Saturday, April 15, 2023

Why Nursing Homes Need A Total Redesign

 by Charles P. Sabatino

The COVID-19 pandemic, more than any other event in our time, has focused a sharp light on the deficient state of nursing home care in our country. A multitude of interwoven, dynamic factors determine quality, but the physical environment creates the concrete template that materially supports or impedes all other factors affecting quality. You would not build a baseball field in the design of a golf course; and you would not build a home in the design of a hospital. The traditional institutional nursing facility design today does not support either quality of care or quality of life. The “home” is missing in most nursing homes. It is time to fundamentally redesign and reimagine nursing homes.

The Current State Of Affairs

During the pandemic, nursing home residents suffered disproportionately high rates of COVID-19 cases, hospitalizations, and deaths compared to the general population. Despite accounting for less than 1 percent of the US population, long-term care residents and staff accounted for at least 23 percent of all COVID-19 deaths in the US as of January 30, 2022.

Even before the pandemic, infection control in nursing homes had been a perennial problem. The Government Accountability Office found that, from 2013 to 2017, 82 percent of all inspected nursing homes had infection prevention and control deficiencies, and about half experienced persistent problems and were cited for multiple years.

The more than 15,000 nursing homes in the US are mostly large facilities. According to the National Center for Health Statistics, they average 106 beds each and house some 1.5 million residents. The nursing home industry mushroomed after the passage of Medicare and Medicaid in 1965 and physically borrowed many institutional design features adapted from hospitals constructed in the same era, including features such as “long corridors, large activity and dining spaces, shared rooms and bathrooms, and lack of ready access to outdoors.”

Most nursing home residents are made to live in shared rooms, usually with one other person but as many as three, as permitted by Medicare and Medicaid regulations. Shared rooms have almost disappeared from modern hospitals, yet they remain the norm in traditional nursing homes, depriving most residents of lifelong patterns of privacy and control over environment and personal association.

Most Americans do not ever want to move to a nursing home. A John A. Hartford Foundation post-COVID-19 survey of older adults found that 71 percent of older adults are “unwilling to live in a nursing home in the future,” and nearly 90 percent said that “changes are needed to make nursing home appealing to them.” Society’s tolerance of nursing homes appears to be based on the mistaken assumption that there is just no other way to care for many persons needing 24/7 care or supervision.

Direct care workers demonstrate an aversion to working in traditional nursing homes. A startling study published in Health Affairs reported that, between 2017 and 2018, the overall nursing home workforce had a mean turnover rate of 128.0 percent, with 140.7 percent mean turnover for registered nurses, 129.1 percent for certified nursing assistants, and 114.1 percent for licensed practical nurses. A recent American Health Care Association Survey found that 98 percent of nursing homes are experiencing difficulty hiring staff.

The kind of long-term institutional environment to which we relegate our most chronically ill elders is a model that we have almost entirely eliminated for persons with mental illness and developmental disabilities and for children in foster care, but we continue to tolerate it for older persons. The expansion of home- and community-based care has been a welcome alternative but will not work for everyone needing long-term care. Society cannot afford to provide one-on-one care to all individuals needing 24/7 care, so group care in some kind of housing will always be needed—but it need not be of institutional design. The lack of will to overcome the institutional inertia of the status quo has been our greatest barrier to change. There is a better alternative.

An Alternative To Traditional Nursing Homes

Small, household models of skilled nursing care are not new, but they have been largely overlooked until the COVID-19 pandemic, during which they fared far better than traditional nursing homes. At the same time, a growing body of research shows a multitude of quality advantages over traditional nursing homes.

The data below highlights the Green House® Project homes, because the research on this model is the most robust. Green House homes feature not only small facility size and private rooms, but also empowered cross-trained staff and welcoming, home-like communal spaces. There are about 300 Green House Homes in 32 states, with 87 percent of them licensed as skilled nursing homes. They are home to a total of more than 3,200 residents and fare better than traditional nursing home on multiple measures. For example:

Mortality. Comparing Green House data with Centers for Medicare and Medicaid Services (CMS) data, Green House homes produced far more favorable outcomes during the first two years of the pandemic. In 2020, Green House homes experienced 25.0 deaths per 1,000 residents versus 86.8 for traditional nursing homes. In 2021, Green House homes experienced 41.3 deaths per 1,000 residents versus 122.4 for traditional nursing homes.

Staff Turnover And Satisfaction. Year-by-year comparable data are not available before 2022, but when comparing Green House homes data from 2020 with available data for traditional nursing homes from 2017 to 2018, Green House homes reported substantially lower turnover rates:

  • Certified nursing assistants (CNAs) (who are cross-trained as universal caregivers in the Green House model): 33.5 percent turnover at Green House homes versus 129.1 percent in traditional nursing homes;
  • Licensed practical nurses: 41.6 percent turnover in Green House homes versus 114.1 percent in traditional nursing homes; and
  • Registered nurses: 63.2 percent turnover in Green House homes versus 140.7 percent in traditional nursing homes.

Those results build on existing research indicating greater staff longevity, along with comparable levels of staff stress, satisfaction, and safety perceptions, compared to traditional homes. CNAs assigned to a single Green House home have broadened roles, including, cooking, housekeeping, personal laundry, personal care to residents, implementation of care plans, and assisting residents to spend time according to their preferences. Because of this cross-training of staff, there are also fewer specialized task workers moving in and out of the home, thus reducing risk of disease transmission.

Sustained Occupancy. The pandemic adversely impacted nursing home occupancy as safety concerns rapidly mounted, but Green House homes sustained and even increased their census figures during that time. The average census in Grown House homes from 2021 to 2022 rose slightly, from 84.8 percent to 87.9 percent, while national data showed average nursing home census declining from 71.1 percent to 70.6 percent.

