Saturday, February 4, 2023

Seneca County Public Guardianship Program receives major grant funding

By Staff

File Photo: Seneca County Joint Justice Center

Tiffin, Ohio —
The Seneca County Public Guardianship Program has received a $55,000 grant from the Allen Eiry Foundation to support its services for the county’s elderly and vulnerable residents. The grant, managed by the Columbus Foundation, will provide the program with its first vehicle, a part-time office assistant, and improve office technology.

Under the leadership of Judge Jay A. Meyer, the Public Guardianship Program provides 24-hour guardianship and conservatorship services to indigent residents aged 55 and older who have been declared legally incompetent or suffer from a medical or mental disability. The Public Guardian serves as a trusted companion and advocate, attending appointments, monitoring the health and safety of program participants, and making financial and medical decisions when necessary.

The grant from the Allen Eiry Foundation, established in 1983 in honor of the late Seneca County resident, businessman, and farmer Allen Eiry, will allow the program to visit participants more frequently and ensure they are transported to crucial appointments. “The funds we receive from the Allen Eiry Foundation will help us continue to provide this integral service to our community,” said Judge Meyer.

“It is a great honor and privilege to serve as the Public Guardian and help protect our community’s most vulnerable,” said Public Guardian Jay Rishty. “Thanks to the generous support from the Allen Eiry Foundation, as well as partnerships with local agencies, we can continue to provide life-supporting services to our program participants at no charge.”

For more information, visit the Seneca County Probate Court’s website at

Full Article & Source:
Seneca County Public Guardianship Program receives major grant funding

Disgraced former L.A. lawyer Tom Girardi indicted on client theft

by: Associated Press

Disbarred and disgraced Los Angeles celebrity lawyer Tom Girardi has been indicted in Chicago on charges of stealing $3 million from clients who lost family members in the 2018 Lion Air crash.

The charges mark the latest in a string of legal disasters for a powerful player who rubbed elbows with politicians and celebrities as one of the nation’s most prominent plaintiff’s lawyers, known for winning settlements such as the one portrayed in the movie “Erin Brockovich.”

U.S. prosecutors say Girardi, another lawyer and his firm’s accounting chief misappropriated settlement funds intended for five clients who reached settlements with Boeing, makers of the 737 Max operated by Indonesia’s Lion Air that crashed into the Java Sea on Oct. 29, 2018 — killing 189 people.

“The substantial misappropriation alleged in this indictment compounded the grief and anguish of the clients who lost loved ones in the Lion Air crash,” said John Lausch, the U.S. attorney for the northern district of Illinois. “Attorneys who violate the trust of their clients and breach a fiduciary duty that is paramount to the practice of law must be held accountable.”

Girardi, who once played a supporting role on “Real Housewives of Beverly Hills,” which starred his now ex-wife Erika Jayne, was disbarred last summer for siphoning funds intended for clients. His firm Girardi Keese is bankrupt and he’s said to be suffering from dementia, according to a court conservatorship.

A Chicago law firm filed a racketeering lawsuit last year alleging that Girardi and his associates essentially ran a Ponzi scheme, siphoning off $100 million from their clients, attorneys they worked with and others.

“The real story is one that seems like a tale out of a John Grisham novel: Girardi Keese was little more than a criminal enterprise, disguised as a law firm,” according to the lawsuit filed in Los Angeles by Edelson, the Chicago law firm. “Indeed, the Girardi Keese firm operated what we now know was the largest criminal racketeering enterprise in the history of plaintiffs’ law.”

Girardi and another attorney, David Lira, face eight charges of wire fraud and four counts of criminal contempt of court, Lausch’s office said in a statement.

The law firm’s head of accounting and finance, Christopher Kamon, faces the same charges.

Arraignments in federal court have not been scheduled yet.

Online court records do not indicate whether Girardi or the other two men have attorneys in the case.

Full Article & Source:
Disgraced former L.A. lawyer Tom Girardi indicted on client theft

Former Portland lawyer who embezzled millions from clients sentenced to 14 years in prison

Author: Kyle Iboshi (KGW)

PORTLAND, Ore. — A Multnomah County Circuit Court judge on Wednesday sentenced former Portland attorney Lori Deveny to 14 years in prison for stealing millions of dollars from her clients.

The state sentence comes on top of Deveny’s federal sentence of more than 8 years. The two sentences will run concurrently, meaning they'll be served at the same time.

Prosecutors alleged Deveny stole money from her clients by forging insurance checks, stealing the funds and lying to her clients about the payouts. According to investigators, Deveny defrauded at least 135 clients out of roughly $4.5 million. She used the money to pay for her extravagant lifestyle, including big game hunting trips in Africa, a home remodel and expensive cigars, according to prosecutors.

Deveny pleaded guilty in state court to 28 counts, including aggravated theft and identity theft.

“To all the victims who came to me in physical or emotional pain, who shared their stories and their lives with me, I can only tell you how sorry I am that instead of helping you, I inflicted more pain,” Deveny said during Wednesday’s hearing.

Defense lawyer Wayne Mackeson asked for leniency by claiming Deveny was trapped in an abusive relationship.

Deveny, who surrendered her law license in Oregon during May of 2018, wore a standard jail uniform while in court.

“I want each individual to know that I did not set out to hurt them. I did not choose them to be a target, but I did fail to see them,” said Deveny. “I see them now and will always feel an obligation to them.”

State prosecutor Scott Healy said Deveny left her clients with unpaid medical bills and mortgages, lost savings and lost jobs.

“Don’t make the mistake of thinking that she has one ounce of remorse about what she did to these victims over the course of 18 years,” Healy told Judge Jerry Hodson.

As a result of the case, the Oregon State Bar raised its cap on how much victims of a dishonest lawyer can claim from the bar’s client security fund. Additionally, state lawmakers passed legislation that requires insurance companies notify beneficiaries when they send settlement checks so the client will know money is available at the same time as the lawyer.

The Oregon State Bar has called the Deveny case the worst fraud by a single lawyer in state history.

Full Article & Source:
Former Portland lawyer who embezzled millions from clients sentenced to 14 years in prison

See Also:
Former Portland Attorney Pleads Guilty to Embezzling Client Funds

Friday, February 3, 2023

State investigation underway at southeast Iowa nursing home

by Nik Todorovich

Iowa state officials are looking into horrifying allegations about the treatment of two residents at a southeast Iowa nursing home.

