Family caregivers deserve legal standing

Every day, millions of Americans face a health care crisis at home. They’re providing around-the-clock care for an ailing parent, spouse, or other relative, often while running a family and holding down an outside job. As the baby boomer generation gets grayer, and pressure to reduce medical spending mounts, more people are joining the ranks of these de facto health care providers. They deserve legal standing.

A 2015 AARP survey of Massachusetts registered voters age 45 and older found a majority have, or were, providing care for a relative who is “ill, frail, elderly, or who has a disability.” AARP has estimated the value of these unpaid services at $11.6 billion annually in Massachusetts alone.

 While family caregivers can turn to various state and national organizations for assistance and emotional support, more comprehensive action is needed on the state and federal levels. Attention at a policymaking level would bring order to a stopgap, sometimes chaotic, system that robs caregivers of dignity all too easily. A bill under consideration in the Massachusetts Legislature would allow a patient to name a family caregiver — a designation that would help legitimize the role family members play in the health care system. Under the law, patients could not be discharged from a hospital without their caregiver being notified. The bill builds in important safeguards to prevent hospitals from discharging patients without sufficient attention to what comes next: Hospitals would be required to offer detailed instructions on how to perform such tasks as administering drugs and changing bandages. Called the Caregiver Advise, Record, Enable Act, or CARE, it mirrors bills that have been passed in 18 other states. “It’s a big step in getting consistency across the board,” said state Representative Chris Walsh, the legislation’s sponsor.

These long-overdue steps could also prevent readmissions, which are all too common for elderly patients. “Hospital discharge policies really need to come into the modern age,” said John Schall, chief executive of the nonprofit Caregiver Action Network, based in Washington, D.C. “So many medical errors occur at that point.”

Another Massachusetts caregiver-related bill would build in essential workplace protections by prohibiting employers from discriminating against workers who are caring for a relative. And another proposal breaks new ground by recognizing the burden on spouses by offering a modest weekly stipend for those caring for patients covered by MassHealth — the state insurance plan for low-income and disabled residents. Other family members — including children and grandchildren — as well as friends, already are eligible for caregiver payments, but spouses are unfairly excluded.

The spouse of a patient being treated at home often “has to make some real tough choices like, ‘Do I cut back on work?’ ” noted Mike Festa, director of AARP Massachusetts, which is one of many state groups supporting the legislation.

In Washington, several efforts are underway to ease the financial burden on family caregivers. New York congresswoman Nita Lowey, for instance, is pushing a bill that would offer a Social Security credit to anyone who has to quit a job or work fewer hours to take care of a family member. In introducing the legislation, Lowey cited an astounding figure showing that the country’s 65 million unpaid caregivers lose an average of $324,000 in pay and benefits over a lifetime. Democratic presidential candidate Hillary Clinton has made family caregiving a part of her campaign platform — she also backs a Social Security credit for family caregivers, as well as a tax credit of up to $6,000 to offset expenses.

Together, these changes would make a significant difference in the lives of caregivers, and the family members who depend on them. Sooner or later, as a caregiver or patient, it’s an issue most of us will take personally.

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Family caregivers deserve legal standing

Where the looters and the poachers stalk prey

“The ‘Greatest Generation’ is the greatest generation to exploit.” This quote by Chayo Reyes, a retired Los Angeles Police Department specialist in elder fraud, from a DVD titled “Saving Our Parents” appropriately depicts increasing, yet often unreported, activities targeting today’s elderly and their families.

The assets of older Americans are being looted via actions in which probate instruments such as powers of attorney, wills, trusts or guardianships are used to gain control of property. These actions evolve into an involuntary redistribution of assets (IRA) as ultimate financial resource distribution becomes contrary to the asset owner’s intentions.

Family members are sometimes IRA perpetrators, but non-family individuals can come into an older person’s life with equally damaging results. It can be a premeditated effort or an “opportunity knocks” act. And don’t ever think the elderly don’t exploit each other! A senior woman with no money, an inflated sense of entitlement and a life expectancy of another 10 years or more can easily become a financial predator. The exploited elderly person may not understand (or live to see) the actual IRA action. Instead, honest and responsible people in the target’s life may be left to deal with the aftermath and even become secondary targets — especially if they are heirs/beneficiaries for whom assets are rightfully designated and/or are obstacles to an IRA practitioner’s ultimate success.

Expensive, prolonged legal entanglements as well as intimidation and harassment are common tools used to pressure heirs/beneficiaries to cede rights of inheritance if outright looting is not easily accomplishable.

Because the pool of those willing to exploit the elderly is endless, it is important to be aware of places and venues where today’s predators search for potential victims. The list might be surprising, but remember: The guise of community respectability, professional credibility, even enhanced morality or religiosity can be important entry points into the life of a predator’s next mark. With that, here is a list of where the looters and the poachers stalk prey:

• Senior centers
• Government-sponsored lectures (especially through departments/agencies specializing in eldercare, aging)
• Civic groups (Kiwanis, Rotary, etc.)
• Churches, synagogues
• Retirement communities, homeowners’ associations
• Support groups (church-sponsored and otherwise)
• Medical facilities, nursing homes, assisted living facilities
• Estate planning seminars, sales presentations (beware “free food” ploys)
• Consultations with “professionals” (lawyers, caregivers, accountants, social workers, etc.)
• Any places that cater to an older clientele (gyms, dance clubs, libraries, restaurants, etc.)

