesses like coronary artery disease.

But people who aren’t isolated can still feel lonely, a more subjective state. “My friends moved to Florida and California and said, ‘Come visit!,’ ” said Shelley Youner, 79, who recently moved into the Hebrew Home in Riverdale, in the Bronx. (More dialogue by Neil Simon.) “I could have heard from President Obama sooner than my friends.”

Loneliness brings its own dangers; studies have shown associations with higher blood pressure, with nursing home admissions, with risky health behaviors like inactivity and smoking, and with dementia.

Researchers at the University of California, San Francisco, followed 1,600 participants (average age: 71) and found that those who reported loneliness were more likely to develop difficulties with activities of daily living. Even when the study controlled for socioeconomic status and health, the lonely had higher mortality: Nearly 23 percent died within six years, compared with 14 percent of those who weren’t lonely.

It’s heartening, therefore, to hear Ms. Youner kvell about her new friend, Shirley Zweibel, 87.
“We’re constantly having a conversation,” Ms. Youner said.

“Shelley can’t stop talking, that’s the reason,” Ms. Zweibel bantered. But, she added: “When you’re a kid and say you have a friend, you don’t even know what that means. At this age, it goes deeper.”

In fact, older adults have probably developed important relational skills, said Rosemary Blieszner, distinguished professor of human development at Virginia Tech and a longtime friendship researcher.

“They’re pretty tolerant of friends’ imperfections and idiosyncrasies, more than young adults,” she said. “You bring a lot more experience to your friendships when you’re older. You know what’s worth fighting about and not worth fighting about.”

I couldn’t help noticing how many of the elders I spoke with had benefited from living in retirement communities and nursing homes — the very destinations so many people dread. They can provide proximity, shared activities and a larger pool of prospective friends.

Flo Jakubiak, 85, left her condo in Sun City, Ariz., a year ago, when she felt herself growing socially cut off. “Nobody there knew I existed,” she said. In an independent living center, she has found friends with whom to share meals, movies and canasta games.

But happenstance plays a role, too.

Sandi Schwartz met her two closest friends a few years back when she ran into an acquaintance at a bus stop in Fair Lawn, N.J. Ms. Schwartz’s partner had recently been institutionalized, she told the woman, confessing to loneliness and depression. A stranger sitting at the stop took Ms. Schwartz’s phone number, said she would call — and did.

“I always tell her she saved my life,” Ms. Schwartz said. Now she and two close friends, all in their early 80s, are on the phone daily and go out weekly.

With strong evidence that friendship does, indeed, help save lives and promote health, social workers and researchers wish we could pay more attention to its central role. Activity directors, senior center staff members and family caregivers: Are there better ways to help elders stay in touch with the friends they care about, or meet new ones? We’re all willing to drive relatives to doctors’ appointments; driving them to spend time with friends may matter as much.

“I’ve seen those tender moments,” said Sylvia Frank’s younger son, Michael Lasky. Last spring, Ms. Frank developed a serious heart problem and spent two weeks in a hospital, then another two in rehab. By phone, Mr. Lasky kept a worried Judy Sanderoff apprised of his mother’s condition.

When he took her home after a month, they found an unexpected welcome. “Judy had put balloons on my mom’s front door,” Mr. Lasky said. “Then she came downstairs and they hugged each other for a good 10 minutes.”

Full Article & Source: 
Loneliness Can Be Deadly for Elders; Friends Are the Antidote

Firefighter trusted his gut, likely saved nursing home from disaster

Firefighter Brian Severs
Firefighter Brian Severs was struggling just to get a correct address from the 911 caller.

Another voice came on the line, explaining that the nursing home resident who called was prone to complaining about his health.

"To be honest with you, there's nothing wrong," the nurse said. "This happens all the time."

Severs, a nine-year veteran of the department, sent medics anyway. When they arrived at Bryden Place on the Near East Side on Tuesday evening, they found levels of carbon-monoxide high enough to evacuate a wing of the nursing home. Fire officials said this week that the nursing home dodged a bullet, thanks to the 911 call and Severs' actions.

“There was nothing that set it apart from any other call,” Severs said. “Something told me, 'Don’t blow this off; this person called 911 because they thought they needed help.'”

The Columbus firefighters, who field between 1,000 and 1,500 calls each day, tend to have about a decade of street experience. Department officials say that background gives them the tools to notice subtle red flags and decide the right course of action.

“With this run here, he did exactly what you’re supposed to do: Go with your gut feeling,” said Capt. Loren Peck.

Eventually, 10 medics were sent to the 143-occupant nursing home at 1169 Bryden Road around 5 p.m. Ten residents and employees with elevated carbon-monoxide levels were sent to the hospital.

Firefighters clear a building at 35 parts per million of carbon monoxide. First responders measured readings of between 60 and 120 ppm on the second and third floors of Bryden’s south wing, and 350 ppm in its basement.

That afternoon, Severs said, there were more calls coming in than there was screen space at the dispatch center. It would have been easy for him to tell the nurse to call back if things got worse.

But instead he erred on the side of caution.

“One little mistake leads to another mistake, and next thing you know we’re on national television because 10 people died in a nursing home,” he said.

As he does with every call he takes, Severs pictured the scenario by recalling years of emergency situations that he's handled.  

In this case, he said, medics might have encountered someone in need of medical attention. At the very least, they could check the distressed caller's vitals and reassure him.

"We can visually already kind of see what’s going on even though you’re not there," Severs said, "because we’re on these runs too."

And that's why it's imperative that emergency responders are the ones who pick up 911 calls, Severs said.

“Every time you answer that phone, you don’t know what you’re getting involved in," he said. "The only way to really know it, or see it, or feel it, is to be a part of it."

Tuesday’s close call also highlighted the importance of carbon-monoxide awareness, especially in winter. As temperatures drop, people inadvertently put themselves at risk by bumping up furnace use, warming homes with propane heaters, overusing gas stoves or running generators out of garages.

There were no carbon-monoxide detectors in Bryden Place, Battalion Chief Steve Martin said earlier this week, and state law does not require them.

Because the gas is colorless, odorless and tasteless, people might not identify symptoms such as dizziness or nausea as carbon-monoxide poisoning. Fire officials warned that if there’s any doubt, vacate a building and shut all windows and doors on the way out so firefighters can get an accurate reading. When safely outside, wait for emergency responders.

“If you think something’s wrong, call us,” said Peck. “Don’t hesitate. That’s what we're here for."

Full Article & Source:
Firefighter trusted his gut, likely saved nursing home from disaster

Polley waives hearing in financial scam cases

A former funeral home owner, charged with stealing from customers, waived his right to a preliminary hearing Monday and allowed the case against him to proceed.