Quality. The use of single rooms, by itself, has been shown to have enormous positive consequences. Besides better infection control, single rooms “enhance residents’ sense of home, privacy, and control” in long-term care settings and are “associated with improved sleep patterns and reduced agitation and aggressive behavior among people with dementia.”

The Green House homes, in particular, have shown improvement in several other quality indicators when compared to traditional nursing homes. An early study comparing residents’ reported outcomes in Green House homes to those of two traditional nursing homes reported:

  • greater satisfaction with their institution as a “place to live,”
  • lower rates of depression, reduced activity, and decline in functional abilities,
  • higher likelihood of participating in social outings off the grounds, and
  • higher scores on emotional well-being indicators.

A related study focusing on residents’ families found that Green House families reported higher satisfaction with their loved one’s care and with their own experience as family members. At the same time, they experienced no greater family burden.

A study focusing on staffing time reported that direct care staff spend 24 minutes more per resident day in direct care activities than CNAs in traditional nursing facilities without increasing overall staff time.

A 2016 review of primary and secondary data sources found that, while conformity to the Green House model varied across facilities, Green House homes overall demonstrated reductions in hospital readmissions, three minimum data set measures of poor quality, the number of bedfast and catheterized residents, and the number of pressure ulcers in low-risk residents.

Financial Viability. Green House homes have been shown to operate at median costs similar to the national median value for nursing homes. They incur modestly more capital costs compared to traditional nursing homes mainly due to increased square footage requirements per resident, but these costs are in part compensated for by higher percentage occupancy gains of Green House homes.

A study of the Green House home impact on Medicare shows potential cost saving. An analysis of residents of Green House homes showed that the Green House model significantly reduced overall annual Medicare Part A spending.

What Will It Take To Redesign Existing Nursing Home Facilities?

According to the Green House homes Senior Director Susan Ryan, Green House and related small homes continue to grow in numbers but still make up a small fraction of the skilled nursing home supply. In a dollar-driven industry, financial incentives are needed to turn the tide. These can and should be both state and federal in the form of subsidized development and re-development financing programs and enhanced Medicare and Medicaid reimbursement incentives for small household models that provide single rooms and meet quality standards. The stick of regulation will also be needed to ensure a gradual transition toward single rooms and bathrooms.

As the federal level, Housing and Urban Development (HUD) programs have always provided important stimuli to encourage development of both affordable housing and health care facilities. New initiatives and expanded funding under the HUD Section 232 Program could provide significant core support. This program provides mortgage insurance to finance purchase, refinance, construction, or rehabilitation of nursing homes, assisted living, and other residential care facilities.

CMS serves as the primary federal regulatory agency responsible for standard setting, reimbursement, and oversight. Any transition toward single rooms and private baths needs recognition in reimbursement rates, since the Green House model’s method of space allotment and facility design requires more space per resident. An enhanced rate for small household model homes that meet certain design/operations specs would be a major incentive for their development. Seeking additional federal funding is never easy politically, but state caregiving trends over the past several years toward home- and community-based care reduced the number of nursing home beds nationally, even before the pandemic, and that trend is expected by many to continue. So, enhanced reimbursement to small homes is offset at least in part by the reduction in costs resulting from declining numbers of nursing homes overall.

An area in which CMS has clear authority is in facility standard-setting, including room occupancy. To accompany the incentives described above, CMS could require residential care facilities to undertake a phased-in transition to single rooms and private bathrooms. CMS has already limited rooms certified after November 28, 2016, to “accommodate no more than two residents” and to have their “own bathroom equipped with at least a commode and sink.” This requirement would continue as rooms transition to single occupancy.

States have a long history of providing targeted incentives for particular kinds of development, from sports stadiums to housing, community development, historic rehabilitation, and myriad other purposes. Incentives may be in the form of mortgage subsidies, capital assistance, income tax or real estate tax breaks, enhanced payment rates for services, waiver of certain regulatory requirements, or other devices. Reimbursement rate incentives can be especially effective; Arkansas, for example, gave an increased Medicaid reimbursement rate to a provider for developing Green House homes. Providing meaningful incentives for the development or redevelopment of nursing facilities into the small household model has not been part of the discussion in most states. That needs to change.

On the side of regulatory sticks, states have direct control over nursing home licensure laws, which can go well beyond federal standards. Thus, states can require residential care facilities to transition toward single occupancy rooms and private bathrooms. However, this should be paired with significant incentives, as it may be politically difficult to achieve otherwise.

States also need to liberalize or waive certificate-of-need (CON) requirements for development/redevelopment of nursing homes toward the small household model such as Green House homes. State CON laws exist in the majority of states and consist of review processes for proposed new or expanded health facilities or services to control health care costs by curtailing unnecessary expansion or duplicative services. This is another area in which federal incentives to states may be needed to encourage state action.

Finally, any of the above options can be focused on an individual states or providers through new federal-state demonstration programs. This could include, for example, HUD targeted support for small home development and CMS enhanced reimbursement for single rooms, coupled with state waivers or modifications of CON requirements and state tracking of costs and quality indicators during the demonstration period. The goal would be to demonstrate a cost-effective model that is attractive to the nursing home industry and improves the quality of care and experience of care for the sickest and most vulnerable of our society and their families.

The number of ways forward are abundant. Only the vision and will have been lacking. None of the options described above will change the nursing home industry or resident experience overnight. This is a long-term, momentous effort. But if we’ve learned anything from the pandemic, it is that the status quo poses a serious human rights issue for which inaction is inhumane. We can and must strike a bold new course.

Author’s Note

The author is a board member of the Center for Medicare Advocacy.

Full Article & Source:
Why Nursing Homes Need A Total Redesign

‘Lock her in the closet:’ Brevard County caregivers livestream abuse of elderly patient, deputies say

by Jacob Langston

Jada Harris and Shy’Tiona Bishop face multiple charges

8-year-old Jada Harris (left) and 20-yer-old Shy’Tiona Bishop (right) (Brevard County Sheriff's Office)

– Two healthcare workers face charges after they livestreamed themselves abusing an elderly patient with dementia, according to the Brevard County Sheriff’s Office.