Anecdotal evidence tells of probate judges attending meetings at senior centers and other community venues ostensibly providing seniors with “prepare now for future needs” information. A forum apparently frequented by individuals with Connecticut probate experience depicts a system in which public officials troll for prospective cases to meet the challenge of operating in a state with numerous probate courts constantly vying for justification of their court’s existence. And though Connecticut residents may experience more visible aggression in these pursuits, similar reports are heard across the country.

Meetings sponsored by anyone — government agencies, churches, civic groups, support groups, whomever — can be beneficial for those looking to poach property of the unsuspecting. An IRA practitioner might be the featured speaker or he/she might be in the audience looking to “befriend” unsuspecting marks. Gatherings put on by seemingly respectable organizations can be viewed as safe havens fostering greater trust and openness to those with whom personal contact is made — a point well known to poachers on the prowl. Support groups can be especially rich in potential targets as the group’s commonality (grief, caregivers, divorce, etc.) may increase their emotionalism and vulnerability — another point not lost on IRA stalkers.

A 2005 Los Angeles Times series titled “Guardians for profit” reported:

Conservators find clients by sponsoring breakfasts at senior centers and networking at legal luncheons. Nursing homes call when residents become too addled to pay the rent, wanting a conservator to write checks for them. Hospitals call when patients have outlasted their insurance, hoping that a conservator will move them somewhere else.

Conservators, also known as guardians, use probate procedures to gain control over an individual’s personal liberty and property. Though the Times articles focus on California, these cases are not uncommon elsewhere.

Stories regarding IRA cases within Florida’s probate system were detailed by the St. Petersburg Times in a 1994 Pulitzer prize-winning series called “Final Indignities.” And though published 21 years ago, the same stories are heard today — from Florida and almost every other state.

IRA predators are a fact of today’s life. Due to the wealth transfer getting ready to occur in the next 15 or so years, IRA actions will likely skyrocket. People think proper estate planning will protect them — wrong! People think they don’t have enough assets to be a target — wrong!!

There is no inoculation from the threat of IRA. There is no avoidance of being a potential target. This information is not offered as a broad-based indictment of all organizations and entities, but awareness should exist on the part of those hosting and attending community events. Knowledge of today’s predatory landscape and recognition of the places haunted by asset looters and property poachers will provide an upper hand. And as forewarned is forearmed, stay alert!
–Lou Ann Anderson

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Where the looters and the poachers stalk prey

Elder Abuse Growing into a National Crisis

Do you know what America's "dirty little secret" is? The hidden problem of elder abuse, according to the National Clearinghouse on Abuse in Later Life (NCALL). Here's what you should know about this serious social problem.

Elder abuse isn't a new phenomenon.
 
But awareness of the problem is relatively new. One of the first public reports on elder abuse was published in a 1975 British Medical Journal paper, which described the occurrence of "granny battering" or "granny bashing."

By the mid-1970s, America had awakened to reports and articles on battered and abandoned elders that were documented in professional literature. The initial response to these reports was disbelief and denial, which turned into public outrage as soon as elder abuse stories hit the mainstream media.
Elder laws and definitions can vary widely.
 
Each state has created statutory laws that address elder abuse, neglect and exploitation. These statutes can differ greatly.

Defining elder abuse would seem straightforward, but it's not. The National Center on Elder Abuse (NCEA) states that definitions vary, the problem is mostly concealed, and what actions or inactions constitute abuse are hard to pin down.

In broad terms, elder abuse can be defined as "any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult."

Elder abuse is a complex problem. 

The NCEA provides general categories of elder abuse. Domestic elder abuse is mistreatment toward an elder by a person in a trust relationship with him or her in a home setting, whereas institutional elder abuse is committed by a person who has a legal or contractual obligation to him or her in a residential setting.

Seven types of elder abuse are physical abuse, sexual abuse, emotional and psychological abuse, neglect, abandonment, financial and material exploitation and self-neglect.

America's growing elderly population is a contributing factor.

The older population is expected to rapidly grow between 2010 and 2050. U.S. Census Bureau data show that the number of seniors aged 65 and over will double, from 44.7 million in 2013 to 88.5 million in 2050. With the projected growth in the elderly population, the prevalence and incidence of elder abuse will likely increase.

Elder neglect is the most common type of abuse.

In a domestic setting, neglect is the most common type of abuse (55%), followed by physical abuse (14.6%), financial and material exploitation (12.3 percent), emotional abuse (7.7 %), sexual abuse (less than 1 percent), and other types of abuse (6.1 percent), as reported by the NCEA.

The extent of the elder abuse problem is largely unknown. 

No one knows how many older Americans are victims of elder abuse. A conservative estimate says that every year about 2.1 million older Americans are victims of elder abuse, neglect, and exploitation.