Toby Polley, 47, is charged with five counts of financial exploitation of the elderly, a Class B felony; stealing by deceit, a Class C felony; violating the Missouri Preneed Funeral Contract Act, a Class C felony; and unlawful merchandising practices, a Class D felony.

Polley appeared in court Dec. 12 with his public defender Greg Moser. Polley signed a formal waiver that Moser provided to Associate Circuit Judge Lori Baskins.

Baskins explained to Polley that he has a right to a preliminary hearing, during which the prosecuting attorney must prove there is sufficient evidence, or probable cause, for the case to be bound over to the circuit court level, where it could eventually proceed to trial.  (Continue Reading)

Full Article & Source:
Polley waives hearing in financial scam cases

My Mother Lives in the Backyard: The Granny Pod Evolution

If that’s your answer to queries about where your elderly mother lives, you and your mom are part of one solution for the looming problem of how to care for America’s rapidly aging population, which is growing at the rate of some 1.7 million seniors each year.

Maybe your mother lives in a portable self-contained medical cottage in your backyard. Dubbed “Granny Pods,” these pre-fabricated and pre-equipped medical cottages can be installed in a backyard behind a caregiver’s home, zoning laws permitting, and hooked up to the existing sewer, water and power lines.

Inspired Independence Courtyard Cottage

Though some critics see granny pods as little more than storage containers for the elderly, over time these increasingly sophisticated medical cottages have become viewed as viable alternatives to expensive long-term care facilities, one that keeps aging seniors close to families while offering supervision and care when needed, along with the independence seniors desire.

The prototype “granny pod” units cost up to $125,000 installed, have standard safety features like hand railings, defibrillators and first aid supplies, lighted floorboards and a soft floor to minimize damage from falls.

MEDCottage Granny Pod

The high tech units are also equipped with interactive video and devices that monitor vital signs, like blood pressure and blood glucose, and transmit real time readings to caregivers and physicians.

Cameras at floor level and sensors alert caregivers to a fall, the toilet seat records weight and temperature, a hammock-like chair lift transports a resident from bed-to-bathroom, and a computer reminds residents when it is time to take medications.

Better Care for Seniors
The Reverend Kenneth Dupin, a Methodist minister from Salem, VA, gets credit for the Granny Pod concept, though that’s not what he called the units. (According to the Washington Post, credit for that goes to a Fairfax County supervisor who equated the pods to storage containers.)

As the story goes, after visiting a depressed parishioner whose family had moved her to a nursing home, Rev. Dupin decided America should do better for its aging population. He founded a company, N2Care, and, working with Virginia Tech Research Center in Blacksburg, VA, designed the MEDCottage, now known as the granny pod.

MEDCottage Granny Pod Layout

Though several versions now exist, the basic MEDCottage is about 12 by 24 feet, or the size of a master bedroom, has vinyl siding, double French doors (to accommodate a wheelchair and hospital equipment) and looks like a small bungalow. Inside, it resembles a hotel suite, with living space, small kitchen and bathroom.

Though the initial cost may seem steep, proponents point out that nursing home care is also expensive, costing upwards of $50,000 a year for a semi-private room, depending on location, and the company will buy back the units when no longer needed.

Granny pods and other auxiliary dwelling units, or ADUs, offer a blend of independence and 24/7 caregiving, plus closeness to family and friends instead of isolation in a distant nursing home.

Helping Meet the Care Need
More practically, these modular medical care units may be essential to providing care for the soaring numbers of seniors, a number the Census Bureau predicts will more than double from 35 million in 2000 to more than 70 million by 2030.

Inspired Independence Courtyard Cottage Layout

Since Genworth, a firm specializing in long-term care and life insurance, predicts that at least 70 percent of the nation’s elderly will require long-term care at some time in their lives, the nation’s current 15,700 long-term care facilities may not be sufficient to meet the need. Something more is needed and these self-contained medical units could meet that need.

The MEDCottage, the original granny pod, may have received the most publicity, but as the auxiliary care unit idea has caught on, others have entered the field. Among the other versions are ASAPs, or Architectural Solutions for Aging Populations, developed by an architectural firm in San Francisco.

Fab Cab in Seattle also has a pre-fabricated version, as do PALS (Practical Assisted Living Solutions) in Rockfall, Conn., and ECHOAs or Elderly Cottage Housing Opportunity Additions. Larson Shores, an architecture firm in the San Francisco Bay Area, provides pre-designed in-law cottages that are accessible, affordable, and sustainable, and built on the owner’s property.

Local zoning laws have stalled the growth of the “granny pod” movement in some parts of the country. In 2010, Virginia amended state zoning laws to permit the addition of a temporary health care structure behind an existing home, but with the stipulation that a physician documented the medical need. Other states, including California and New York, followed. (If you are not sure about your area, check with your local agency on aging or the Accessory Dwellings website for regulations by city and state.)

Yet the prefabricated units still encounter some opposition, especially from potential neighbors who worry about overcrowding, and warn that adding seniors and disabled residents will change the character of a neighborhood, increase traffic, and affect property values. Too, some people simply don’t like the idea of “warehousing” the elderly in a self-contained unit, even one that is close to family and friends.

Full Article & Source:
My Mother Lives in the Backyard: The Granny Pod Evolution

Friday, December 16, 2016

Family sees first victory in guardianship case

LAS VEGAS (KTNV) - Victims of Clark County's guardianship system can celebrate a first-of-its-kind victory this week.

Elizabeth Indig lost her home and everything in it -- furniture, a lifetime of collectibles, even the clothes in her closets. It all came at the hands of private, for-profit guardian April Parks who was appointed by Clark County Family Court to protect Mrs. Indig. Instead, a judge found Parks committed fraud.

"Parks separated us, she stole everything in the house," says Mrs. Indig's daughter who has the same name. "The house was lost that my mom planned to live in until she died and basically Parks sentenced my mom to a life sentence in a nursing home!"

Mrs. Indig's daughter has been fighting the guardianship system for years. "I have seen things that I did not want to know that people could do to each other," she says.

But a hearing Tuesday in Family Court is giving her hope.

"It's unique and promising and encouraging," says Homa Woodrum, Mrs. Indig's attorney. She tells us Mrs. Indig's victory came in the courtroom of Judge Nancy Allf.

"And she ruled that $100,000 was lost through the conduct of April Parks," Homa explains. "She ruled that $40,000 in value of the home was lost because of the conduct of April Parks and that April Parks had paid herself and her attorney over $15,000 without court approval."

Parks was a no-show in court, but her voice was heard through her own financial records.

"Some days were over 100 hours of billing," says Homa. "That's not physically possible."