Deputies said that on April 3, Jada Harris and Shy’Tiona Bishop livestreamed the abuse of the patient at the Market Street Memory Care through Snapchat on four separate video clips.

“They actually put it up on a livestreamed platform so that their friends could watch it, laugh about it, as they mocked this elderly person in her condition,” Sheriff Wayne Ivey said in a video message posted on Facebook.

Jada Harris, 18, and Shy’Tiona Bishop, 20, face multiple charges in the incident, according to an arrest affidavit.

Deputies said in the first video clip, a cellphone was placed on a bathroom sink to record as Harris holds up an adult diaper and stated, “this is so embarrassing.”

Bishop grabbed the phone and added, “everyone is laughing” while turning the camera to Harris and the patient.

According to the affidavit, in the next clip, Harris said, “I don’t know why she is embarrassing me like that in front of all this people” before using an expletive to describe the patient’s bodily fluid.

In clip number three, deputies said Harris and Bishop lock themselves in the bathroom, leaving the elderly woman in the room unattended, while the patient bangs on the door. Harris is heard saying, “Like she’s psycho or something,” in addition to other comnents.

In the last clip, the patient can be heard saying “Help me” while Bishop is recorded responding “Ain’t no help you.” Deputies said as the livestream continued, the elderly woman attempted to grab the phone with Harris saying, “Don’t touch my phone,” at which point Harris reads out loud the comments the people watching are making.

Deputies said Harris read aloud a comment that said “Lock her in the closet,” then laughs before saying, “I didn’t even do nothing.”

According to the arrest affidavit, the patient has been at the facility since August 2022 and has been diagnosed with dementia, diabetes and Fibromyalgia.

Harris was arrested and faces charges of video voyeurism, exploitation of the elderly and using an electronic device in the commission of a felony.

Bishop was arrested and faces charges of video voyeurism and exploitation of the elderly.

“I’ve asked out team to make sure they work closely with the state attorney’s office and the judicial system to make sure that these two can never be involved in any type of healthcare again in their lives. I’ll be honest with you, I wouldn’t let them care for a pet cobra because he might accidentally bite ‘em and he would die of scumbag poisoning,” Ivey said.

Full Article & Source:
‘Lock her in the closet:’ Brevard County caregivers livestream abuse of elderly patient, deputies say

See Also:
2 Florida women arrested after taunting, abusing elderly woman on live stream, sheriff says: 'pieces of crap'

Wrongful Death Lawsuit Filed Against Residential Care Facility After 86-Year-Old Resident With Dementia is Sexually Assaulted and Neglected

Published April 11, 2023

The Oakleaf Village facility has been cited for more than 50 health violations since August 2021

TOLEDO, OH, April 11, 2023 /24-7PressRelease/ -- A family is suing the owners and operators of "Oakleaf Village," a residential care facility in Toledo, on behalf of the estate of their elderly mother. The suit comes after the family discovered that while under Oakleaf's care, their mother, who suffered from dementia and had limited mobility, was repeatedly neglected, sexually assaulted, and suffered numerous falls, including a traumatic head injury that led to her untimely death. It was also discovered that the facility has been cited for more than 50 health violations since August 2021.

Charles Boyk Law represents the family and filed the lawsuit in the Lucas County Court of Common Pleas on April 4, 2023. Oakleaf Village, LTD and its owner, JHT Wallick Holdings, LLC, are named as defendants in the suit, along with the "John Doe" who it is alleged committed the sexual assault.

The Complaint asserts that while Oakleaf promoted itself as having a high staff-to-resident ratio, highly skilled and caring dementia caregivers, and a state-of-the-art facility to keep residents safe and secure, they were actually understaffed, provided substandard care and services, and lacked the security to keep dementia residents safe. The family's lawsuit alleges systemic negligence, lack of security, mismanagement, and inadequate staffing contributed to their mother's injuries, assault, falls, and death.

"Sometimes an assisted living facility is the best, safest living situation for a loved one suffering from dementia or who needs around-the-clock assistance or supervision. This company markets and promotes itself as an organization that you can trust your loved one with," says the family's attorney, Wes Merillat. "However, in this situation, every indication is that they set aside their claimed values in the name of business and exposed this woman to terrible injuries and suffering. You must make the neglect, inadequate care, and exploitation of the vulnerable and the dependent unprofitable."

Read the official, file-stamped complaint online at

Wrongful Death Lawsuit Filed Against Residential Care Facility After 86-Year-Old Resident With Dementia is Sexually Assaulted and Neglected

Friday, April 14, 2023

Senators to Seek Alternatives to ‘Civil Death’ of Guardianship

The US Senate Special Committee on Aging will hold a hearing Thursday to explore alternatives to guardianships, which limit the rights of adults to make their own decisions and can lead to fraud and abuse.
Photographer: Aaron P. Bernstein/Bloomberg via Getty Images

by Ronnie Greene 

When the US Senate Special Committee on Aging gathers Thursday to examine the nation’s fractured guardianship system, one prime focus will be to find ways to eliminate unnecessary guardianships by turning to less onerous options.

Sen. Bob Casey (D-Pa.), the committee chairman, said that even after Britney Spears’ fight to escape her conservatorship attracted global attention, “there are still countless families across the nation fighting against exploitative or abusive guardianships with little recourse.”

This week’s hearing, Casey said, will explore ways to help those in need without always turning to court-ordered guardianships.

“The Aging Committee will examine the Nation’s patchwork guardianship system and explore alternatives to guardianships to protect Americans’ civil rights while getting them the support they need,” he said in a statement to Bloomberg Law.