For every one elder abuse case reported to the authorities, roughly five go unreported, according to NCEA prevalence data.

The number one risk factor for elder abuse is vulnerability. 

Vulnerable older people are susceptible to the abusive behaviors of people who hold negative views toward elders.

Other risk factors for elder abuse and neglect include dementia and cognitive impairment, transgenerational violence, personal and financial problems of the abuser, and environmental conditions.

Elder abuse is usually perpetrated by someone the victim knows and trusts. 

Family members were the perpetrators in about 90% of cases of domestic elder abuse and neglect, according to The National Elder Abuse Incidence Study.

Adult children are most often the perpetrators of elder abuse, followed by other family members and spouses, according to the American Psychological Association (APA). Forty-two percent of murder victims over 60 were killed by their offspring, while 24 percent were killed by their spouses, according to a Bureau of Justice Statistics Special Report.

Elder financial abuse can be just as devastating as other forms of abuse. 

The MetLife Study of Elder Financial Abuse revealed that older victims of financial exploitation lose about $2.9 billion annually.

Study findings also showed that about 60% of perpetrators of financial crimes against the elderly are males aged 30 to 59.

The same study found that women were twice as likely to be victims of elder financial abuse, as compared to men. Most victims were aged 80 to 89, lived alone, and depended on others for medical or financial assistance.

Gender matters in the calculus of elder abuse. 

Women are at greater risk to become an elder abuse victim during their lifetime, according to The National Elder Abuse Incidence Study.

Study results also found that women were the victims in 76.3% of cases of emotional or psychological abuse, 71.4 of physical abuse, 63% of financial/material exploitation, and 60% of neglect. Men were the majority of victims (62.2%) of abandonment.

Community-based organizations are available to assist victims and their families.

Should you suspect that a family member or a relative is being neglected, abused, or exploited, your first call should be made to Adult Protective Services (APS).

Other state resources to go for help include Area Agencies on Aging, Long-Term Care Ombudsman, law enforcement, legal services, and domestic violence programs.

Preventing and combating elder abuse is everyone's responsibility. We can all do our part to create healthy and safe community environments for our elderly loved ones, relatives, neighbors, and friends.

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Elder Abuse Growing into a National Crisis

Patient in So-Called “Vegetative State” Knew Doctors Were Dehydrating Him to Death

We dehydrate to death helpless people in this country because they have a catastrophic cognitive impairment. Advocates for dehydration say it is just medical ethics, the withdrawal of the medical treatment of tube feeding. (Now, there is even a lawsuit to compel starvation by withholding spoon feeding–not a medical treatment!)

Dehydrating helpless people to death was once unthinkable. Then, in the 80s, bioethicists began advocating withdrawing tube-supplied food and fluids. And so it came to pass.

Advocates for dehydration started by claiming it should be reserved strictly for those who are unconscious. They have, of course, broadened the dehydration caste since. But recent scientific studies have now also shown that many supposedly unconscious patients aren’t unaware at all.

And now we learn some are paying attention to their surroundings!  From the Cambridge University report:

A patient in a seemingly vegetative state, unable to move or speak, showed signs of attentive awareness that had not been detected before, a new study reveals. This patient was able to focus on words signalled by the experimenters as auditory targets as successfully as healthy individuals. If this ability can be developed consistently in certain patients who are vegetative, it could open the door to specialised devices in the future and enable them to interact with the outside world.

And get this:

These findings suggest that some patients in a vegetative or minimally conscious state might in fact be able to direct attention to the sounds in the world around them.

If this is true of other patients, imagine the horror of hearing doctors and family discussing removing your food and water. Imagine the pain of the actual event!

Actually, we know what that is like. Kate Adamson, thought mistakenly to be unconscious after a brain stem stroke, underwent abdominal surgery with inadequate anesthesia. She was then left unfed (but hydrated via drip) during the healing process–and it was more painful than the sensation of being cut open!

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Patient in So-Called “Vegetative State” Knew Doctors Were Dehydrating Him to Death

Rossen Reports: Thieves target seniors at nursing homes

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Across the United States, nursing-home residents are having their money stolen by people they know: the homes’ bookkeepers and office managers who handle their trust funds and manage their expenses.

It's a crime that's been committed against thousands of nursing-home residents, including Leo Foster’s 89-year-old mother at the Vicksburg Convalescent Center in Vicksburg, Miss.

“It made me feel sick at my stomach,” Leo’s wife Phyllis Foster told TODAY's National Investigative Correspondent Jeff Rossen. “It just didn't dawn on me that someone would be so low as to steal from a vulnerable adult.”

Police learned that a woman named Lee Ray Martin, a business office coordinator at the Vicksburg Convalescent Center and Shady Lawn Health and Rehabilitation homes, had been raiding residents’ trust accounts.

“In (a) three-month period there were 12 or 15 cash withdrawals,” Phyllis Foster said of her mother-in-law’s account. “And we knew that there was something drastically wrong.”