Because of what they're calling egregious over-billing, Parks' records on file with the court show on just one day in July 2013, she raked in more than $12,000. Woodrum says Judge Allf ruled Parks must return all the money she billed Mrs. Indig, plus interest and attorneys fees.

"It validates all the things I've been saying all these years about what she did to me."

While Elizabeth is grateful for this decision in a civil court, she says she won't rest until Parks faces criminal charges.

"After all, a judge actually used the words fraud and conversion and breach of fiduciary duty. Doesn't something have to be done now?"

District Attorney Steve Wolfson told Contact 13 that something will be done soon. He says the criminal investigation into April Parks is ongoing and moving quickly toward a resolution.

We tried to contact April Parks through lawyers she has worked with, no one has returned our calls.

Full Article & Source:
Family sees first victory in guardianship case

See Also:

BREAKING: Private Guardian April Parks Found Guilty Of Fraud, Theft, And Conversion

Steve Miller: The Story of Elizabeth Indig 

Elderly couple fights guardianship system

The Vegas Voice: Guardianship, Part 3: NOW GET RESULTS!

Steve Miller: Jared Shafer's Clark County Family Court Lackeys Removed From All Guardianship Cases

Contact 13 Investigates: Guardian Gouging?

Steve Miller on the Removal of Nevada Private Guardian April Parks

Couple liberated from guardianship system

New Family Court Judge Puts Immediate Stop To Elder Abuse And Exploitation By For-Hire "Guardians" Jared Shafer And April Parks

Steve Miller: The Story of Elizabeth Indig
Steve Miller: A Message From the Son-in-Law of an Exploited Ward of the Clark Co. (Nevada) Family Court

Boulder City police investigate guardianship cases

Steve Miller: Judge Steel Frees Three "Wards" From Exploitive Court Ordered Guardianship On Same Day

Dan Roberts, The Vegas Voice on Private Guardian April Parks: She Had the Dogs Killed

Families Caught up in Guardianship Losing Their Homes

Steve Miller: "Guardian" April Parks Home and Office Raided by Police and Nevada AG

Search warrants served as police investigate guardianship exploitation
Contact 13: Judge in guardianship cases recuses herself

Guardianship Commission to ask for criminal investigations

Steve Miller: Embattled Private Guardian April Parks Censured For Exploiting The Elderly, Mastermind Jared Shafer Stays Under The Radar - For Now

Authorities consider criminal investigation of suspended Las Vegas attorney

Robert Graham

Law enforcement authorities are discussing whether to investigate allegations that suspended probate lawyer Robert Graham stole millions of dollars from clients before abruptly abandoning his law practice, District Attorney Steve Wolfson said Monday.

“I personally spoke with the sheriff today, and I can tell you that both his agency in collaboration with my office are on it,” Wolfson said. “We are in the beginning stages of determining whether a criminal investigation is warranted.”

Undersheriff Kevin McMahill said the FBI and Nevada attorney general’s office also are involved in the discussions.

“We’re going through the process of determining who has the appropriate jurisdiction for the investigation and prosecution,” McMahill said. “We have to determine what crimes have been committed.”

Las Vegas police conducted some interviews last week.

Attorney Michael Kling, who represents a former Graham client owed more than $1 million in an estate case, confirmed Monday that he and the potential victim spoke with detectives last week about Graham’s failure to turn over the money despite a court order.

Joseph Kistler, another lawyer working to recoup $1 million for the estate of Michael Macknin, obtained a court order on Friday to freeze eight financial accounts in which Graham and his Lawyers West law firm held client funds.

The order, signed by District Judge Gloria Sturman, prohibits both Graham and his wife Linda Graham, who is also an attorney, from disbursing funds in the accounts.

Kistler said Monday that he also was interviewed by police last week.

In court papers, Kistler alleged that Graham last month circulated a phony bank statement purporting to show that he had enough money in a trust account to cover the $1 million payment to the Macknin estate.

But Graham ignored a Nov. 17 order by Sturman to hand over the money, court documents show.

Kistler also said in his papers that he was concerned that Linda Graham may have access to the assets of her husband’s clients and “may be working in concert with Graham and against the interests of Mr. Graham’s clients.”

The State Bar of Nevada alleged in a complaint last week that her husband stole millions of dollars in client funds before closing Lawyers West on Dec. 2, leaving employees without jobs and abandoning client files in a rented Summerlin office. The firm, which was about to be evicted, also had offices in Utah and Colorado.

An initial bar analysis of Graham’s bank records shows that his law practice should be holding more than $13 million in funds for clients. But the balances in his accounts are “much less” than that, Assistant Bar Counsel Janeen Isaacson wrote in the complaint last week.

In court documents obtained by the Las Vegas Review-Journal, Isaacson said the $13 million figure is likely to grow because the bar has examined only about half of Graham’s more than 100 cases.

Attorneys Jasen and Brandi Cassady, who were appointed to take over Graham’s cases, set up a GoFundMe web page over the weekend to raise money nationwide for Graham’s former clients.

Jasen Cassady said on the website that less than $200,000 remains in Graham’s client trust account, but Isaacson disclosed in her complaint that Graham kept an undisclosed amount of client money in other banking and investment accounts.

The Nevada Supreme Court on Friday temporarily suspended Graham’s license while the state bar conducts disciplinary proceedings.

The bar complaint alleges that Graham, who has been practicing law in Nevada since 1992, “misappropriated millions of dollars from his current and former trust, probate and estate clients.”

Graham had “routinely and consistently” failed to distribute funds being held for clients and lied to them about the status of their funds, the complaint alleges.

The firm’s financial failings surfaced in September when American Express Bank filed a lawsuit against Graham seeking to recover more than $150,000 in unpaid charges to his “business platinum card.” The charges stemmed from a June 6 statement.

Attorney P. Sterling Kerr, who is representing Graham in the state bar proceedings, said over the weekend that Graham is in Las Vegas and poses no flight risk.

Efforts to reach Graham and his wife have been unsuccessful.

Full Article & Source:
Authorities consider criminal investigation of suspended Las Vegas attorney

New hope in bid for Claudia law

A NEW law to give families greater control over the affairs of missing people could be introduced next year in honour of Claudia Lawrence.

Claudia disappeared on her way to work at the University of York in March 2009. Her father, Peter has been campaigning with the Missing People charity for the introduction of Claudia’s Law – new guardianship legislation which would help families take control of loved ones’ financial and legal affairs.

Ryedale MP Kevin Hollinrake has said he will now present the bill to the Commons in January, via the 10-minute Rule Motion, which allows backbenchers to put forward legislation.

Mr Hollinrake said: “I am delighted that the Government has given time for this Bill as I believe it to be long overdue. When someone goes missing, their families are often unable to manage their affairs, such as keeping up with mortgages and overseeing direct debits, adding further anxiety and distress to an already traumatic situation.”