In November 2022, a female resident was complaining of a headache. Her headache then turned into a migraine, which then turned into a stroke.

The resident complained about the pain to Aimee K. Crow, who is a nursing administrator at Windsor Place Nursing Home in Sigourney, Iowa.

The Iowa Department of Inspections and Appeals (DIA) is conducting investigations and officials have released 72 pages of legal paperwork detailing the allegations. The paperwork can be found HERE and HERE.

Full Article & Source:
State investigation underway at southeast Iowa nursing home

'Where will they live?': Humboldt nursing home residents displaced

Where will they live?

That's the question for 45 residents of a Humboldt nursing home that's closing its doors. It's one of six Iowa care facilities shutting down and displacing 260 residents by order of state regulators.

"I think it's awful that people are going to have to go so far away to see their family. My daughter works there, and she is losing her job, so that's a bummer," said Mandy Davis, who lives in Humboldt.

Davis says it’s the talk of the town. State regulators say the new owners, Blue Care Homes, must close the Humboldt facility along with five others across the state. And now, health care leaders in Humboldt County are scrambling to help.

"We are here to help any way we can," said Michelle Sleiter, CEO of Humboldt County Memorial Hospital.

Sleiter also oversees the Humboldt County Health Department. She is sending hospital workers to the Humboldt Care Facility to help as it closes. The hospital will now run the last 28-bed nursing home in Humboldt. But there’s a problem.

"Our nursing home at the hospital is the only option now after this closes, and again I only have 28 beds, and unfortunately, we're full," said Sleiter.

Sleiter says nursing homes are closing due to many factors. They include worker shortages, supply chain issues and revenue trouble. She is urging state lawmakers to investigate the problem

"This is going to be a long-term game that we are going to have to work through. Nothing is going to change overnight," said Sleiter.

The hope of Iowa leaders is that the residents will be placed within 20 miles. A new burden for the residents and their families who call Humboldt home.

"It's hard. These are people's lives, and most of them have lived in Humboldt their entire lives. So having to potentially find placement outside of our community hits close to home," Sleiter said.

Full Article & Source:
'Where will they live?': Humboldt nursing home residents displaced

Employee of Mount Lebanon nursing home charged with sexually assaulting resident

By Rich Pierce

MOUNT LEBANON, Pa. — A nursing home worker in Mount Lebanon is charged with sexual assault for what police say he did with a resident there.

Certified nurse assistant Solomon Rivers, 32, also known as Solomon Roberson, is charged with institutional sexual assault.

According to the criminal complaint, a resident at Mount Lebanon Rehabilitation and Wellness told police he performed a sex act on Rivers in the bathroom of his room.

Documents show the victim in this case has the mental capacity of a 7-year-old and is confined to a wheelchair.

According to the complaint, Rivers was interviewed multiple times and admitted to what happened saying “it went too far.”

People 11 News spoke to were disturbed by it.

“I find it weird that somebody thought that it was okay to do to another person when they know that they aren’t able to say anything back to them,” Jessica Berger said.

The report also says Rivers told police he would no longer “pursue a job in the healthcare field.”

It is unclear whether Rivers was fired from his position.

11 News reached out to management at the center over the phone and in-person. We were told no one there could speak with us and we’d have to try another day.

We also spoke with retired clinical social worker Vinceena Deiulus who says if you have a loved one in a nursing home and are worried about them being mistreated, there is something you can do.

“When you visit a person, when they know you’re there and around it changes the scenario of things. If they know you never show up? Not so much,” she said.

Full Article & Source:
Employee of Mount Lebanon nursing home charged with sexually assaulting resident

Thursday, February 2, 2023

NYSP: Schoharie woman steals from guardianship account

by: Harrison Gereau

COBLESKILL, N.Y. (NEWS10) — A Schoharie woman is doing time in Schenectady County Jail after she allegedly stole over $265,000 from a guardianship account. The funds were reported missing on Oct. 6, 2022, from an account owned by Daniel S. Ross of Ross Law Offices in Middleburgh.  

While investigating the alleged theft, officers learned that Amber M. Wood, 39, of Schoharie, had worked as a secretary for Ross. Between November 2013 and June 2021, police claim Wood took the cash out of her boss’ guardianship account and deposited it into her personal bank account.

During the same time frame, Wood allegedly altered business records related to the guardianship bank account. Those were later filed with Schoharie County Surrogate Court containing false information, police said. 

Wood was charged with second-degree grand larceny, eight counts of third-degree grand larceny, five counts of second-degree forgery, five counts of first-degree falsifying business records, and fourth-degree grand larceny.

On Friday, Wood turned herself over to state police. She was arraigned at the Cobleskill Town Court and sent to Schenectady County Jail. She will be arraigned in Schenectady County soon on charges stemming from the same incident.

Full Article & Source:
NYSP: Schoharie woman steals from guardianship account

Nursing home owners drained cash while residents deteriorated, state filings suggest

by Jordan Rau

New York state records show nearly half the state's 600-plus nursing homes hired real estate, management and staffing companies run or controlled by their owners, frequently paying them well above the cost of services. Meanwhile, in the pandemic's height, the federal government was giving the facilities hundreds of millions in fiscal relief. Maskot/Getty Images

After the nursing home where Leann Sample worked was bought by private investors, it started falling apart. Literally.

Part of a ceiling collapsed on a nurse, the air conditioning conked out regularly, and a toilet once burst on Sample while she was helping a resident in the bathroom, she recalled in a court deposition.

"It's a disgusting place," Sample, a nurse aide, testified in 2021.

The decrepit conditions Sample described weren't due to a lack of money. Over seven years, The Villages of Orleans Health & Rehabilitation Center, located in western New York near Lake Ontario, paid nearly $16 million in rent to its landlord — a company that was owned by the same investors who owned the nursing home, court records show. From those coffers, the owners paid themselves and family members nearly $10 million, while residents injured themselves falling, developed bedsores, missed medications, and stewed in their urine and feces because of a shortage of aides, New York authorities allege.