In August, Martin pleaded guilty to 29 counts of exploitation of a vulnerable person and one count of conspiracy. She is accused of stealing more than $100,000 from 83 residents’ trust funds and going on shopping sprees at stores like J.C. Penney, Gap, Walmart and American Eagle. In one instance, Martin bought a pair of designer jeans and expensed them to an elderly resident with no legs.

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Rossen Reports: Thieves target seniors at nursing homes

Thefts from nursing home trust funds target the elderly

The administrator at the Vicksburg Convalescent Center knew something was wrong when she saw the receipt: a $90 debit from a resident's trust fund account for a pair of designer jeans.

Of all the elderly residents at the 100-bed nursing home, Amy Brown figured, this one was especially unlikely to spend his savings on pricey pants.

Both of his legs had been amputated.

Brown pored over the trust fund books. There were receipts to back up every charge, so audits had found nothing amiss. But she spotted "receipts for things I knew the residents wouldn't buy" — North Face jackets and Ugg boots, hair dryers and makeup, even a baseball bat. "I felt sick," Brown recalls.
Suspicions fell on Lee Martin, an office staffer at the Mississippi facility and an affiliated nursing home across town. Martin was charged in 2012 with billing $101,000 in personal expenses to the trust accounts of 83 residents at the two facilities. She pleaded guilty in August to multiple counts of exploitation of vulnerable adults.

"These (residents) are vulnerable; the nursing home is supposed to take care of them," says Phyllis Foster, 67, whose 89-year-old mother-in-law had funds embezzled by Martin. "I was surprised there wasn't more oversight."

Thousands of residents in U.S. nursing homes and other long-term care institutions for the aged and disabled have had their personal savings raided or mismanaged after relying on the facilities to safeguard the money in special trust fund accounts, a USA TODAY investigation shows.

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Thefts from nursing home trust funds target the elderly

Medicare Drug Program Putting Seniors, People With Disabilities At Risk

Ten years ago, a sharply divided Congress decided to pour billions of dollars into subsidizing the purchase of drugs by elderly and disabled Americans.

The initiative, the biggest expansion of Medicare since its creation in 1965, proved wildly popular. It now serves more than 35 million people, delivering critical medicines to patients who might otherwise be unable to afford them. Its price tag is far lower than expected.

But an investigation by ProPublica has found the program, in its drive to get drugs into patients' hands, has failed to properly monitor safety. An analysis of four years of Medicare prescription records shows that some doctors and other health professionals across the country prescribe large quantities of drugs that are potentially harmful, disorienting or addictive. Federal officials have done little to detect or deter these hazardous prescribing patterns.

Searches through hundreds of millions of records turned up physicians such as the Miami psychiatrist who has given hundreds of elderly dementia patients the same antipsychotic, despite the government's most serious "black box" warning that it increases the risk of death. He believes he has no other options.

Some doctors are using drugs in unapproved ways that may be unsafe or ineffective, records showed. An Oklahoma psychiatrist regularly prescribes the Alzheimer's drug Namenda for autism patients as young as 12; he says he thinks it calms them. Autism experts said there is scant scientific support for this practice.

The data analysis showed widespread prescribing of drugs such as carisoprodol, which was pulled from the European market in 2007. In 2010 alone, health-care professionals wrote more than 500,000 prescriptions for the drug to patients 65 and older. The muscle relaxant, also known as Soma, is on the American Geriatrics Society's list of drugs seniors should avoid.

The data, obtained under the Freedom of Information Act, makes public for the first time the prescribing practices and identities of doctors and other health-care providers. The information does not include patient names or the reasons why doctors prescribed particular drugs, so reporters interviewed the physicians to learn their rationales.

Medicare has access to reams of data about its patients, their diagnoses and the medical services they received. It could analyze all of this information to determine whether patients are being prescribed appropriate drugs for their conditions.

But officials at the Centers for Medicare and Medicaid Services say the job of monitoring prescribing falls to the private health plans that administer the program, not the government. Congress never intended for CMS to second-guess doctors - and didn't give it that authority, officials said.

"CMS's payments don't go to physicians, don't go to pharmacies. They go to plans, which is how our oversight framework has been established," Jonathan Blum, the agency's director of Medicare, said in an interview. The philosophy "really has been to defer to physicians" about whether a drug is medically necessary, he said.

Asked repeatedly to cite which provision in the law limits their oversight of prescribers, CMS officials could not do so.

The Office of the Inspector General of the Department of Health and Human Services has repeatedly criticized CMS for its failure to police the program, known as Part D. In report after report, the inspector general has advised CMS officials to be more vigilant. Yet the agency has rejected several key recommendations as unnecessary or overreaching.

Other experts in prescription drug monitoring also said Medicare should use its data to identify troubling prescribing patterns and take steps to investigate or restrict unsafe practitioners. That's what state Medicaid programs for the poor routinely do.

"For Medicare to just turn a blind eye and refuse to look at data in front of them . . . it's just beyond comprehension," said John Eadie, director of the Prescription Drug Monitoring Program Center of Excellence at Brandeis University.

"They're putting their patients at risk."

Although Medicare hands responsibility to private insurers, experts say they are ill-equipped for the task. Insurers have access solely to the prescriptions for their members - not to a provider's prescriptions across multiple health plans.