Martin Dales, Mr Lawrence’s friend and spokesman, said: “Peter has done well to keep the pressure on. It has been a long time coming, but the signs are now more positive and this bill will help a lot of families of missing people at a very difficult time.”

Full Article & Source:
New hope in bid for Claudia law

Thursday, December 15, 2016

BREAKING: Private Guardian April Parks Found Guilty Of Fraud, Theft, And Conversion

Written by Steve Miller Date: 12-14-2016

LAS VEGAS - For the first time in the history of Clark County Family Court, a private for-hire guardian has been found guilty of Fraud, Theft, and Conversion of the funds of a ward of the court.

On Tuesday, Family Court Judge Nancy Alf ruled for plaintiffs in a lawsuit brought by the family of Elizabeth Diana Indig after they presented evidence that Indig's court appointed guardian April Parks defrauded the senior citizen of over $300,000, including the sale of Indig's house without court permission.

(Click HERE to view Ms. Indig's complete complaint)

According to the May 19, 2016 Las Vegas Review-Journal, "A private professional guardian recently packed up and left the state with seemingly little concern for the dozens of wards she left behind. Without court approval, April Parks paid herself thousands of dollars from the accounts of the wards she was supposed to care for before running off to Pennsylvania last month, according to the court records."

Parks did not appear in court today, but was represented by attorneys.  Separate criminal investigations are currently underway by the Clark County District Attorney and the Nevada Attorney General involving this and dozens of other complaints against Parks and other Nevada private guardians.  Another civil trial is scheduled this month against April Parks in the case of Rudy and Rennie North.

A federal racketeering lawsuit brought by the late Guadalupe Olvera against Jared Shafer and Wells Fargo Bank Trust Department is also presently working its way through the Federal Court system.

Its been reported that Parks recently declared bankruptcy, but police sources say the bankruptcy will not affect criminal prosecution in the event the DA or AG decides to proceed with charges.

During today's trial, Judge Alf froze all cash and assets that Parks' attorneys claimed are still owed to her by former wards.

Its not yet known if or when Parks will be brought back to Nevada to face criminal charges, but when asked, Clark County DA Steve Wolfson said, "She can run, but she can't hide. My office has jurisdiction over state lines."

April Parks is the second local private guardian to be brought up on charges of exploitation of the elderly. In May, 2014, Patience Bristol, a former employee of veteran Las Vegas private guardian Jared E. Shafer, was convicted of elder exploitation and sentenced to five to eight years in the Nevada State Prison.  At the time of Bristol's crimes, she was employed by Shafer's Professional Fiduciary Services of Nevada Inc. (PFSN) located on Pecos Rd. in Las Vegas.  Shafer and PFSN are currently under investigation based on complaints of financial exploitation of elderly or disabled wards. 

Following an investigation by the Clark County Commission, Charles Hoskin and his appointed Hearing Master Jon Norheim, the two family court judges who consistently appointed Parks and Shafer, were removed from hearing additional guardianship cases by Clark County Chief Judge David Barker.

This is a developing story. Local, state, and federal criminal investigations are currently underway based on criminal complaints filed by numerous clients of Shafer, Parks, and other private guardians licensed to operate in the State of Nevada.


Full Article & Source:
BREAKING: Private Guardian April Parks Found Guilty Of Fraud, Theft, And Conversion

See Also:

Steve Miller: The Story of Elizabeth Indig 

Elderly couple fights guardianship system

The Vegas Voice: Guardianship, Part 3: NOW GET RESULTS!

Steve Miller: Jared Shafer's Clark County Family Court Lackeys Removed From All Guardianship Cases

Contact 13 Investigates: Guardian Gouging?

Steve Miller on the Removal of Nevada Private Guardian April Parks

Couple liberated from guardianship system

New Family Court Judge Puts Immediate Stop To Elder Abuse And Exploitation By For-Hire "Guardians" Jared Shafer And April Parks

Steve Miller: The Story of Elizabeth Indig
Steve Miller: A Message From the Son-in-Law of an Exploited Ward of the Clark Co. (Nevada) Family Court

Boulder City police investigate guardianship cases

Steve Miller: Judge Steel Frees Three "Wards" From Exploitive Court Ordered Guardianship On Same Day

Dan Roberts, The Vegas Voice on Private Guardian April Parks: She Had the Dogs Killed

Families Caught up in Guardianship Losing Their Homes

Steve Miller: "Guardian" April Parks Home and Office Raided by Police and Nevada AG

Search warrants served as police investigate guardianship exploitation
Contact 13: Judge in guardianship cases recuses herself

Guardianship Commission to ask for criminal investigations

Steve Miller: Embattled Private Guardian April Parks Censured For Exploiting The Elderly, Mastermind Jared Shafer Stays Under The Radar - For Now

'No contest' J. Patrick Buckley says to theft and fraud

Disbarred Fort Myers attorney J. Patrick Buckley pleaded no contest to one count of grand larceny of more than $100,000, four counts of practicing law without a license and one count of scheme to defraud.

Adjudication was withheld until a sentencing hearing scheduled on March 7.

"There's no plea deal between him and the state. So we're stepping past the trial and going straight to a sentencing hearing with the judge," said Buckley's court-appointed attorney Christopher Whitney.

Whitney described the hearing this way: "The judge says tell me why I should or should not put him in prison for 30 years."

Typically in Lee County sentences runs concurrently, Whitney said, so it's unlikely Buckley would face the maximum of 55 years for the crimes. "But 30 years in prison is still a long time," he said.

Buckley’s troubles began in 2014 when $286,093.98 was transferred to a trust account he controlled. Lawyers hold trust fund money in connection with their representation of a client, the Florida Bar rules state. It’s not money to be used by the attorney for any of his expenses. In this case the money was from the sale of a house in a divorce case.

In September 2014 the opposing attorney in the divorce case attempted to get an accounting of the trust funds. When Buckley didn’t hand over the records, a judge ordered him to appear in court and he was found in contempt. The next day, Oct. 30, 2014 Buckley wired the money to the opposing attorney’s account.

In the meantime, the Florida Bar received a complaint about Buckley. It issued a subpoena for his bank records and found that the day before his court-ordered appearance, the account was $42,265.25 short.

The day he appeared in court, Buckley deposited a $100,000 insurance payment check into the trust account for another client. The Bar asserts Buckley used a portion of the insurance money to make up for the shortage of the money from the house sale.

Buckley didn’t respond to the Bar’s correspondence or orders. So on Dec. 30, 2014 the Bar filed a petition for emergency suspension, stating Buckley “has caused, or is likely to cause, immediate and serious harm to clients and/or the public and that immediate action must be taken for protection of the respondent’s clients and the public.”