At the height of the pandemic, lavish payments flowed into real estate, management, and staffing companies financially linked to nursing home owners throughout New York, which requires facilities to file the nation's most detailed financial reports. Nearly half the state's 600-plus nursing homes hired companies run or controlled by their owners, frequently paying them well above the cost of services, a KHN analysis found, while the federal government was giving the facilities hundreds of millions in fiscal relief.

In 2020, these affiliated corporations collectively amassed profits of $269 million, yielding average margins of 27%, while the nursing homes that hired them were strained by staff shortages, harrowing injuries, and mounting deaths from COVID-19, state records reveal.

"Even during the worst year of New York's pandemic, when homes were desperately short of staffing and their residents were dying by the thousands, some owners managed to come out millions of dollars ahead," said Bill Hammond, a senior fellow at the Empire Center for Public Policy, a think tank in Albany, New York.

Some nursing home owners moved money from their facilities through corporate arrangements that are widespread, and legal, in every state. Nationally, nearly 9,000 for-profit nursing homes — the majority — outsource crucial services such as nursing staff, management, and medical supplies to affiliated corporations, known as "related parties," that their owners own, invest in or control, federal records show. Many nursing homes don't even own their buildings — they rent the space from a related company. Homes pay related parties more than $12 billion a year, but federal regulators do not make them reveal how much they charge above the cost of services, and how much money ends up in owners' bank accounts.

In some instances, draining nursing home coffers through related parties may amount to fraud. Along with The Villages' investors, a handful of other New York owners are facing lawsuits from Attorney General Letitia James that claim they pocketed millions from their enterprises that the authorities say should have been used for patient care.

Deciphering these financial practices is timely because the Centers for Medicare & Medicaid Services is weighing what kind of stringent staffing levels it may mandate — potentially the biggest change to the industry in decades. A proposal due this spring is sure to spark debate about what nursing homes can additionally afford to spend versus what changes would require greater government support.

Federal Medicaid experts warned in January that transactions with affiliated companies that share the same owner as the nursing home or are controlled by the same people "may artificially inflate" the true cost of nursing home care in reports that facilities file to the government. And the U.S. Department of Health and Human Services' inspector general is investigating whether homes properly report related-party costs.

'A dog would get better care'

Beth Martino, a spokesperson for the American Health Care Association, said there is no evidence that related companies charge more than independent contractors do for the same services. "The real story is that nursing homes are struggling right now — to recruit and retain caregivers and to keep their doors open," Martino said.

Lawyers for The Villages and its investors have asked the judge in the case for a delay until April to respond to the allegations of fraud and resident neglect in the lawsuit that the attorney general filed last November. One of the lawyers, Cornelius Murray, said in court papers that many allegations of short-staffing occurred during the pandemic when workers were out sick and the facility was required to accept any patient who had COVID-19. The attorneys for The Villages declined to discuss the case with KHN.

In a deposition for that case, Ephram "Mordy" Lahasky, one of Fulton's owners, disputed that he and fellow investors improperly depleted The Villages' resources to the detriment of residents.

"I can assure you there was a lot of money left in the facility to make sure that it was not running on a shoestring budget," he testified. The Villages, Lahasky said, was a "beautiful facility" with "beautiful gardens" where "residents look great" and employee morale was strong.

That wasn't the opinion of Margarette Volkmar, the wife of one of the facility's residents. She said in an affidavit filed with the state lawsuit that her husband was left in his bed with only a diaper on, was bruised by a fall, choked by another resident, given the wrong medication doses, dressed in other residents' clothes and covered in bruises that could not be explained. After she moved him to another home, she testified, he gained back the 60 pounds he had lost and never fell at the new facility.

"I wouldn't put a dog in Villages," she said. "A dog would get better care than he did."

The owners invested in hundreds of homes

Both The Villages and its related real estate corporation, Telegraph Realty, were controlled by the same trio of investors, although they arranged for the nursing home to be listed in regulatory filings as solely owned by a silent partner and did not disclose their co-ownership of The Villages, court records show. One co-owner, David Gast, disclosed his net worth was $22 million and revealed that he had shares in more than 100 nursing homes, according to a loan application included in court records. Lahasky, whose disclosed net worth was nearly $73 million, said in a deposition he was the biggest nursing home proprietor in Pennsylvania and owned one of New York's largest ambulance companies.

A third co-owner, Sam Halper, who reported a net worth of about $23 million, is under federal criminal indictment in Pennsylvania on charges of submitting false reports to the government about staffing and patient health at two nursing homes. He has pleaded not guilty. Added together, all the investors in corporations tied to The Villages have stakes or official roles in 275 other facilities across 28 states, federal records show.

The lease that The Villages had with Telegraph Realty required the home to pay up to $1 million in profits on top of the costs of debts and $50,000 a month for rent, according to a copy filed with the lawsuit. The attorney general alleged that, over seven years, the owners gave themselves and other investors more than $18 million from outsized rent profits, management fees, and proceeds from refinancing the property, an act that saddled The Villages with higher debt.

Lindsay Heckler, a supervising attorney at Center for Elder Law & Justice in Buffalo, which provides free legal help to older, disabled, and low-income adults, said she is concerned other nursing home owners in the state fail to provide quality care after purchasing facilities.

"When you see quality of care decline after an ownership change, the question needs to be asked: What's going on with the finances?" she said.

Inflated rents — paid to sister companies — aren't uncommon

Separating a nursing home operation and its building into two corporations is a common practice around the country. In New York, for-profit nursing homes with related-party realty companies spent 19% more of their operating revenue toward rent in 2020 than did for-profits that leased from unaffiliated firms, KHN found.

Fulton Commons Care Center, a nursing home on Long Island, spent nearly a third of its 2020 revenue on rent, a higher portion than all but three other facilities in New York, financial records show. In a lawsuit filed in December, the attorney general charged that the rent paid to Fulton Commons Realty, the company that owned its East Meadow, N.Y., building, was grossly inflated. Both the home and real estate company were owned by Moshe Kalter and his extended family, according to documents filed with the lawsuit.

In 2020, the nursing home paid nearly $10 million in rent to Fulton Realty, but an auditor for the attorney general calculated the property expenses that year were less than $6 million. The owners of Fulton and their families gave themselves nearly $16 million over four years from inflated rent, substantial management fees, and "no-show" jobs for Kalter's eight children, the attorney general alleged.