A Bloomberg Law investigation published this month revealed the cost of unnecessary guardianships: fraud, abuse, and a system that limits the rights of adults to make their own decisions while handing control to guardians who are rarely certified or regulated. Another investigation, by WLRN in Miami, exposed questionable real estate transactions in a county guardianship program.

One group, Disability Rights Texas, refers to guardianships as “civil death, saying they “not only remove a person’s ability to choose where they want to live, what doctor they want to visit, where they work, or how they spend their money, but they can often be as restrictive as limiting what a person wears, what they eat, or who they talk to.”

Those who find themselves under overly restrictive adult guardianships sometimes take years to escape the system.

In Indiana, a teenager who suffered a traumatic brain injury after a car accident remained under guardianship for years even after marrying, having a child, and gaining work. He needed permission for everything from essentials for his daughter to the type of car he could drive. In Georgia, a mother put her daughter with Asperger’s syndrome under guardianship only to have the judge improperly revoke her right to vote and limit her spending – and threaten the mother with jail time. In Indiana, a woman with autism just ended her guardianship after a six-plus-year journey in which her former guardian questioned the family’s spending while running up steep bills.

Less Restrictive Option

Guardianships are governed by states, but each state has its own rules, so no standard system limits the number of cases guardians can handle. Some take on hundreds of cases at a time. Guardians manage more than $50 billion in assets for those they supervise, experts conservatively estimate.

Across the US, disability rights lawyers, American Bar Association veterans, and state officials say guardianships should be a last resort. Instead, they say, adults with disabilities or impairments should more often enter a system called “supported decision making.”

Under this process, adults retain the right to make their own decisions – while turning to a network of supporters when they need counsel on their relationships, their healthcare, their living arrangements, their jobs, or other matters.

Their supporters could be family members, friends, co-workers, lawyers, or others.

Ruby Campos, a Texas woman who was under guardianship until last year, said she has such a network. She now feels empowered to make her own choices.

“At the end of the day, it’s my decision,” Campos said in an interview. “I make some mistakes every now and then. If my WiFi gets cut off, that’s on me. But we’re healing.”

At this week’s hearing, “Guardianship and Alternatives: Protection and Empowerment,” the committee will hear from witnesses including a licensed therapist, guardianship reform advocate, state guardian attorney, and developmental disabilities director.

Casey has pressed for years for a system overhaul, examining financial exploitation of guardianships in 2018 and, in 2021, joining Sen. Elizabeth Warren, (D-Mass.), in urging federal agencies to improve oversight and seek data on state guardianship systems.

Full Article & Source:
Senators to Seek Alternatives to ‘Civil Death’ of Guardianship

See Also:
Voiceless No More, Indiana Woman Freed From Fraught Guardianship

In the Name of Protection, Part 1: The Profiteers: Guardians' Dark Side: Lax Rules Open the Vulnerable to Abuse

In the Name of Protection, Part 2: The Judges: Judge’s Errors, Jail Threats Haunt Georgia Family’s Guardianship

In the Name of Protection, Part 3: The Profiteers: 420 Cases, One Guardian: System Runs Amok on Just $35 a Month

In the Name of Protection, Part 4: The Lawyers: Peter Max’s Bare Ledgers Show Guardianships Drain Even the Rich

In the Name of Protection, Part 5: Guardians’ Abuses Persist as One State’s Easy Fix Goes Unmatched

Porsche billionaire files for divorce over wife’s dementia: report

By Nika Shakhnazarova

Billionaire Porsche executive Wolfgang Porsche is divorcing his wife because her “dementia-like illness” has become unbearable for him, according to a report.

Sources close to the couple say the magnate, 79, finds it “impossible” to live with his wife, Claudia Porsche, 74, whose declining health has permanently altered her personality, the Daily Beast reported, citing German-language tabloid Bild.

The billionaire, who struck up a relationship with Claudia in 2007 before tying the knot in 2019, has reportedly cited her illness and these “drastic changes” to her personality as grounds for separation.

A picture of Wolfgang Porsche.
Billionaire Porsche executive Wolfgang Porsche is divorcing his wife, according to a report.
Mandatory Credit: Photo by

Claudia — a former adviser to the German government — has been unable to move without help for months, the outlet reported.

For the last two years, she has been relying on round-the-clock care from her daughter and four housekeepers.

Meanwhile, it’s believed her soon-to-be ex-husband has been spending time with his longtime pal, 59-year-old Gabriela Prinzessin zu Leiningen, in recent months.

Claudia Porsche and Wolfgang Porsche.
Wolfgang Porsche said his wife’s “dementia-like illness” has become unbearable for him, a report says.
Getty Images
Wolfgang Porsche and his wife Claudia Huebner attend the 2010 Das Goldene Lenkrad awards.
Wolfgang (right) and Claudia (left) started their relationship in 2007 before tying the knot in 2019.
Getty Images

Gabriela is twice divorced, having married her first husband, Prince Karl Emich of Leiningen, in 1991, before their union crumbled seven years later.

Just months after divorcing the prince, she tied the knot with Swiss Karim Aga Khan IV, 86.

Her marriage to the 49th Imam of the Nizari Ismailis lasted 16 years before their divorce in 2014.

he new Porsche Taycan is seen during the 44th Bangkok International Motor Show 2023 at IMPACT in Bangkok, Thailand.
Wolfgang currently serves as chairman of the Supervisory Board of Porsche Automobil Holding SE, as well as Porsche AG.
Anadolu Agency via Getty Images
Wolfgang Porsche  and Claudia Huebner.
Claudia has been unable to move without help for months, relying on care from her daughter and housekeepers, according to reports.
Getty Images

Wolfgang, who resides in Austria, was previously wed to director Susanne Bresser in 1988. The pair welcomed two children together before divorcing in 2008.

He also shares two children with Claudia.