On Jan. 5, 2015 the Supreme Court of Florida suspended Buckley from practicing law, giving him 30 days to stop representing clients.

On May 7, 2015, Buckley was arrested and charged with grand larceny and fraud by swindling, two first degree felonies.

But he didn't stop practicing law.

While in court on Oct. 7, 2015, at a hearing about his fraud and larceny charges, Buckley was arrested again. He was charged with one count of scheme to defraud and four counts of practicing law without a license. The bond was set at $25,000 and Buckley remained in jail for nearly four months.

A trial on both cases was scheduled for Monday. Buckley pleaded no contest to six of the charges.
One count of fraud was merged into the grand larceny charge. Buckley will remain free on bail until March 7.

Buckley, 48, was admitted to the bar in 2001 after graduating from the University of Miami School of Law, according to his bar profile. His suspension and subsequent permanent disbarment in 2015 were the only items in his Florida Bar disciplinary history. Buckley was a gun rights advocate and had gained a reputation as a "firearms attorney" and an expert in federal and state gun laws.

The fact that Buckley was a lawyer may work against him at sentencing. "It's always unfortunate when a lawyer represents someone who used to be one of their own," said Whitney, a former public defender. "And unfortunately that gives the prosecutors something to hammer home a little more."

Full Article & Source:
'No contest' J. Patrick Buckley says to theft and fraud

Wednesday, December 14, 2016

Elder Abuse in Maine – Part 1

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It’s a sobering fact – more than 33,000 Maine seniors are abused each year. That covers everything from physical abuse to financial exploitation.

As hard as it is to hear, most of that abuse is committed by family members.

The National Center on Elder Abuse puts the number at 90 percent.

Maine is working harder than ever to help raise awareness about elder abuse – and to put a stop to it.
“When you have a loved one who suddenly that may be the only family member you have – that a senior has – and suddenly you realize this person is stealing from me, this person is harming me. It’s just the emotions I think can be overwhelming.”

Jill Randall is a lawyer with Legal Services for the Elderly.

The Augusta-based organization offers free help for needy seniors.

She says these days, that help also covers elder abuse cases.

“Physical abuse, emotional abuse, sexual abuse, also financial exploitation. And what we see is rarely do those forms of abuse occur alone. Usually there are multiple forms of abuse happening at the same time.”

It’s estimated more than 30, 000 Maine seniors will be abused in one way or another.

But The National Center on Elder Abuse says only 1 in 14 of those cases will be reported.

Kennebec and Somerset Counties District Attorney Maeghan Maloney says, “They’re cases where people are horrifically hurt and it’s a segment of our population that we all hope to join someday and we want be well cared for.”

Maloney is working to prosecute more elder abuse cases.

Her office now has a dedicated attorney to oversee them.

But before a case can potentially come to court, it needs to be spotted.

Randall says seniors are more vunerable to abuse after major medical issues or the loss of a spouse.

“Those are times when we often see some new person enters the senior’s life. That could be a long lost family member, could be a new friend who gets involved with that senior’s life and slowly may take control of the senior’s finances, their property, and really isolates the senior.”

Warning signs of abuse include – sudden changes in a senior’s appearance, a rapid decline in health, changes in banking and credit card activity, and changes in legal documents, like a will or power of attorney.

“One common scenario that we’ve seen also is family members move in with the senior sometimes with the promise that they’ll provide some homecare or help with household chores and sometimes those family members can become abusive.”

Randall says the more people speak up about elder abuse, the more of a difference it can make.

“Elder abuse is a community problem and it’s something we need to work together as a community to solve. It may be that the seniors being abused physically, emotionally, sexually. There may be neglect happening, a theft of medications so by reaching out, they’re raising awareness, but they also may be saving that senior’s life.”

If you or someone you know suspects elder abuse, you should contact Adult Protective Services – any time – at 1-800-624-8404.

You can also get in touch with Legal Services for the Elderly.
That number is 1-800-750-5353.

We have that information on our website, too.

In Part 2 of Elder Abuse in Maine, we’ll meet a woman who fought hard for her elderly cousin when she found out she was the victim of financial abuse. The perpetrator was sent to federal prison.

And see how the expanded effort in Central Maine to prosecute more elder abuse cases is already bringing justice.

Full Article & Source:
Elder Abuse in Maine – Part 1

Elder Abuse in Maine – Part 2

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From physically to financially, 33,000 Maine seniors will be abused this year. Most of the time by family members.

Behind each one of them is a story of anguish, pain and devastation.

When it comes to stopping elder abuse, prosecutors in Central Maine are upping their efforts to protect seniors and punish those who hurt them.

But even when a person is convicted of a crime, the horror of the abuse doesn’t go away.
“This was at her 99th celebration.”

Hundreds of miles away in South Florida, Gayle Tolchin shares heartfelt memories of her cousin, Jessie Baig – born and raised in Calais.

She also shares a story of heartache.

“It just bothers me so much that this woman who trusted people was so taken advantage of and it’s very hurtful.”

Baig was one of 21 people – most of them elderly – financially abused by a former bank employee from Bucksport.

Lynn Bowden embezzled $3 million from her customers.

In 2014, she was sent to federal prison for eight years.

“It was $750,000 that had been taken from her accounts. The whole thing was just so horrible because Lynn had bought cars and boats with my cousin’s money. She treated my cousin like a commodity and she was waiting for her to die so she could collect it all.”

When Tolchin learned of the abuse, she quickly took over for her cousin, made sure she had the best care possible and helped federal prosecutors in their case against Bowden.

“Hi Brenda, it’s Maeghan Maloney over in the DAs office. How are you?”

As the focus on elder abuse grows, the Kennebec and Somerset County District Attorney’s Offices recently added attorney Suzanne Russell, dedicated to bringing justice to seniors.

Four of the 15 prosecutors now make up the sexual assault, domestic violence and elder abuse unit.

Maloney says, “It makes it possible to keep the elderly in Maine safe and to go after anyone who harms them.”

One example of that is the case involving 67-year-old Linda Brown of Augusta, which started with a domestic violence call.

Russell says, “A young lady was grocery shopping. She pulled in and had gotten out of her car, heard a lot of commotion, observed the defendant striking her mother in the head. Her mother was in a wheelchair.”

As Russell and investigators dug deeper, they found Brown also funneled away more than 200-thousand dollars from her 84-year-old mother.

In September, she pleaded guilty to endangering the welfare of a dependent person and domestic violence assault.

It came with 4 months in jail and a $7,000 fine.

As part of a civil suit, one third of her mother’s estate was also given to Legal Services for the Elderly.