"Rather than honor their legal duty to ensure the highest possible quality of life for the residents in their care, the Fulton Commons owners allegedly maintained insufficient staffing so they could take more money for their own personal gain," James said in a statement.

Raul Tabora Jr. and David Yaffe, lawyers for Kalter, called the lawsuit's charges "one-sided" in a written statement to KHN. They said that the payments to the children were not for jobs but because they were shareholders, and that Fulton kept an average balance of $3 million on hand to cover any pressing needs. "The evidence will demonstrate that any time resources are needed, they are provided by Mr. Kalter," the lawyers wrote.

Residents' families told investigators that staff shortages existed well before the pandemic. In an affidavit filed with the lawsuit, Frank Hoerauf Jr. said workers left his father sitting in adult diapers without pants and let his hair grow so long it covered his eyes. Another time, they left his father screaming in pain from a urinary tract infection, he said.

"Fulton Commons seems like it was operated to be a cash machine for the owners," Hoerauf said. "The care and the quality of life for residents there was very poor."

Another resident, Elena Milack, who had lost one foot to diabetes, complained about poor care for years, including having to ring the call bell for an hour to get help to get to the bathroom, according to an affidavit filed by her daughter-in-law, who was also Milack's health proxy. "GET ME OUT OF HERE OR TELL ME WHAT I CAN TAKE TO KILL MYSELF," she texted her son in the summer of 2019. In 2020, she contracted an infection that turned her remaining foot black.

"Toes are all infected now," Milack, a retired law school secretary, texted. "[M]y upper foot is dying and will soon fall off. I am hoping the good Lord will take me before that happens." She died in November 2020.

Kalter said in a deposition he had never stepped inside his nursing home and did not supervise the quality of the care. He testified he granted full authority over the facility to its administrator and relied on his nephew, who was the controller of the nursing home, to interact with the home's leadership, according to court records.

In his deposition, Kalter said: "I have no personal knowledge of anything that's going on in the nursing home."

According to an affidavit from an auditor for the attorney general's office, over the course of four years, Kalter deposited nearly $12 million from Fulton into the personal bank account he holds jointly with his wife, Frady.

KHN data editor Holly K. Hacker contributed to this report. KHN (Kaiser Health News) is a national, editorially independent program of KFF (Kaiser Family Foundation).

Full Article & Source:
Nursing home owners drained cash while residents deteriorated, state filings suggest

Florence woman arrested for alleged abuse of an elderly person, authorities say

by: Caleb McCusker

FLORENCE, S.C. (WBTW) — The Florence Police Department made an arrest Tuesday afternoon after an elderly person was allegedly abused, according to a news release.

Police arrested Stephanie L. McCullough, 49, of Florence, for abuse of a vulnerable adult and kidnapping, after police responded to a welfare check on an elderly person in the 1300 block of Rebecca Street.

The victim told officers that McCullough had not allowed them to leave and was physically and emotionally abusive toward them, according to the release. 

Officers found that the residence had no running water or electricity, according to the release. The victim was taken into protective custody and transported to the hospital for an assessment.

As of Wednesday afternoon, McCullough remained in custody at the Florence County Detention Center on a $50,000 surety bond, according to the release.

No other information was immediately available.

Full Article & Source:
Florence woman arrested for alleged abuse of an elderly person, authorities say

Wednesday, February 1, 2023

Alzheimer's advocates rally at Iowa Capitol, ask lawmakers to improve dementia care

by Skylar Tallal

On Monday, Iowans from across the state went to the Iowa Capitol, advocating for improvement in dementia care.

Looking to help the 66,000 Iowans currently living with the disease, the Alzheimer's Association Iowa Chapter rallied at the statehouse, asking lawmakers to add a dementia service specialist to each of the six area agencies on aging.

Estimating it would cost $750,000, the association said it pays for itself if it can keep 13 Iowans with dementia out of long term care facilities each year.

It will provide much needed care for people that have been diagnosed with Alzheimer's and their families when they need to figure out what services are out there and what they need to do to prepare for the future," Alzheimer's Association Iowa Chapter public policy director, Robyn Mills said.

They're also hoping lawmakers will create a task force to review the Alzheimer's state plan every three to five years.

Full Article & Source:
Alzheimer's advocates rally at Iowa Capitol, ask lawmakers to improve dementia care

More Steps and Moderate Physical Activity Cuts Dementia and Cognitive Impairment Risk

Summary: Older women who walked or partook in moderate-to-vigorous exercise each day had a reduced risk of developing mild cognitive impairment and dementia.

Source: UCSD

Senior women were less likely to develop mild cognitive impairment or dementia if they did more daily walking and moderate-to-vigorous physical activity, according to a new study led by the Herbert Wertheim School of Public Health and Human Longevity Science at University of California San Diego.

In the Jan. 25, 2023 online edition of Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, the team reported that, among women aged 65 or older, each additional 31 minutes per day of moderate-to-vigorous physical activity was associated with a 21 percent lower risk of developing mild cognitive impairment or dementia. Risk was also 33 percent lower with each additional 1,865 daily steps.

“Given that the onset of dementia begins 20 years or more before symptoms show, the early intervention for delaying or preventing cognitive decline and dementia among older adults is essential,” said senior author Andrea LaCroix, Ph.D., M.P.H., Distinguished Professor at the Herbert Wertheim School of Public Health and Human Longevity Science at UC San Diego.

While there are several types, dementias are a debilitating neurological condition that can cause loss of memory, the ability to think, problem solve or reason. Mild cognitive impairment is an early stage of memory loss or thinking problems that is not as severe as dementias.

According to the United States Department of Health and Human Services, dementia affects more than 5 million people in this country. That number is expected to double by 2050. 

More women live with and are at higher risk of developing dementia than men.

“Physical activity has been identified as one of the three most promising ways to reduce risk of dementia and Alzheimer’s disease. Prevention is important because once dementia is diagnosed, it is very difficult to slow or reverse. There is no cure,” said LaCroix.