Wolfgang currently serves as chairman of the Supervisory Board of Porsche Automobil Holding SE, as well as Porsche AG.

The exec, whose family’s assets are worth an estimated $22 billion, is the youngest son of former Porsche AG designer and chief executive officer Ferdinand Porsche Jr. and Dorothea Reitz.

His grandfather, Ferdinand Porsche Sr., was the founder of Porsche AG.

Full Article & Source:
Porsche billionaire files for divorce over wife’s dementia: report

North Augusta man arrested after elderly mom dies of neglect

Anthony Morgan is accused of neglect in the death of his elderly mother Mary Morgan at this house on Hillcrest Drive in North Augusta.

by Greg Rickabaugh

A North Augusta man ignored injuries to his 88-year-old mother, leading to her death, authorities said Friday.

Anthony Morgan, 45, was charged Friday with abuse or neglect – leading to death of a vulnerable adult. The victim is his 88-year-old mother, Mary Alice Morgan, who died March 14 at the family home on Hillcrest Drive, Coroner Darryl Ables said.

Authorities found an unclean home when they responded to her death a 4:16 p.m. that day. The woman was found in her bedroom, and her body showed signs of neglect. An autopsy showed she died of septic shock, a life-threatening condition that happens when your blood pressure drops to a dangerously low level after an infection.

“It was due to her injuries that were not taken care of,” Ables said. “This lady was not able to care for herself … and care was not given.”

Police said they will release a report on the death Monday, said Lt. Junior Johnson with the North Augusta Department of Public Safety.

Full Article & Source:
North Augusta man arrested after elderly mom dies of neglect

Thursday, April 13, 2023

Expert in self-determination for those with disabilities can speak on alternatives to guardianship

by  Mike Krings

LAWRENCE — Without alternatives to guardianship, people with disabilities and older adults and their families can encounter negative outcomes, according to a University of Kansas expert who has spent 20 years studying the self-determination of people with disabilities.

Karrie ShogrenKarrie Shogren, Ross and Marianna Beach Distinguished Professor of Special Education and director of the KU Center on Developmental Disabilities, part of the KU Life Span Institute, offered testimony March 30 before the U.S. Senate Special Committee on Aging. U.S. Sen. Robert Casey Jr. (D-Pa.) introduced legislation that would expand access to less restrictive alternatives to guardianships and enhance protections.

“Defaulting to guardianship without considering alternatives sustains societal and institutional barriers rooted in prejudice and antiquated attitudes about the lack of decision-making capacities of people with disabilities that are not supported by research, advocacy or lived experience,” Shogren said.

Shogren is available to speak with reporters about proposed reforms to guardianship — sometimes called conservatorship — and how supported decision-making can serve as an alternative. She has published extensive research in disability rights, self-determination and related topics.

Full Article & Source:
Expert in self-determination for those with disabilities can speak on alternatives to guardianship

Bill would support MN Adult and Teen Challenge in Alexandria

By Al Edenloff

Jordan Rasmusson
ST. PAUL — Legislation is moving through the Minnesota Senate that would help individuals with disabilities live more independently, expand access to substance abuse treatment, and ensure more dollars go to a Fergus Falls long-term care facility.

The Human Services budget bill, authored by Sen. Jordan Rasmusson, R-Fergus Falls, would provide supplemental funding to Minnesota Adult and Teen Challenge facilities in Alexandria and Brainerd.

“I'm very passionate about getting this bill done this session because of the exceptional work that Adult and Teen Challenge provides throughout our state,” said Rasmusson, who represents part of Douglas County. “This organization has remarkable success, with 80% of their long-term graduates establishing a sustained life of sobriety. I believe that Adult and Teen Challenge is a great investment for our state as it shows successful outcomes and leverages private philanthropy. I know that this supplemental funding would provide Minnesotans facing substance abuse disorders with expanded access to life-changing treatment.”

To ensure individuals with disabilities can live more autonomous and independent lives, Rasmusson authored SF 2397 . According to Rasmusson, Supported Decision-Making is recognized as a best practice to help individuals with cognitive or other limitations make informed choices while respecting their autonomy.

During the 2020 legislative session, meaningful reforms and updates were made to recognize Supported-Decision Making as an alternative to court-ordered guardianship. Yet guardianship is still too often used as the state’s default support, Rasmusson said.

“The heart of this bill is about supporting independence for Minnesotans with disabilities,” Rasmusson said, “For a long time, the primary tool we used in society when someone had diminished capacity to make decisions was a court-ordered guardianship. This legislation would allow our state to further recognize Supported Decision-Making as an alternative to more restrictive guardianship and conservatorship.”

The legislation would establish a new grant program, administered by the Department of Human Services for organizations and counties to develop and enhance their Supported Decision-Making services. It also directs DHS to issue a report with recommendations for medical assistance programs to provide reimbursement for Supported Decision-Making services.

When Rasmusson’s legislation first received a hearing in the Human Services Committee, he was joined by Jean Hauff, a self-advocate who spoke in favor of this bill . “I want to live my own life and make my own decisions,” Hauff said. “I am deciding about going to college, my career, where I live, and who I vote for. Sometimes, I need help like anyone else. My family, friends and coworkers support me. I like to understand my options. Making my own decision is empowering.”

Currently, the supplemental group residential housing rate is set at a cap of $250 per month and has not changed in 22 years. Under Rasmusson’s SF 2529 , the individual county could negotiate a reimbursement rate of up to $750 per month. Rasmusson said there is a precedent for this, as there have been several supplemental rate exemptions granted for different organizations located throughout Minnesota.

When SF 2529 was first heard in committee, Senator Rasmusson was joined by Sam Anderson , center director for the Brainerd Campus of Adult and Teen Challenge. “I don't meet anyone anymore who doesn't know somebody who's struggling with addiction,” Anderson said. “We all have family, friends, relatives, neighbors, coworkers who are struggling with addiction. We’re doing everything we can. There's a desperate need, as you know, in rural Minnesota. Everyone agrees that if you can attend treatment closer to your home area and the support services that are provided there–family, children, relatives–the outcomes are better.”