Russell hopes to aggressively prosecute more cases like that.

“Elder abuse cases I think are where we were with domestic violence cases 20 years ago. And it took a long time to get domestic violence victims to come forward and I think that’s where we are with elder abuse cases.”

Tolchin believes more checks and balances are needed to protect seniors.

Despite all her cousin endured, Tolchin is thankful for the role she played in the final days of her life.

“Once I became the conservator till she died, she was treated like gold and at least I know I did everything I could to make her last months as comfortable as possible.”

“Just behave yourself and live a good clean life.”

If you or someone you know suspects elder abuse, and that person is in immediate danger, call 911.

You can also contact Adult Protective Services – any time – at 1-800-624-8404.

And, Legal Services for the Elderly helps seniors who might not be able to afford legal help.

That number is 1-800-750-5353.

Full Article & Source:
Elder Abuse in Maine – Part 2

GAO contends CMS website falls short in comparing nursing homes

Nursing Home Compare, an online resource provided by the Centers for Medicare and Medicaid Services, enables consumers to research and compare nursing homes using a rating system. However, an audit by the Government Accountability Office has found that while the website is helpful it lacks key information, such as consumer satisfaction scores.

“Nursing home selection can be a stressful and time-sensitive process, so these are important tools that CMS makes available to the public. However, our review found opportunities for improvement in both the website and the ratings,” concludes the report.

In the United States, nearly 16,000 nursing homes participating in the Medicare and Medicaid programs provide care to 1.4 million Americans annually—a number that is expected to grow as baby boomers age. To help the growing population of seniors in need of such services, CMS developed Nursing Home Compare to assist consumers in finding and comparing nursing homes based on a five-star quality system.

Specifically, the GAO discovered several factors inhibiting the ability of the rating system to help users understand nursing home quality and choose between high- and low- performing homes—which is the primary goal that CMS is attempting to achieve.
According to auditors, the “ratings were not designed to compare nursing homes nationally, limiting the ability of the rating system to help consumers who live near state borders or have multistate options.” Further, the GAO concluded that the rating system “does not include consumer satisfaction survey information, leaving consumers to make nursing home decisions without this important information.”

To address these and other shortcomings, GAO made four recommendations to CMS on how it can improve the Nursing Home Compare website and make it a better tool for consumers:

  • Establish a systematic process for reviewing potential website improvements that includes and describes steps on how CMS will prioritize the implementation of potential website improvements.
  • Add information to the five-star system that allows consumers to compare nursing homes nationally.
  • Evaluate the feasibility of adding consumer satisfaction information to the five-star system.
  • Develop and test with consumers some introductory explanatory information on the five-star system to be prominently displayed on the homepage. Such information should explain, for example, how the overall rating is calculated, the importance of the component ratings, where to find information on the timeliness of the data, and whether the ratings can be used to compare nursing homes nationally.
A CMS spokesperson declined to comment on the GAO findings and recommendations, and instead referred to the agency’s official written response published in the audit report.

In its written comments, CMS concurred with three of the GAO’s four recommendations but did not agree to add national comparison information to the Nursing Home Compare website. The agency argued that because of state variation in the execution of standard surveys, it is difficult to compare homes nationally on the health inspection component. It also noted that the five-star system is just one of many factors consumers should use when selecting a nursing home.

However, GAO insists that this information is important and should be included.

“We maintain that the ability for consumers to compare nursing homes nationally is critical to making nursing home decisions, especially for those consumers who live near state borders or have multistate options, and that our recommendation remains valid,” states the report.

Full Article & Source:
GAO contends CMS website falls short in comparing nursing homes

Tuesday, December 13, 2016

Minn. nonprofits seek to overhaul legal guardianship system for vulnerable adults

Steve Allen & Candace Hanson-Johnson
As the final moments of their date night ticked away, Candace Hanson-Johnson burrowed her face into the chest of her longtime fiancé, Steven Allen, and begged him not to leave. In the six years since they met, the adult couple had yet to spend more than a few hours alone together on a single date. Even trips to the cinema required preapproval, and overnight stays have been out of the question.

“It’s like we’re being held hostage for a crime we didn’t commit,” said Allen, 34, of Apple Valley, who has a cognitive disability caused by fetal exposure to alcohol.

Like 15,000 other vulnerable adults in Minnesota, Allen lives under the supervision of a court-appointed guardian. For decades, these caretakers have been granted broad authority over the money, medical care and even the personal relationships of the “wards” they are assigned to protect. Once appointed, guardians are rarely removed, and even when abuses occur their sweeping powers often go unchallenged by the courts.

Now, a coalition of large Minnesota nonprofits is developing a less-intrusive alternative. With a $1 million federal grant, Volunteers of America of Minnesota and Wisconsin will lead a group of social service agencies in building a way to protect vulnerable adults while respecting their dignity and preserving their rights against overzealous guardians. And instead of relying on overburdened courts, the new system will connect people like Allen with relatives and teams of social workers who have expertise in caring for people with disabilities.

Advocates predict that if the model catches on, hundreds of Minnesotans could regain control over such basic decisions as where to live, whom to date and how to spend their money.

“This has the potential to be a revolutionary approach,” said Anita Raymond, project director at Volunteers of America. “We are seeking to change the culture in Minnesota of defaulting to the use of guardianship.”

Dinner and a little TV
In guardianship documents, Steven Thomas Allen is categorized as “an incapacitated person.” He needs a guardian, the papers say, because he “lacks sufficient understanding or capacity to make or communicate responsible decisions” and has “demonstrated behavioral deficits.” A Dakota County judge granted Allen’s adoptive parents all the powers allowed under Minnesota’s guardianship law, including control over his residence, medical care and personal property.

But Allen doesn’t see himself as “incapacitated” or helpless. He holds a job as a courtesy clerk at the Hy-Vee grocery store in Eagan, where he bags groceries and corrals shopping carts for $10 an hour. He cooks his own meals, can balance his checkbook and arranges transportation to and from work. Apart from needing reminders to take medications and pay bills, Allen insists he is capable of living without court-ordered supervision.

“Anyone who spent a day in my shoes would see that I’m not ‘incapacitated,’ ” he said on a recent afternoon after wrapping up a shift at Hy-Vee.

Yet many of Allen’s basic rights have been stripped away. He wants to move out of the group home in Apple Valley, a residence chosen by his guardians more than a decade ago, and move in to his fiancée’s apartment in Eagan. That request was denied by his guardians without explanation, he says. His social life is also carefully circumscribed: He is allowed only three “outings” from his group home each week, each limited to five-and-a-half hours. His fiancé is not allowed to visit his group home.