However, because few large studies have examined device measures of movement and sitting in relation to mild cognitive impairment and dementia, much of the published research on the associations of physical activity and sedentary behavior with cognitive decline and dementia is based on self-reported measures, said first author, Steven Nguyen, Ph.D., M.P.H., postdoctoral scholar at the Herbert Wertheim School of Public Health.

For this study, the researchers sampled data from 1,277 women as part of two Women’s Health Initiative (WHI) ancillary studies — the WHI Memory Study (WHIMS) and the Objective Physical Activity and Cardiovascular Health (OPACH) study. The women wore research-grade accelerometers and went about their daily activities for up to seven days to obtain accurate measures of physical activity and sitting.

The activity trackers showed the women averaged 3,216 steps, 276 minutes in light physical activities, 45.5 minutes of moderate-to-vigorous physical activity and 10.5 hours of sitting per day. Examples of light physical activity could include housework, gardening or walking. Moderate-to-vigorous physical activity could include brisk walking.

More women live with and are at higher risk of developing dementia than men. Image is in the public domain

The study findings also showed that higher amounts of sitting and prolonged sitting were not associated with higher risk of mild cognitive impairment or dementia.

Together, this information has clinical and public health importance as there is little published information on the amount and intensity of physical activity needed for a lower dementia risk, said Nguyen.

“Older adults can be encouraged to increase movement of at least moderate intensity and take more steps each day for a lower risk of mild cognitive impairment and dementia,” said Nguyen.

“The findings for steps per day are particularly noteworthy because steps are recorded by a variety of wearable devices increasingly worn by individuals and could be readily adopted.”

The authors said further research is needed among large diverse populations that include men.

Co-authors include: John Bellettiere, UC San Diego; Kathleen M. Hayden and Stephen R. Rapp, Wake Forest University School of Medicine; Chongzhi Di, Fred Hutchinson Cancer Center; Priya Palta, Columbia University Irving Medical Center; Marcia L. Stefanick, Stanford University School of Medicine; JoAnn E. Manson, Harvard Medical School; and Michael J. LaMonte, University at Buffalo – SUNY.

Funding: This research was funded, in part, by the National Institute on Aging (P01 AG052352, 5T32AG058529-03) and the National Heart, Lung, and Blood Institute (R01 HL105065). The Women’s Health Initiative was funded by the National Heart, Lung, and Blood Institute (75N92021D00001, 75N92021D00002, 75N92021D00003, 75N92021D00004, 75N92021D00005).

Full Article & Source:
More Steps and Moderate Physical Activity Cuts Dementia and Cognitive Impairment Risk

Tuesday, January 31, 2023

Supporting decision making as cognition declines

This post is a preview of a presentation for the Baruch A. Brody Lecture in Bioethics. Want to learn more about this topic? Tune into the lecture Feb. 7 at noon CT.  Register Today! Coupon code for Baylor physicians: BIOETHICS23

Dementia – the progressive loss of cognitive and behavioral abilities to an extent that interferes with daily life – is among the most feared conditions of old age. What ignites such fear? It’s not merely or even primarily the prospect of physical suffering. Rather, it’s that our society places significant emphasis on independence and on the ability to self-determine. Rational thinking and memory are needed to engage in daily tasks independently; dementia robs people of exactly these skills, threatening autonomy.

Numerous diseases cause dementia. The most common of these is late-onset Alzheimer’s disease (AD). Historically, AD has been a clinical diagnosis. This meant that it was diagnosed based on the detection of dementia with a characteristic onset and pattern of cognitive and functional impairments.

Now, however, research is pulling the threads of AD and dementia apart. Clinicians and researchers can use biomarkers to identify AD neuropathology in vivo, rather than post mortem. There is evidence that AD biomarkers begin accumulating years or even decades before the onset of cognitive impairment. This means that we can reconceptualize AD as a continuum disorder – one that begins in a preclinical stage (defined by the presence of pathology in the absence of cognitive impairment) and moves through a prodromal stage before the individual experiences Mild Cognitive Impairment or dementia.

In prior work, I have conducted interview studies with cognitively unimpaired older adults to understand how they react to learning that they are at increased risk for developing dementia caused by AD because they have AD biomarkers. I’ve found that many individuals note the information has unique implications for their identity, but they also find it empowering because it allows them to plan for the possibility of cognitive impairment. 

They choose to share this information with others, particularly family members, because it allows them to make plans for caregiving and surrogate decision-making. Similarly, when I have interviewed family members of older adults who’ve learned AD biomarker information, they also discuss the importance of planning. They envision themselves stepping into a caregiver role in the future.

Once we envision AD as a continuum disorder and we realize the importance patients and families place on planning ahead, we can see the urgent need to find new approaches to protect and promote autonomy and support patient wellbeing across the Alzheimer’s continuum. Unfortunately, the law and ethics are currently lagging behind scientific progress.

One promising means of helping patients is supported decision-making, in which an adult with cognitive impairment (called a beneficiary) identifies one or more trusted others (called supporters) to assist them in decision-making. The domains and types of decision-making assistance are specified by the beneficiary, and the resulting decisions are the beneficiary’s own. While Texas was the first state in the U.S. to recognize supported decision-making in law—and nearly half of states now recognize or are considering recognizing supported decision-making—there is an ongoing need to spread awareness and increase the uptake of this important tool.

In my 2023 Baruch A. Brody Award Lecture, I will:

  • Discuss AD as a disease of autonomy
  • Describe how our evolving scientific understanding of AD requires that we find new social approaches to AD
  • Present supported decision making as an ethically and legally appealing approach

By Dr. Emily A. Largent, the Emanuel & Robert Hart Assistant Professor of Medical Ethics and Health Policy at the University of Pennsylvania Perelman School of Medicine and a Greenwall Faculty Scholar in Bioethics. She is the recipient of the 2022-2023 Baruch A. Brody Award & Lecture in Bioethics sponsored by the Baylor College of Medicine Center for Medical Ethics and Health Policy, Houston Methodist and the Rice University Department of Philosophy.

Full Article & Source:
Supporting decision making as cognition declines

Windsor attorney arrested on charges of fraud and embezzlement from family trusts


Santa Rosa Police arrested a local attorney on charges of embezzlement and fraud in connection with the theft of more than $500,000 from trust funds he was managing.

Michael Voorhees of Windsor faces seven felony counts, Santa Rosa Police Sgt. Chris Mahurin said Thursday.