Only Medicare can see that.

"A red flag can turn out to be nothing, or it can turn out to be something really, really horrible," said Kathryn Locatell, a California physician who specializes in geriatrics and elder abuse. "You won't know unless you flag it."

In lawsuits and disciplinary records, state and federal authorities cite a number of reasons that doctors prescribe improperly. Some run mills where patients get prescriptions if they pay cash for a visit. Others have relationships with drug companies that influence what they prescribe. Regulators say some doctors choose inappropriate medications under pressure from families or facilities.

Research also shows that doctors often don't keep up with the latest studies and drug warnings.
ProPublica's examination of Part D data from 2007 through 2010 showed that, in many cases, Medicare failed to act against providers who have been suspended or disciplined by other regulatory authorities.

Doctors barred by state Medicaid programs for questionable prescribing remain able to dole out the same drugs under Medicare. So can dozens of practitioners who have been criminally charged or convicted for problem prescribing, or who have been disciplined by state medical boards.

The Part D records detail 1.1 billion claims in 2010 alone, including prescriptions and refills dispensed. ProPublica has created an online tool, Prescriber Checkup, to allow anyone to search for individual providers and see which drugs they prescribe.

About 70 providers each churned out more than 50,000 prescriptions and refills in 2010, the data show, averaging at least 137 a day.

A few had high tallies because they work in institutional settings, such as nursing homes, or operate busy clinics. In other cases, doctors said they think the prescriptions of their colleagues were attributed to them. They acknowledged in interviews that their numbers should have sparked questions.

Some families say they, too, think Medicare should be paying closer attention.

When 79-year-old Mable "Nanny" Webb's family put her in a nursing home near Fort Worth in 2004 to rehabilitate her back, she came under the care of Adolphus Ray Lewis, who would later become one of Medicare's busiest prescribers.

Records show that the Texas medical board temporarily restricted Lewis's license in 1998 for improper prescribing of painkillers and that he was sued repeatedly for malpractice. But Webb's family didn't know that.

While under Lewis's supervision, Webb developed a urinary tract infection that went untreated and was given a painkiller in doses that were excessive and dangerous for her condition, court testimony shows. Within a month, she died.

Webb's relatives sued. During the 2008 trial, Lewis admitted responsibility for her death, testifying that he had not reduced the dosage ordered by a nurse he supervised.

A jury ordered Lewis to pay $1.6 million in damages to Webb's relatives. They later settled for a lesser amount - one of at least eight malpractice settlements in cases involving Lewis since the mid-1990s, according to court records and interviews.

Yet Lewis continued to prescribe, racking up nearly 99,000 Medicare prescription claims including refills in 2010, fifth-most in the country. He wrote 46,000 more under Medicaid that same year. He declined to comment for this article.

Webb's granddaughter, Michelle Wheeler, said that though it's too late for her family, information about a doctor's drug choices could help others decide who should care for their loved ones.

"Everybody should be able to know that," she said.

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Medicare Drug Program Putting Seniors, People With Disabilities At Risk

Guardianship: Time for Accountability

Guardianship abuse seems to be one of the most profitable scams of the day!  Are you safe from it?  Not necessarily.

Professional guardians, and professionals who become guardians, in some states, can isolate the ward (even from family and friends), bill outrageous amounts, sell houses and other property, take over bank accounts and make the ward’s life absolutely miserable as they do.  Don’t believe it?  Neither did many others, until it happened to them.

The public is led to believe they have the right to pick the person they wish to make decisions for them, should they become unable to do so or need some help.  However, in Florida, it appears, judges are allowed to ignore the person’s wishes and place him or her under the care of a professional guardian.  Once that appointment has been made, the family can be completely excluded from the ward’s life.  Worse, if there can be a worse, the ward is completely at the mercy of the guardian for better or for worse.

A guardian should be someone who is looking out for the best interest of the ward — not the ward being a money-making product to be billed to pennilessness.

When a guardian has already been chosen by the person, the courts should not be allowed to ignore that wish and appoint a professional guardian, unless there are some serious extenuating circumstances.

In my opinion, one of the first signs something is terribly wrong with a guardian situation is when the ward is isolated from family and friends.  This action alone suggests there is something to hide.  If not, then why would a guardian worry about the ward associating with all the people that had meant so much to him or her?

People who don’t understand the harm isolation can do, should spend a couple of months alone in a room with no stimulation and the only human contact (and brief words exchanged) being when someone brings a meal and picks up the tray.  That experiment will give you a taste of what many under guardianship go through and what you may one day be looking forward to, if the laws are not changed.

The courts should not have the right to over-ride a person’s wishes, without true cause to do so.  This is a person’s life after all.  And family members and friends should be considered for guardianship prior to any professional being thought of.

Professional guardians should be held to the strictest of standards and there should be no immunity for them not also given to a family member or friend acting in the same capacity.

Guardians should not be allowed to create bills and then sell off the ward’s home and possessions to make payment, as easily as it seems it can be done in many jurisdictions.