The Human Services budget bill also includes Rasmusson’s SF 1769 to adjust the property rate for Fergus Falls-based PioneerCare , which operates a nursing home and provides other long-term care services. Rasmusson’s bill would put PioneerCare on a fair rental value property rate system that more closely matches facility costs.

The budget bill will now move to the Senate Finance Committee for further consideration.

Full Article & Source:
Bill would support MN Adult and Teen Challenge in Alexandria

At 100 years old, I’m the ‘world’s oldest practicing doctor’—5 things I never do to live a long, happy life

by Dr. Howard Tucker

Dr. Howard Tucker has been practicing medicine since 1947.
Photo: Austin Tucker for “What’s Next?”

When I was born in 1922, the average life expectancy in the U.S. was 58 years old for men, and 61 years old for women.

So as a 100-year-old practicing medical doctor and neurologist, patients often ask me for tips on how to stay healthy, happy and mentally sharp.

Good genes and a bit of luck can give you a head start, but here are some lifestyle rules I have lived by over the past century:

1. I don’t spend my days retired.

I’ve been working for more than 75 years, and was even named as the world’s oldest practicing doctor by the Guinness World Records. Sara, my wife of 65 years, also still practices psychoanalysis and psychiatry at age 89.

During the pandemic, I treated patients for five or six days a week. Then I switched to teaching medical residents for up to three days a week. (My hospital just shut down, so I’m currently doing medical legal review work while I look for another role.)

When I’m not working, I like spending time with my four children and 10 grandchildren, snowshoeing, and watching Cleveland sports.

If you’re blessed to have a career you enjoy and are still able to work, consider delaying retirement. Many people who retire and become inactive in their day-to-day routine are at an increased risk of cognitive decline.

2. I don’t let myself get out of shape.

Swimming, jogging, hiking and skiing well into my late-80s has kept me strong and healthy.

While I no longer ski and am not quite as active as I once was, I try to get in at least three miles on my treadmill at a brisk pace most days of the week. Watching Turner Classic Movies in the background helps curb some of the boredom.

Studies have found that something as simple as a 15-minute walk outside could lower your risk of premature death by almost 25%.

3. I don’t smoke.

When I was in high school in the 1930s, I told my father that I wanted to take up smoking. He said, “That’s alright with me. But why would anyone want to put anything but fresh air into his lungs when life is so short as it is?”

That immediately took the fun and excitement out of tobacco for me.

I remember attending medical meetings where doctors would, with a cigarette dangling from their mouths, tell patients to take up smoking because it would “curb your appetite and quiet your nerves.”

Today, we know that cigarette smoking leads to cancer, stroke, peripheral artery disease, coronary artery disease, and other pulmonary and cardiovascular diseases.

4. I don’t restrict myself.

Moderation allows us to live life to the fullest while also keeping us from going overboard and impacting our health in the long run.

I’ll have a martini and New York strip steak occasionally, but not every day. Sara is an excellent chef, and she’s helped me maintain a healthy and varied diet. We have salad with every meal, and enjoy greens like bok choy, broccoli and Brussels sprouts.

The real secret to longevity is that there are no secrets. But we live daily and die once, so we must make the most of the time we have.

5. I don’t let my knowledge go to waste.

Having practiced neurology for over seven decades, I’ve witnessed medicine evolve from lobotomies to the latest computerized imaging techniques.

I thoroughly enjoy teaching my medical residents and students, and I learn a great deal from them as well.

I have also been participating in upcoming documentary about my life. It’s been a joy to share stories from my long career with the next generation.

Dr. Howard Tucker is a neurologist from Cleveland, Ohio and was named the ”Oldest Practicing Doctor″ by Guinness World Records. He received his law degree and passed the Ohio Bar Exam in his late 60s, and served as chief of neurology of the Atlantic fleet during the Korean War. A feature documentary about Dr. Tucker is in the works.

Full Article & Source:
At 100 years old, I’m the ‘world’s oldest practicing doctor’—5 things I never do to live a long, happy life

Wednesday, April 12, 2023

Woman in legal limbo at Mayo cleared to go home

Disability advocates say Cindy Hagen, who is quadriplegic and has been at Mayo Clinic’s Austin hospital since last summer, underscores continued challenges in the systems surrounding people living with disabilities.

A case closely watched by disability advocates appears to be coming to a close after a judge vacated a court-ordered guardianship and conservatorship for Cindy Hagen, who has been living in Mayo Clinic’s Austin, Minn. hospital since last summer.

Hagen, 49, is quadriplegic as a result of injuries sustained as a child in a car crash.

Earlier this year, a judge put Hagen under emergency guardianship and conservatorship after attempts to discharge her to an appropriate facility failed.

Blue Earth County Human Services petitioned the courts for the guardianship. According to court documents, the county was unable to find in-home care for Hagen, which she had previously had at her apartment in Mankato, Minn., in part due to wide-spread staffing shortages.

Meanwhile, Hagen was offered services in skilled nursing facilities or in an apartment in the Twin Cities but she did not agree to them, according to court documents.

Hagen declined an interview, but said in court documents she instead wanted to go home to her apartment where she lived for years until 2020.

Systemic challenges

Hagen’s situation highlights challenges in some of the systems that surround people living with disabilities, said David Dively, executive director of the Minnesota Council on Disability.

Recent legislative changes make it harder to put people living with disabilities under guardianship. But courts and families have been slow to embrace those changes, he said.

 “We want to move as far away from guardianship as realistically and practically possible, because it is so restrictive. And in Minnesota, we do it pretty heavy handedly,” he said.