“Based on interviews and evidence obtained through search warrants, detectives believe the suspect was illegally writing checks to himself from the trust accounts,” Mahurin said. “The embezzlement is estimated between $500,000 and $600,000.”

Reached by phone on Thursday, Voorhees declined comment. His attorney, Marty Woods, also declined comment.

Voorhees, who was arrested Jan. 11, is accused of stealing money from trusts he comanaged with the late Richard Holm, a real estate investor. Members of Holm’s family believe the embezzlement amounted to about $700,000, though total losses could be more.

Richard Holm died in May 2022. Voorhees was Holm’s lawyer, business partner and friend of over 40 years, according to Holm’s niece, Jackie Nelson.

“The relationship goes back years and years and years. Mike's mother worked for my uncle. It's a sad, sad thing” Nelson said.

Holm had invested in real estate since the 1970s, Nelson said. Nelson, a retired certified public accountant, began to help her uncle with his bookkeeping and tax returns in 2008.

She said she repeatedly requested financial statements from Voorhees over the years, but “he could never produce a financial statement for all the trusts that he was in charge of,” Nelson said.

She grew increasingly suspicious, and she and members of her family hired a lawyer before Holm died.

Nelson said that just weeks after her uncle’s death, Voorhees produced bank statements. He then resigned from the trust on May 24, 2022, three weeks after Holm died. Nelson said within a few days of receiving the financial documents she said it was “very obvious” and she notified police.

A Sonoma County District Attorney’s Office spokeswoman said Voorhees’ case remained under review. He was scheduled to appear in court on Friday.

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Windsor attorney arrested on charges of fraud and embezzlement from family trusts

Assessing the Drawbacks and Benefits of Adult Guardianship

by  Hendershot Cowart P.C.

Adult guardianship is a legal relationship in which a person (the “guardian”) is appointed by a court to make decisions on behalf of another adult (the “ward”). Adult guardianship arrangements are meant to benefit and protect vulnerable adults, such as those who are dealing with cognitive or mental disabilities, or those who may not be able to communicate their wishes due to a physical condition.

Types of Adult Guardianship in Texas

In Texas, there are four types of adult guardianship, including:

  • Guardian of the person: This can be full or limited. The guardian will make important personal decisions for the ward, including their living arrangements, whether they will enter a care or nursing home, and the type of medical treatment they will receive. A guardian of the person may also represent the ward in important, personal legal matters, such as divorce and other non-financial issues.

  • Guardian of the estate: This can be full or limited. The guardian will be responsible for managing their ward’s financial affairs, including paying bills, overseeing investments, applying for Medicaid and other government benefits, and can even buy and sell property on behalf of the ward.

  • Guardian of the person and the estate: This can be full or limited. The guardian will make personal and financial decisions for the ward, as outlined by the court’s guardianship order.

  • Temporary guardianship: This is typically used in urgent situations as a stopgap to ensure that the ward’s affairs are taken care of while permanent guardianship is established.

Once established, the guardian has several legal responsibilities that must be fulfilled. In addition to managing the affairs of their ward as outlined in their guardianship order, they must also file yearly reports and accountings of the ward’s estate with the court that appointed the guardianship. Furthermore, they may also be required to submit certain decisions to the court for approval, as outlined by their guardianship order.

The Benefits of Adult Guardianship

When someone is incapacitated or otherwise unable to make important life decisions for themselves, a legally appointed guardian can help them make individual decisions and, in many ways, work to safeguard the ward's well-being. Depending on the type of guardianship established, the guardian can make a wide range of decisions for their ward, including medical, financial, educational, and legal.

There are several potential benefits to adult guardianship:

  • Protection: The guardian can help protect the ward’s health, safety, and general welfare by making important decisions on their behalf.

  • Support: The guardian can provide emotional and practical support to the ward, helping them live a full, more independent life.

  • Finances: The guardian can manage the ward’s financial affairs, ensuring that their bills are paid and their assets protected.

  • Medical decisions: The guardian can make important medical and care decisions on behalf of the ward when the ward cannot do so themselves, ensuring they receive the care they need when they need it.

  • Legal representation: The guardian can represent the ward in legal matters, including signing contracts or representing them in court.

From helping their ward secure housing to ensuring that their financial concerns are taken care of, the guardian plays a critical role in their ward’s life. As such, it is vitally important that anyone who is or will be appointed guardian over someone else seriously consider the weight of the responsibility and consult with an attorney so that they are fully aware of what will be expected of them.

Potential Drawbacks to Adult Guardianship

Though the goal of guardianship is to ensure that the ward is taken care of both personally and financially, it is not without its drawbacks. As with any legal arrangement, guardianship will not be appropriate for every situation and generally should not be your first-choice solution.

Some potential drawbacks to guardianship include the following:

  • A loss of autonomy for the ward: This is the most significant drawback to establishing legal guardianship over an adult. Because the guardian is responsible for making decisions on behalf of the ward, the ward may not have any say or may feel they have lost control of their own lives. This loss of independence can be difficult for the ward to deal with emotionally and practically.

  • Costs: Establishing legal adult guardianship can be a costly process, and the expenses associated with legal fees and other ongoing costs related to the care and support of the ward may be significant.

  • Conflict: Depending on the circumstances of the guardianship, there may be a conflict between the guardian and the ward over decisions that are made. This can be particularly challenging if the ward is able to understand and express their wishes but is unable to make their own decisions.

  • Lack of flexibility: Because guardianship is a legally binding arrangement, it can be very difficult to amend or terminate once it is established. As circumstances change over time, the rigidity of legal guardianship may become problematic.

  • Stigma: There may be a stigma attached to adult guardianship, as it implies that the ward cannot make their own decisions and requires the support of a guardian. This can be a source of shame or embarrassment for the ward.

Before moving forward with guardianship, it is important to consider all potential benefits and drawbacks to establishing guardianship. This is something that your attorney can help you with, as there may be alternatives to guardianship that serve the potential ward better.

Alternatives to Adult Guardianship

It’s important to note that adult guardianship should only be considered as a last resort, and it is generally preferred for adults to have the capacity to make their own decisions whenever possible. In most cases, less restrictive alternatives can be used to give adults the support they need to make their own decisions.