On nights out with Hanson-Johnson, Allen keeps a close eye on the clock to make sure he does not go over his allotted social time. On most nights, the couple settles for dinner at home and snuggling on a couch to watch “Law and Order” reruns before Candace’s mother rushes Allen home by his 9 p.m. curfew.

On a recent night, the couple cooked spaghetti and meatballs as they talked excitedly about plans to get tattoos. Allen’s tattoo would say, “Why are you so beautiful?” and Candace’s would respond, “Because you think I am!,” mimicking an exchange they repeat each date night.

“It’s hard to believe that we’ve been together for six years, and the most we’ve been allowed to do is take long naps together,” Allen said.

This summer, Allen took the rare step of contesting his guardianship. With help from a family friend, he sent a letter to the court asking that his guardian be removed and that he be given a hearing to explain. Weeks later, a Dakota County judge denied the request, citing his failure to provide “any medical support.” Allen was never granted a hearing.

“It’s frustrating because this is not a medical issue,” said Tammi Johnson, Candace’s mother. “This is a happiness-of-life issue.”

Allen’s guardian declined to comment for this story.

‘Supported decisions’

Allen is hardly alone in his struggle. Each year, Minnesota courts receive 1,500 to 2,000 petitions for guardianship. Even though a guardian’s role can be restricted based on a person’s specific needs, judges routinely grant them unlimited powers under the law.

Minnesota is one of just three states with a “bill of rights” for wards, but these rights are routinely ignored, disability advocates say. For instance, state law explicitly gives wards the right to associate with people of their choosing, yet overprotective guardians often prevent meetings with people who could challenge their authority, said Lee Ann Erickson, executive director of Arc Southwest, a disability rights group.

“Grown adults are treated like children,” she said.

In many cases, guardians seek unlimited powers even when their wards need help only with limited aspects of their daily lives, such as managing money or taking medications. “There is a lot of overreach,” said Hennepin County Judge Jamie Anderson, a former probate judge. “Often a person is able to live independently but may lose track of bills … and suddenly [a guardian] wants total control.”

The new approach, known as “supported decisionmaking,” would allow more flexibility, advocates say. Instead a single guardian having broad legal authority, a team of social workers and family members would guide a vulnerable adult through important decisions. The goal is to pinpoint areas where a client needs help making decisions, then develop a customized plan. Unlike the court system, they say, the model presumes people are capable decisionmakers.

Guardians would be appointed by courts only as a last resort.

To build this system, Volunteers of America plans to create a center to promote supported decisionmaking for older persons and adults with disabilities. The center would train social workers, attorneys and judges and, through a statewide hot line, is expected to help more than 500 people a year and train hundreds of professionals.

While the concept isn’t new, supported decisionmaking is still largely untested in the United States.

Last year, Texas became the first state to recognize supported decisionmaking agreements as legal alternatives to guardians. The most far-reaching reforms took effect in British Columbia, Canada, where people with disabilities can contract with one or more individuals to help with everyday life decisions.

“Guardianship is a forced bludgeon,” said Amanda Vickstrom, executive director of the Minnesota Elder Justice Center in St. Paul, one of the groups spearheading the new effort. “Before we strip away all of a person’s rights, we have a duty to explore less-restrictive alternatives.”

Full Article & Source:
Minn. nonprofits seek to overhaul legal guardianship system for vulnerable adults

VA leaves Veteran's body in shower room; tries to cover it up

PINELLAS COUNTY, Fla. - Bay Pines VA hospital staff left the body of a Veteran in a shower room for over nine hours, then tried to cover it up.

U.S. Representative Gus Bilirakis (FL-12) released a statement in response to the report:
“I am deeply disturbed by the incident that occurred at the Bay Pines VA hospital, and even more distressed to learn that staff attempted to cover it up. The report details a total failure on the part of the Department of Veterans’ Affairs and an urgent need for greater accountability. Unsurprisingly, not a single VA employee has been fired following this incident, despite a clear lack of concern and respect for the Veteran. The men and women who sacrificed on behalf of our nation deserve better.” 
Bilirakis strongly supported House passage of the VA Accountability Act, legislation to make it easier for the VA Secretary to fire employees for misconduct or poor performance.
Bay Pines VA's Statement:
I can confirm the accuracy of most of what has been reported, but feel that the words “cover-up” or “hide” used by the Tampa Bay Times are highly inaccurate.  It is true that the general issue identified in the article did, in fact, take place (A deceased Veteran was prepared for transportation to the morgue; however, transport took more than nine hours to occur).  With that being said, our leadership team took swift and deliberate actions to investigate the incident and determine the cause as soon as the issue was reported.

As reflected in the outcomes of our thorough internal reviews, it was found that some staff did not follow post mortem care procedures.  We view this finding unacceptable, and have taken appropriate action to mitigate reoccurrence in the future. Some of these actions include recommitment by all hospice staff to VA’s core values, education and training, and review of policy and procedures. Furthermore, hospice nursing professionals were required to provide a signature commitment of understanding and adherence to policy and practice related to post mortem care.  Nursing safety rounds were also initiated as a way to ensure ongoing education and oversight within the unit.  Appropriate personnel action was also taken, however, I am not able to provide details as these actions are considered confidential between the agency and employees involved. We feel that we have taken strong, appropriate and expeditious steps to strengthen and improve our existing systems and processes within the unit.

Again, this event was undesirable and unacceptable. While there is no specific VA policy or directive that provides guidance on the specific timeframe in which a decedent should be transported, it is our expectation that each Veteran is transported to their final resting place in the timely, respectful and honorable manner.  America’s heroes deserve nothing less.

Thank you,

Jason W. Dangel
Public Affairs Officer
Bay Pines VA Healthcare System

Full Article & Source:
VA leaves Veteran's body in shower room; tries to cover it up

Anemia in Seniors: What to Look for and How to Treat It

Decades ago when my grandmother was alive and living with my family, a public health nurse would come to the house once a month and give her a vitamin B12 shot. While I remember this well, it didn’t register with me at that young age how vital this injection was for Grandma. Once I started writing about health issues, I began to understand the seriousness of her condition. It seems that Grandma had pernicious anemia, which is not uncommon in elderly people.

A number of things can cause anemia in seniors, such as chronic disease, iron deficiency, B12 deficiency (like my grandmother), bleeding, and more. It is important to be aware of the signs and symptoms of anemia to make sure it can be medically treated as quickly as possible.

For more information on this condition, I contacted Carole Eldridge, DNP, RN, CNE, NEA-BC, Vice President of Post-Licensure & Graduate Programs at the Chamberlain College of Nursing, and asked her to educate us, as caregivers, about anemia in seniors. Below, Carole shares the knowledge we need to keep watch over our loved ones (and ourselves) as we age.

AgingCare: What exactly is anemia?