Instead, disability advocates say the state — and nation — should be moving toward a process of “supported decision-making.”

That process recognizes that people with disabilities can make their own decisions, said Anita Raymond, program director of the Center for Excellence in Supported Decision Making at Volunteers of America MN. 

“Often when people can approach them and provide the support they need, help them understand the situation and the decisions they face in language they can understand, we are finding — and the research backs it up — that people can make decisions with the support of others without needing guardianship,” she said.

Lack of staff

A big challenge, however, are staffing shortages in assisted living facilities and in the profession of in-home care shortages made worse by the pandemic.

More and more, patients who no longer need acute care end up stuck in the hospital as a result, said Mayo Clinic Dr. Tamara Buechler, who works in Rochester. 

“In these past couple of years with the pandemic, the challenges have only increased,” she said. “In any given quarter we have over 900 delays related to post-acute care. On any given day, in our hospital 10 percent or more of the population are patients who are delayed in the hospital setting because we need to establish a next level of safe care for them.”

Buechler said that means there are fewer beds available for patients who are just coming into the hospital for care.

Still, Raymond said that guardianship doesn’t solve the problem of labor shortages. 

“Let's not use guardianship for a situation where we're basically setting a guardian up to fail because there's nothing they can consent to because there are no resources,” she said. 

Court documents say Hagen's guardianship and conservatorship will be reinstated if she doesn't move home within 45 days.

Full Article & Source:
Woman in legal limbo at Mayo cleared to go home

See Also:
'I just want to go home': Inside a Minnesota woman's fight to overturn a guardianship

The Constitution vs. Convenience: AZ Legislature Defends Constitutional Rights in Guardianship & Conservatorship

SB1291 Probate Reform Bill Passes Committee with Unanimous, Bipartisan Support Responding to Issues Brought Forward by Victims and Advocates

PHOENIX--()--On Wednesday of this week the Arizona House of Representees Hearing Room 4 was packed with victims of probate abuse and their advocates in attendance to tell their stories and show support for SB1291 sponsored by Sen. John Kavanagh-R. The bill brings sweeping changes to Arizona Revised Statutes Title 14 guardianship and conservatorship laws. The testimony and committee comments offered a passionate look into the issues with opposition to the bill citing issues of convenience and desire to keep the lower evidentiary threshold. (Full hearing video here)

Rep. Analise Ortiz-D prior to the hearing said, “There is never a time when it is appropriate to overlook anyone’s constitutional rights. This bill will make certain that anyone in guardianship or conservatorship proceeding in Arizona will have the right to a trial by jury, to be present in court, and know full well what their rights are.” Freshman Representative Alex Kolodin-R submitted a strike-all amendment to the introduced bill, adding in language that provides for stronger constitutional protections, in cooperation with Sen. Kavanagh.

In response to probate attorney Yvette Banker’s testimony opposing the increased evidentiary threshold from “preponderance of evidence” to “clear and convincing” and the right to a jury trial Kolodin said, “It seems to me, and I’m frankly surprised that you differ with me – especially as a lawyer- that the actual standard for depriving someone of their liberty ought to be beyond a reasonable doubt. I think that’s probably what the Constitution requires.” When the roll call was taken, Democrats and Republicans alike expressed their support for due process and protecting the rights of all, passing the bill unanimously.

Sherry Lund, founder of “5-14 Protecting Liberty”, whose national decade-long fight against the loss of liberty through probate court abuse inspired Sen. Kavanagh to take up the bill, watched in the hearing room as testimony took place. After the hearing Lund said, “The disconnect between reality and fiction was played out in full view of the Arizona House Judiciary today. The only people opposing protecting the Constitutional Rights of private citizens were the people who stand to gain financially by keeping the standard low, violating the laws and rights of people, in contrast to a room full of people with personal experiences in being deprived contact with family members, bankrupted by a court ordered fiduciary, or who were powerless as precious loved ones were left to languish, overly medicated in a care center. There is no excuse for the courts, attorneys or anyone else to violate the laws or the rights of a person or their family in probate court or any other court.”

The pathway to final passage requires a full vote on the House floor, then a return to the Senate for passage of the strike-all amendment before heading to Governor Katie Hobbs.

About 5-14 Protecting Liberty: Developed by a grassroots coalition of citizens who have experienced abuse, separation from loved ones, the loss of individual liberty, personal property and finances in the probate system. 5-14 Protecting Liberty is dedicated to protecting the rights of all.


Kim Owens
Gordon C. James Public Relations
O 602-274-1988 / C 602-689-9449

Full Article & Source:
The Constitution vs. Convenience: AZ Legislature Defends Constitutional Rights in Guardianship & Conservatorship

Exec’s $2 million estate ‘wasted’ as disabled niece waits for inheritance: records

By Kathianne Boniello and Helayne Seidman 

A profoundly disabled Upper East Side woman is about to run out of cash she needs for life-saving medications and aides — as a more than $1 million inheritance has been allegedly mishandled by a former home health aide during an eight-year court battle, records show.

Multiple scleroris has left Meryn Klabouch, 74, a quadriplegic, forcing her to burn through $20,000 to $30,000 in monthly medical costs, legal filings show.

She’s survived off a $1 million bequest from her father, Francis, who died in 2015, and was due another hefty payout when her aunt, Mutual of America Insurance Co. CEO Dolores Morrissey, died in 2016 at age 88.

But the money hasn’t materialized.

Morrissey’s estate included cash, stocks, and a 1-bedroom, 1.5-bath Yorkville co-op, itself once valued at $1 million, according to Manhattan Surrogate Court documents.  

Her aunt’s former home health aide — Janina Lewandowska — was named executor of the roughly $2 million-plus estate, but has let costs pile up, failed to dole out any of the cash and allowed Morrissey’s home to languish for nearly a decade before finally selling it in July for $825,000, Klabouch has charged.