Alternatives to guardianship can include:

  • Powers of attorney

  • Advance healthcare directives

  • Special needs trust

Another option to guardianship, supported by Texas law, is establishing a supported decision-making arrangement. This enables an adult with a disability or other impairment that affects their ability to make certain decisions to enter a beneficial legal agreement with their chosen supporter. This legal arrangement allows the supported adult to provide their supporter with the information needed to assist them in making important decisions regarding their everyday life.

Altering or Terminating a Guardianship

Modifying or ending guardianship requires going through a legal process. This process will likely require the assistance of an attorney as you will have to present evidence that the proposed changes or termination are in the ward’s best interest. These proceedings are held at a court hearing before a probate judge.

Guardianships are unusual legal relationships, and they can make for complex proceedings. 

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Assessing the Drawbacks and Benefits of Adult Guardianship

Monday, January 30, 2023

Small-town nursing homes closing amid staffing crunch

Many facilities that remain open are limiting admissions, while others shutter. That means more patients are marooned in hospitals or placed far away from their families.

Marjorie Kruger visits with son Dan White in her new room at the Evangelical Lutheran Good Samaritan Society nursing home in Waukon, Iowa. Kruger transferred to the Waukon facility in September because Good Samaritan was closing its Postville, Iowa, home, where she lived for six years.Tony Leys / KHN

By Tony Leys, Kaiser Health News

WAUKON, Iowa — Marjorie Kruger was stunned to learn last fall that she would have to leave the nursing home where she’d lived comfortably for six years.

The Good Samaritan Society facility in Postville, Iowa, would close, administrators told Kruger and 38 other residents in September. The facility joined a growing list of nursing homes being shuttered nationwide, especially in rural areas.

“The rug was taken out from under me,” said Kruger, 98. “I thought I was going to stay there the rest of my life.”

Her son found a room for her in another Good Samaritan center in Waukon, a small town 18 miles north of Postville. Kruger said the new facility is a pleasant place, but she misses her friends and longtime staffers from the old one. “We were as close as a nice family,” she said.

The Postville facility’s former residents are scattered across northeastern Iowa. Some were forced to move twice, after the first nursing home they transferred to also went out of business.

The Evangelical Lutheran Good Samaritan Society nursing home in Postville, Iowa, closed in November. It was the only nursing home in the town of 2,500 and one of at least 15 care centers to have closed in Iowa last year.Tony Leys / KHN

Owners say the closures largely stem from a shortage of workers, including nurses, nursing assistants, and kitchen employees.

The problem could deepen as pandemic-era government assistance dries up and care facilities struggle to compete with rising wages offered by other employers, industry leaders and analysts predict. Many care centers that have managed to remain open are keeping some beds vacant because they don’t have enough workers to responsibly care for more residents.

The pandemic brought billions of extra federal dollars to the long-term care industry, which was inundated with covid-19 infections and more than 160,000 resident deaths. Many facilities saw business decline amid lockdowns and reports of outbreaks. Staff members faced extra danger and stress.

The industry is still feeling the effects.

From February 2020 to November 2021, the number of workers in nursing homes and other care facilities dropped by 410,000 nationally, according to the federal Bureau of Labor Statistics. Staffing has rebounded only by about 103,000 since then.

In Iowa, 13 of the 15 nursing homes that closed in 2022 were in rural areas, according to the Iowa Health Care Association. “In more sparsely populated areas, it’s harder and harder to staff those facilities,” said Brent Willett, the association’s president. He noted that many rural areas have dwindling numbers of working-age adults.

The lack of open nursing-home beds is marooning some patients in hospitals for weeks while social workers seek placements. More people are winding up in care facilities far from their hometowns, especially if they have dementia, obesity, or other conditions that require extra attention.

Colorado’s executive director of health care policy and financing, Kim Bimestefer, told a conference in November that the state recognizes it needs to help shore up care facilities, especially in rural areas. “We’ve had more nursing homes go bankrupt in the last year than in the last 10 years combined,” she said.

In Montana, at least 11 nursing homes — 16% of the state’s facilities — closed in 2022, the Billings Gazette reported.

Nationally, the Centers for Medicare & Medicaid Services reported recently that 129 nursing homes had closed in 2022. Mark Parkinson, president of the American Health Care Association, said the actual count was significantly higher but the federal reports tend to lag behind what’s happening on the ground.

For example, a recent KHN review showed the federal agency had tallied just one of the 11 Montana nursing home closures reported by news outlets in that state during 2022, and just eight of the 15 reported in Iowa.

Demand for long-term care is expected to climb over the next decade as the baby boom generation ages. Willett said his industry supports changing immigration laws to allow more workers from other countries. “That’s got to be part of the solution,” he said.

The nursing home in Postville, Iowa, was one of 10 care centers shuttered in the past year by the Good Samaritan Society, a large chain based in South Dakota.

“It’s an absolute last resort for us, being a nonprofit organization that would in many cases have been in these communities 50 to 75 years or more,” said Nate Schema, the company’s CEO.

The Evangelical Lutheran Good Samaritan Society, the full name of the company, is affiliated with the giant Sanford Health network and serves 12,500 clients, including residents of care facilities and people receiving services in their homes. About 70% of them live in rural areas, mainly in the Plains states and Midwest, Schema said.

Schema said many front-line workers in nursing homes found less stressful jobs after working through the worst days of the covid pandemic, when they had to wear extra protective gear and routinely get screened for infection in the face of ongoing risk.

Lori Porter, chief executive officer of the National Association of Health Care Assistants, said nursing home staffing issues have been building for years. “No one that’s been in this business is in shock over the way things are,” she said. “The pandemic put a spotlight on it.”

Porter, who has worked as a certified nursing assistant and as a nursing home administrator, said the industry should highlight how rewarding the work can be and how working as an aide can lead to a higher-paying job, including as a registered nurse.

Care industry leaders say that they have increased wages for front-line workers but that they can’t always keep up with other industries. They say that’s largely because they rely on payments from Medicaid, the government program for low-income Americans that covers the bills for more than 60% of people living in nursing homes.