Wards should not lose the right to fight for their freedom from guardianship, especially if it is a wrongful one.  As it is, if the guardian has all the say — the ward can be silenced and kept from fighting against an abuse guardianship situation.  How is that right?  Doesn’t that defeat the very purpose of guardianship?

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Guardianship: Time for Accountability

Don't Sign Arbitration Agreements in Nursing Homes

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Don't Sign Arbitration Agreements in Nursing Homes

Alzheimer’s Cure on the Horizon

 

In a recent interview with Ira Flow at NPR, Stephen Strittmatter explained his new research published in the journal Neuron.  He is Vincent Coates Professor of Neurology at Yale University’s School of Medicine and cofounder of Axerion Therapeutics, a private biotechnology company specializing in the research and development of treatments for Alzheimer’s disease.  His new study offers key insights into Alzheimer’s disease and gives hope that a cure might be on the horizon.

Since we have not proven what actually causes the disease, Strittmatter worked off the theory that Alzheimer’s disease is caused by abnormally folded proteins called amyloid oligomers.  It is believed that these toxic oligomers are the primary cause of all amyloid-related degenerative diseases.   They interact with neurons in the brain to damage synaptic function, creating memory deficits.  According to this theory, amyloid plaques build up in the brains of patients suffering from Alzheimer’s as a result of these protein interactions.  Strittmatter focused his study on figuring out exactly how these irregularly folded proteins interact with the neurons.  They already knew that the bad proteins interact with prion proteins on the neuron’s surface, but they didn’t know how the interaction was communicated to the inside of the cell.

The study’s main discovery was the protein called mGlur5 or Metabotropic Glutamate Receptor Five.  It is the protein responsible for the communication between the abnormally folded proteins and the inside of the neurons in the brain, triggering the internal chemistry that changes the synapses causing the neuron to lose synaptic function.  In essence, the protein mGlur5 crosses the cell membrane of the neuron and activates changes on the inside of the cell triggered by the bad, misfolded proteins causing the damage to the synapse.  Additionally, Strittmater found that blocking the mGlur5 protein using a drug called MTEP not only prevents the damage to the neuron, but may even reverse the loss of synaptic function, bringing back the lost memory.  This new knowledge of Alzheimer’s means a cure could be on the horizon.

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Alzheimer’s Cure on the Horizon

Aging AIDS population causes new challenges for health care system

WASHINGTON --
Half of the HIV/AIDS population in the United States will be 50 or older by 2015, a pivotal development that brings new challenges to the treatment and prevention of the disease, experts told a congressional panel Wednesday.

Drug resistance, other diseases, high rates of depression and a lack of prevention, screening and early diagnosis could all pose significant problems as the population of Americans with HIV or AIDS ages, they said during a hearing of the Senate Special Committee on Aging.

As research for a cure for AIDS continues, there is a vital need to examine the aging AIDS population, since any drug or vaccine must now work on an older population, said Sen. Bill Nelson, D-Fla., the committee’s chairman.

“The so-called graying of the population comes with the need to refocus our work on these new challenges,” Nelson said.

Older Americans tend to take fewer precautions against HIV, get diagnosed later and respond less to antiretroviral therapy, said Dr. Ronald O. Valdiserri, a top infectious diseases official with the Department of Health and Human Services.

Older people with HIV are more likely to develop cardiovascular disease, cancer, and liver and kidney disease, as well as depression, the experts said.

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Aging AIDS population causes new challenges for health care system

Survey Finds Disability Abuse Widespread

More than 7 in 10 with disabilities say they’ve been abused, according to a new national survey, and in many cases individuals say the problems occur repeatedly.

In what’s believed to be the largest survey of its kind, over 7,200 people with disabilities, family members, advocates, service providers and other professionals were polled between May and October 2012.

The findings, released this week, suggest that abuse of people with disabilities is widespread across the country and often overlooked.

More than 70 percent of those with disabilities polled said they had been abused and over 60 percent of family members indicated that their loved one with special needs had been mistreated.

In about half of cases, victims said they experienced physical abuse. Some 40 percent reported sexual abuse and nearly 90 percent of those who said they had been violated indicated they were verbally or emotionally harmed. Neglect and financial abuse were also frequently cited.

“Too many people are abused too much, with very little on the response side to help in the aftermath,” said Nora J. Baladerian, director of the Disability and Abuse Project, which conducted the survey. “The extent of abuse is epidemic, and the inadequate response is disturbing.”

Among those who were victimized, more than 9 in 10 said they were abused more than once with 57 percent indicating they had experienced mistreatment more than 20 times, the survey found.

Incidents of abuse were not reported in about half of cases and even when authorities were alerted, survey results indicate that arrests were made only about 10 percent of the time.

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Survey Finds Disability Abuse Widespread

Advocacy Group Publishes Nation’s First-Ever, State-By-State Nursing Home Report Card

TALLAHASSEE, FL) – Families for Better Care, a Florida-based nursing home resident advocacy group, published the first-ever state-by-state nursing home report card.

The group scored, ranked and graded states on eight different federal quality measures ranging from the percentage of facilities with severe deficiencies to the number of hours frontline caregivers averaged per resident per day.