Carole: When someone is anemic, the number of red cells in their blood or the amount of hemoglobin in these cells is lower than it should be. This condition is diagnosed by measuring the amount of each through a simple blood test. Anemia can occur due to a loss of blood, insufficient or faulty production of red blood cells (RBCs), or the destruction of these cells.

Hemoglobin is a protein in RBCs that carries oxygen to all the tissues in the body, making it an essential component of health and life. If the hemoglobin level is below 12 grams per deciliter of blood in a woman, and 13 grams per deciliter in a man, that person may be said to be anemic.

AgingCare: What are the signs that we should look for if we suspect anemia in our loved one?

Carole: When older people notice that they are tired or a little weaker than they used to be, they often attribute it to general aging. Sometimes that is a correct assumption. However, common symptoms of “old age,” such as fatigue, weakness, dizziness, irritability, pale skin and shortness of breath, often point to more serious (and treatable) illnesses. These signs should always indicate that a loved one needs to be evaluated by a healthcare provider.

AgingCare: What causes low RBC and hemoglobin levels, and how does it develop?

Carole: Anemia can either be acute, with a sudden and severe onset, or it can be chronic, developing slowly over a long period of time. This difference in the two types reflects the cause of the anemia, and the treatment will be different depending on the cause. Sometimes a cause can’t be found, but even then, anemia can often be treated with good results.

Approximately 13 percent of people older than 70 are anemic. In about 70 percent of these cases, the cause can be identified. The two most common are chronic disease (30-45 percent) and iron deficiency (15-30 percent). Between 5 and 10 percent of cases are due to deficiencies in vitamin B12 or folate. Some of the many possible chronic diseases associated with anemia include ulcers, liver or kidney disease, hypothyroidism, inflammation of the stomach or intestines, and cancer.

It is helpful to think of anemia as a symptom of another underlying condition rather than the primary concern. This is especially true in seniors, who often have multiple health issues. In severe cases of anemia, the heart can become damaged from working harder to circulate enough oxygen throughout the body, but the main threat and target for treatment is still the patient’s underlying health conditions.

AgingCare: What are the implications of overlooking the symptoms and not receiving treatment?

Carole: It is important to detect and treat this as quickly as possible. Anemic seniors are twice as likely to lose some of their physical abilities and experience functional decline as those who are not anemic. Furthermore, studies have found a 150 percent increase in the risk of hospitalization for older people with anemia and a 200 percent higher risk of their admission to a nursing home. Even borderline anemia makes a significant difference. Mildly anemic elders experience 1.5 times the risk of losing physical abilities as those without.

AgingCare: How is anemia due to a nutritional deficiency treated?

Carole: Iron deficiency, vitamin B12 deficiency, and folate deficiency can be relatively easily identified and treated. Addressing nutritional issues can make an enormous difference in the way a senior feels and functions and may prevent the loss of physical abilities that could result in hospitalization or placement in a nursing home. Simple blood tests are used to diagnose these deficiencies and then dietary supplements are typically prescribed.

Low iron is the most well-known cause of anemia, but typically affects younger individuals. When it occurs in seniors, it is usually due to limited absorption in the intestines or gastrointestinal bleeding.

Someone with iron deficiency anemia may be prescribed iron supplements, and it is crucial to follow the healthcare provider’s instructions regarding supplementation. Too much iron intake can cause vomiting, diarrhea, headache, irritability, fatigue, and even heart and joint damage. Even in proper doses, iron supplements can still cause constipation, nausea, diarrhea, and stomach pain.

These side effects may be lessened by taking the pills with food. Iron and calcium supplements should not be taken together, since calcium interferes with the absorption of iron. Timed-release iron supplements are not usually recommended, because absorption is best in the upper part of the digestive tract. Taking these pills with a little orange juice or in conjunction with a vitamin C supplement may help promote absorption as well. Another easy fix may be adding more iron-rich foods to a loved one’s diet. Red meat, egg yolks, nuts, seafood, beans, and whole grains are all healthy sources of this mineral.

Seniors sometimes lose the ability to absorb vitamin B12 from their food. Deficiencies of vitamin B12 may be treated with oral supplements, but injections are usually the most effective treatment. Depending on the severity of the deficiency, these injections may be needed periodically for life. To increase the amount of this vitamin in the diet, seniors should eat beef, poultry, fish, liver, oysters, clams, milk, cheese and eggs.

Folate deficiencies can be helped with a diet that includes plenty of raw or lightly cooked green, leafy vegetables, cruciferous vegetables (broccoli, Brussels sprouts, and cauliflower), fresh fruits, dairy products, and whole grains. A healthcare provider might prescribe a folic acid supplement, which is a form of folate.

AgingCare: How are other types treated?

Carole: When it is caused by a chronic disease, naturally, the best thing to do is treat the underlying condition. This type is also known as “anemia of chronic disease” or ACD, and patients often have adequate iron and nutrients in the body, but they are not being used efficiently in the formation of new red blood cells. Although the reason for this impaired ability to use iron is not known, some experts believe it to be a part of the body’s immune response to prevent bacterial growth and further harm. This is part of why iron supplementation is not an effective treatment for ACD.

Infections, inflammation, hormonal imbalances and malignancy are a few main causes of ACD.
Chronic kidney disease is one specific example, and there are helpful drugs available that stimulate the bone marrow to produce more red blood cells. Another is chronic lymphocytic leukemia (CLL), a type of slow-growing cancer that some seniors live with for years before experiencing noticeable symptoms. Other conditions, such as tuberculosis, diabetes, endocarditis, chronic urinary tract infections (UTIs), osteoarthritis, hepatitis, lupus, pressure ulcers, myeloma and lymphoma can also be culprits. Specific methods of treatment depend entirely on the individual’s overall health and comorbid conditions.

There are other forms of anemia that are less common and require serious medical intervention. Treatment might include steroids, blood transfusions, or even surgery to remove an enlarged spleen, repair abnormal blood vessels, tumors, or heart valves among other things.

Certain medications can also contribute to anemia. This is especially true for older individuals who typically take multiple prescriptions. Numerous medications can have a synergistic effect and cause side effects to have a greater impact on the body. Examples of these medications include ACE inhibitors, angiotensin-receptor blockers (ARBs), and certain antibiotics and anticonvulsants. Cancer treatments like radiation and chemotherapy can also damage bone marrow, where red blood cells are created.

The key to dealing with anemia is always to discover the root cause when possible and then to work with a healthcare provider to treat both the cause and the symptoms.

AgingCare: Thank you, Carole, for answering our questions about anemia and helping us know what to look for. As caregivers, this information is invaluable.

Full Article & Source:
Anemia in Seniors: What to Look for and How to Treat It