In recent years, most states have increased how much their Medicaid programs pay to nursing homes, but those rates are still less than what the facilities receive from other insurers or from residents paying their own way. In Iowa, Medicaid pays nursing homes about $215 per day per resident, according to the Iowa Health Care Association. That compares with about $253 per day for people paying their own way. When nursing homes provide short-term rehabilitation for Medicare patients, they receive about $450 per day. That federal program does not cover long-term care, however.

Willett said a recent survey found that 72% of Iowa’s remaining nursing homes were freezing or limiting admissions below their capacity.

The Prairie View nursing home in Sanborn, Iowa, is one of them. The facility, owned by a local nonprofit, is licensed for up to 73 beds. Lately, it has been able to handle only about 48 residents, said administrator Wendy Nelson.

“We could take more patients, but we couldn’t give them the care they deserve,” she said.

Prairie View’s painful choices have included closing a 16-bed dementia care unit last year.

Nelson has worked in the industry for 22 years, including 17 at Prairie View. It never has been easy to keep nursing facilities fully staffed, she said. But the covid pandemic added stress, danger, and hassles.

“It drained the crud out of some people. They just said, ‘I’m done with it,’” she said.

Prairie View has repeatedly boosted pay, with certified nursing assistants now starting at $21 per hour and registered nurses at $40 per hour, Nelson said. But she’s still seeking more workers.

She realizes other rural employers also are stretched.

“I know we’re all struggling,” Nelson said. “Dairy Queen’s struggling too, but Dairy Queen can change their hours. We can’t.”

David Grabowski, a professor of health care policy at Harvard Medical School, said some of the shuttered care facilities had poor safety records. Those closures might not seem like a tragedy, especially in metro areas with plenty of other choices, he said.

“We might say, ‘Maybe that’s the market working, the way a bad restaurant or a bad hotel is closing,’” he said. But in rural areas, the closure of even a low-quality care facility can leave a hole that’s hard to fill.

For many families, the preferred alternative would be in-home care, but there’s also a shortage of workers to provide those services, he said.

The result can be prolonged hospital stays for patients who could be served instead in a care facility or by home health aides, if those services were available.

Rachel Olson, a social worker at Pocahontas Community Hospital in northwestern Iowa, said some patients wait a month or more in her hospital while she tries to find a spot for them in a nursing home once they’re stable enough to be transferred.

She said it’s particularly hard to place certain types of patients, such as those who need extra attention because they have dementia or need intravenous antibiotics.

Olson starts calling nursing homes close to the patient’s home, then tries ones farther away. She has had to place some people up to 60 miles away from their hometowns. She said families would prefer she find something closer. “But when I can’t, I can’t, you know? My hands are tied.”

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Small-town nursing homes closing amid staffing crunch

Agencies join forces to fight elder abuse

by Don Reid - Coldwater Daily Reporter

BRANCH COUNTY — A joint effort is underway in Branch County to help and protect vulnerable adults from abuse, neglect, and exploitation in the community.

Participants signed the protocol at the new Branch County Jail Wednesday morning to use an interdisciplinary team, termed IDT, approach to address the growing number of cases of adult exploitation.

Laura Sutter, Probate Judge Kirk Kashian,
prosecutor Zack Stempien, and Sheriff John Pollack sign the new elder abuse protocol Wednesday. (Don Reid/Coldwater Daily Reporter)

Laura Sutter, director of the Area Agency on Aging Region, received a grant beginning in 2018. Since then, her program served over 100 adults, with 15 individuals investigated and helped between Oct. 1 and Dec. 31.

“That’s just our agency,” Sutter said.

With the new protocol and IDT, this number is expected to increase.

Since 2020, Branch County Elder Abuse Coalition worked to put together a joint program and protocol, but was slowed by COVID-19.

“We’ve learned communications and collaboration is the key to success,” Sutter said.

Beginning Feb. 1, all alleged complaints will be jointly reviewed by the members, the Branch County Sheriff’s Department, the Michigan Department of Health & Human Services — Adult Protective Services, Legal Services of South-Central Michigan, the Branch County Prosecutor’s Office, Pines Behavioral Health and the AAA, a division of the Branch Hillsdale St. Joseph Community Health Agency.

Representatives of each attendee signed onto the protocol Wednesday morning in the sheriff’s squad room.

“Many times, crimes against older or vulnerable adults are ‘silent,' not reported or talked about, and the IDT group wants that to change," Sheriff John Pollack said. "My office is in full support of the effort.”  

Pollack installed the state elder abuse reporting form on the vehicle computer so his officers can fill out reports and referrals from the scene to speed review.

Representatives of the organization's elder abuse inter-disciplinary team watch Laura Sutter, Probate Judge Kirk Kashian,
prosecutor Zack Stempien, and Sheriff John Pollack sign the new elder abuse protocol Wednesday. (Don Reid/Coldwater Daily Reporter)

Prosecutor Zachary Stempien assigned chief assistant Nora Geiger to elder abuse prevention and the prosecutor’s efforts since he took office.

“Nora has been directly involved in the coalition and protocol revision," Stempien said. "I fully support its implementation in Branch County.”

Probate Judge Kirk Kashian said his office sees numerous cases. Some were family or people who offer help, moved in, and used Social Security or other funds for their own benefit.

“We often have trouble when we ask the state Adult Protective Services to intervene,” Kashian said. 

Local APS staff are now part of the protocol to start investigations.

The IDT approach applies the specialized professional expertise from varying agencies and departments to provide a thorough and comprehensive review of each incidence of abuse involving the elderly or vulnerable adults.

Sutter said her staff helped many whom most would not consider vulnerable. People scammed over the internet or phone who send funds based on false pretenses.

“Banks have helped recover funds in many instances or stopped more from being taken,” Sutter said.

In one instance during a training, a law enforcement officer realized a technical service subscribed to online was really a scam allowing access to the officer’s computer.

AAA Director Laura Sutter
(Don Reid/Coldwater Daily
Sutter said, “The team will work to coordinate efforts, problem-solve, and develop positive solutions for individuals who’ve been victimized.”

Sutter said her office “will continue to support community prevention efforts as well as directly serve victims.”

Those who might suspect abuse, or need help or services for victims can contact AAA Victim Assistance Program at 517-278-2538 or visit the website

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Agencies join forces to fight elder abuse