“We’re excited about getting this report into the hands of public officials, nursing home owners, advocates, and—most importantly—residents and their families,” said Brian Lee, Families for Better Care’s executive director.  “Our goal is to applaud those states that provide good care while motivating improvement for those that score poorly.”

Top nursing home states included Alaska, Rhode Island and New Hampshire while Texas, Louisiana and Indiana hit rock bottom.

“A distinctive trend differentiated the good states from the bad states,” Lee exclaimed.  “States whose nursing homes staffed at higher levels ranked far better than those with fewer staffing hours.”

Three states (Alaska, Hawaii, and Maine) scored “superior” grades in every staffing measure and each ranked among America’s best nursing home states.  Conversely, of those four states with failing marks (Georgia, Louisiana, Tennessee, and Texas) each scored below average grades.

Full Article and Source:
Advocacy Group Publishes Nation’s First-Ever, State-By-State Nursing Home Report Card

See Also:
Report Says Texas Nursing Homes Are the Worst in the Country, And This Video Might Just Convince You

What You Should Know about Guardianships

When a person can no longer make financial or health decisions, a guardian may be appointed to fulfill these duties—but this position comes with great responsibility.

Often times, a person is appointed guardian to decide on financial and personal matters for someone who is unable to make such decisions—whether it’s old age or a disability. A family member or person of interest can petition the court to be named the guardian.

“You don’t plan to have a guardian,” says Randy Kessler, founding partner of Kessler & Solomiany.
“Depending on the terms of the guardian order—it’s like a power of attorney—the broadest would be every decision including medical decisions but the more common ones are financial,” says Kessler. In some states, “conservatorships” refer to having the authority to make financial decisions for a person, while the term “guardianship” generally refers to both financial and medical decisions.

“If someone’s in mental duress, a civil court could appoint a guardian when there’s financial decisions involved,” says Kessler. It’s a guardian’s job to make the best decisions on behalf of the other person, also called the ward.

If you’re seeking a guardianship over someone, experts suggest considering the time commitment. “It’s literally almost a tethering of the guardian to the ward,” says Robert Meyring, family law and estate planning attorney in Atlanta. “They take on handling everything and reporting back to the courts to the extent required.”

Before looking to take on this responsibility, experts provide the following information and tips to help maneuver through the process:

What’s the guardianship process?

Guardianships are a court-appointed process that can take four to eight weeks and can get ugly. And even though guardians are paid, the costs to establish the guardianship and time commitment can be high.

“It is a huge difference in cost with [estate] planning versus if you didn’t plan and [a guardianship] was imposed upon you later on,” says Randy Michel, family law and estate planning attorney in College Station, Texas. “The difference can be a few hundred dollars [for an estate plan] versus tens of thousands of dollars [for a guardianship], easy.” If a guardianship is contested, the costs can spiral out of control.

“If you’re appointed guardian, you can use the person’s money to pay legal fees,” says Michel. “If you lose, you’re going to pay out of your own pocket.”

Having an estate plan can take care of any situation that may occur prior to death. “In more than 50% of the time, someone will suffer incapacity before they pass away,” says Meyring.

How are Wards Protected?

The person you are seeking guardianship over will be made aware of your intentions.

“The person who wants to become a guardian needs to understand the person will be served with papers that they’re incapacitated and they may be mad about that,” says Michel. This safeguard protects people from losing control over their lives if they are still competent to handle their health and financial decisions.

“In certain states, if you owe this person money, you’re not qualified to be guardian,” he adds.

A psychologist typically reports on the person’s mental health to decide if a guardian is needed. “The person can give testimony in court in opposition to the guardianship. If they have a very lucid moment, it could complicate matters,” says Michel.

The court appoints an attorney to represent the person in question’s best interest, whether the guardianship has merit and the fitness of both people. “It’s really the lawyer’s duty to make sure that the person seeking the guardianship follows the law,” says Michel.

Full Article and Source:
What You Should Know about Guardianships

Report Says Texas Nursing Homes Are the Worst in the Country, And This Video Might Just Convince You

Minnie Graham, a 98-year-old great-great-grandmother, kept telling her family that people were hitting her at Garland's Winters Park Nursing and Rehabilitation Center. When her loved ones found her eyes blackened and her arms bruised, they demanded answers. Graham, they were told, had fallen out of her wheelchair. Her granddaughters didn't buy it.

So, they set set up a clock with a hidden camera in her room and waited. What it documented was horrifying, as you'll see in the CBS News video above. Graham was slapped, pushed, pulled, sprayed in the face with water and gagged with a towel that had just been used on her body. At one point, she's crying out, "Somebody help me." She died not long thereafter. Because of her treatment, her granddaughters think she had simply lost the desire to live.

Her case may be extreme, but it's a symptom of a far larger, just as insidious pattern of neglect and lax oversight in Texas. According to a report from the organization Families for Better Care, which analyzed staffing data, performance measures from the Centers for Medicare and Medicaid Services and complaints from the Office of the State Long-Term Care Ombudsman, Texas nursing homes are the worst in the country.

Fewer than 15 percent of its facilities are staffed at above-average professional nursing levels, while nearly 70 percent hire below the minimum number of caregivers needed to properly meet the needs of its residents.