Meryn Klabouch needs $20,000 to $30,000 a month to pay for medications and aides.
Helayne Seidman

With funds from her father’s bequest running out, Klabouch says the court battle is now a matter of life or death.

“If Meryn does not receive a distribution from the estate she will end up dead, with no money to pay for her medication, caretakers, therapists and doctor,” her attorney wrote in court filings.

“This is truly an emergency which we beg the court address itself to, as there is plenty of money for Meryn’s care and the estate is being wasted each day.”

Meryn Klabouch, 74, gets help from her home health aide Joy, in her Upper East Side apartment.
Helayne Seidman

Dolores Morrissey was CEO of Mutual of America Insurance company.
Helayne Seidman

“I’ll be put in a nursing home,” Klabouch told The Post. “They’d probably kill me.”

Morrissey left modest amounts to about a dozen other relatives, none of whom have received the money.

Klabouch, in addition to $1 million cash, is supposed to receive half of whatever is left of her aunt’s estate after the co-op is sold and the other bequests are completed.

She recently got a measly $80,000 payout — but fears nothing else is left after Lewandowska — who blamed the co-op for delaying the apartment’s sale, told the court in December only $161,000 remained.

Francis Klabouch, left, and his wife Madeleine, left an inheritance to care for their disabled daughter as did Madeleine’s sister, Dolores Morrissey (center).
Helayne Seidman

Klabouch said she’s tried to find out what happened to Morrissey’s money, but that Lewandowska has flouted court directives and hasn’t shared any financial information.

“One can only guess the reason she refuses to provide the information is that it will evidence the breach of her fiduciary duty,” Klabouch contended in court papers.

Lewandowska, who moved to Florida without telling the court, also got Morrissey’s cat, Timmy, and has allegedly refused to give Klabouch jewelry from her mother, Morrisey’s sister. 

The executor of Morrissey’s estate, Janina Lewandowska, left, seen here in an undated photo with Morrissey. Lewandowska was once Morrissey’s home health aide.
Helayne Seidman

It took executor Janina Lewandowska nearly eight years to sell Morrissey’s East End Avenue co-op.
Helayne Seidman

“We do not know if the estate is still in existence or if the executor has wasted it all,” according to court documents filed by Klabouch’s attorney, who added, “I believe that the executor always thought my client would die, and the executor … would keep …the money.”

Lewandowska declined comment. 

Full Article & Source:
Exec’s $2 million estate ‘wasted’ as disabled niece waits for inheritance: records

Tuesday, April 11, 2023

Virginia Passes AARP-Backed Guardianship Reforms

 By Natalie Missakian

 En espaƱol | We applaud Virginia lawmakers and Gov. Glenn Youngkin for approving a series of AARP-backed bills that will strengthen protections for thousands of Virginians who rely on guardians to make crucial life decisions.

The legislation, among other changes, calls for a visitation requirement for private guardians, limits a guardian’s ability to restrict contact with family and friends, and requires periodic court reviews to ensure that guardianship is still necessary.

AARP has for years been calling for stronger oversight over guardians, who make decisions for people who are unable to manage their own affairs, to reduce the potential for abuse and neglect. Over the last decade, we’ve successfully advocated for guardianship reforms in Texas, Florida, Montana, Colorado and other states.

In Virginia, a state panel in 2021 recommended reforms after finding oversight of private guardians lacking. There are strict standards in place for public guardians, who are funded and managed by the state, the panel found. But most adults under guardianship in Virginia are served by court-appointed private guardians, who can be a family member, friend, attorney or another professional.

“The 12,000 adults under guardianship are some of our most vulnerable Virginians, and their rights must be protected,” said Jim Dau, AARP Virginia state director. “These legislative reforms are important steps toward improving our guardianship system in Virginia.”

Keep up with our advocacy work in Virginia, and learn more about our resources for caregivers and how to spot and report elder abuse.

Full Article & Source:
Virginia Passes AARP-Backed Guardianship Reforms

Miami Beach law firm employee accused of stealing from elderly woman under guardianship

Police: Susan Rolle, 53, used ‘incapacitated’ woman’s credit card at McDonald’s, Victoria’s Secret, among other stores

by  Chris Gothner

MIAMI BEACH, Fla. – Police arrested a former employee of a Miami Beach law firm Wednesday after accusing her of stealing from an elderly woman under its guardianship.

According to a Miami Beach police report, the investigation into Susan Rolle, 53, began on Jan. 20 after another employee of Kahn & Kahn, based on Normandy Isle, told police that a review of the victim’s assets revealed unauthorized activity on her credit card.

A judge had named one of the firm’s attorneys the woman’s guardian after finding her to be “totally incapacitated,” the report states.

The employee told police that Rolle, of northwest Miami-Dade, was assigned to work with the attorney on her file, giving her access to the woman’s personal information and her credit card.

Police accuse Rolle of racking up nearly $600 in charges on the woman’s card in December and January, including visits to Publix, McDonald’s, Walmart, Family Dollar and Victoria’s Secret.

According to the report, officers presented a Dec. 22 surveillance photo of Rolle from the Publix at 6876 Collins Ave. to one of the firm’s attorneys.

Police said he immediately recognized her, pointing out she was wearing the same “festive” Christmas sweater in the photo that she wore during an office Christmas celebration.

The report states that detectives then subpoenaed the victim’s bank records and found that Rolle wrote herself a $5,290 check from the woman’s trust account, which she later deposited into her own account.

Police said Rolle wouldn’t speak to investigators without legal counsel prior to her arrest Wednesday.

Rolle, who was charged with grand theft, organized scheme to defraud, elderly exploitation, uttering forged instruments and credit card fraud, was being held in the Turner Guilford Knight Correctional Center on a $16,000 bond as of Thursday afternoon.

Full Article & Source:
Miami Beach law firm employee accused of stealing from elderly woman under guardianship