Full Article and Source:
Report Says Texas Nursing Homes Are the Worst in the Country, And This Video Might Just Convince You

The 5 Most Controversial Decisions Alzheimer's Caregivers Will Ever Face

1. Should the Person Stop Driving?

Late one evening, I was deeply immersed in editing the photographs I'd taken at the Cincinnati Zoo that day when I was startled by the phone ringing. I thought it was probably Ed, my Romanian life partner and soul mate.

But it wasn't. It was a sweet female voice I didn't recognize calling to tell me she'd found Ed driving on the wrong side of the road. He'd pulled over and so she'd stopped too, and seeing how confused he was, she offered him a ride home.

Suddenly, I realized the cold hard truth: He could no longer drive safely. My heart sank and I told him very quietly that he had to stop driving.

Sooner or later, driving becomes a problem for all people with Alzheimer's. There are usually many warning signs that it is no longer safe for them to be driving. The Alzheimer's Association lists five primary ones:

• Forgetting how to locate familiar places
• Failing to observe traffic signs
• Making slow or poor decisions in traffic
• Driving at an inappropriate speed
• Becoming angry or confused while driving

I would add two obvious items to this list: Causing an accident or running into another car while parking.

When loved ones exhibit one or more of these, it's time to get them to stop driving. This will be one of the most difficult actions you will ever have to take. We all cherish the independence of being able to drive anywhere we want -- any time we want -- and people with Alzheimer's are no exception.

It's highly likely that you will face all manner of resistance, but you are ultimately responsible for getting the person to stop driving, one way or another.

2. Should the Person Be Placed in a Long-Term Care Facility?

Placing a loved one with Alzheimer's in a long-term care facility is highly controversial. The vast majority of families don't want to do it, and many refuse to even think about it. Some feel it's the most cruel, shameful thing they could possibly do to their loved one, even if they have access to a high-quality facility nearby.

Full Article and Source:
The 5 Most Controversial Decisions Alzheimer's Caregivers Will Ever Face

Study Shows People in “Vegetative” State Were Incorrectly Diagnosed

There is more encouraging news coming out of Canada regarding the very unscientific persistent vegetative state (PVS) diagnosis. Once again there has been a study regarding three people who were incorrectly thought to be in a PVS.

Why is this so important? One reason is that the PVS diagnosis can be used as a motive to kill a person with a brain injury, as it was in my sister, Terri Schiavo’s case. This is not the first time this type of testing has taken place with similar types of results.

From the story, “Brain scans reveal which ‘vegetative’ patients are alert, trapped in bodies”:

A man who had appeared to have been in a vegetative state for 12 years knew his name and knew where he was, Canadian researchers report in a study showing it’s possible to use MRI brain scans to establish communication with people who seem completely unconscious. Three people tested using a special form of MRI called functional magnetic resonance imaging were able to answer simple “yes” or “no” questions, the team at Western University in London, Ontario report.

And once again, just like most of these reports where they find people have been wrongly diagnosed as being in a PVS, they felt it necessary to point out that there is no way possible that they were wrong when Terri Schiavo was diagnosed as being in PVS and then subsequently killed because of it.

In fact, they often say, as in this report, the autopsy proved it. To help strengthen their claim, they bring in the “experts” like the “omniscient” bioethicist, Art Caplan who believes it was okay to deny Terri the same tests he seems to approve for others in similar conditions:

Full Article and Source:
Study Shows People in “Vegetative” State Were Incorrectly Diagnosed

Elderly Abused at 1 in 3 Nursing Homes: Report

Reports of serious, physical, sexual and verbal abuse are "numerous" among the nation's nursing homes, according to a congressional report released today.

The study, prepared by the minority (Democratic and Independent) staff of the Special Investigations Division of the House Government Reform Committee, finds that 30 percent of nursing homes in the United States — 5,283 facilities — were cited for almost 9,000 instances of abuse over a recent two-year period, from January 1999 to January 2001.

Common problems included untreated bedsores, inadequate medical care, malnutrition, dehydration, preventable accidents, and inadequate sanitation and hygiene, the report said.

Many of the abuse violations caused harm to the residents, the report said.

In 1,601 cases, the abuse violations were serious enough "to cause actual harm to residents or to place the residents in immediate jeopardy of death or serious injury," it said.

"What we have found is shocking," says Rep. Henry Waxman, D-Calif., the committee's minority leader, who instructed the staff to do the study.

Full Article and Source:
Elderly Abused at 1 in 3 Nursing Homes: Report

Disability Spending Drops For First Time In Years

For the first time in decades, a new report finds that total government spending on individuals with developmental disabilities has declined.

When adjusted for inflation, government funding fell 0.2 percent in 2011 as compared to the year prior, according to findings in the 2013 State of the States in Developmental Disabilities, a report produced by the University of Colorado.

That’s the slowest growth rate documented in at least 35 years, researchers said.

Overall government spending on people with intellectual and developmental disabilities for 2011 — the most recent year for which data is available — was $56.65 billion, the report found.

Of the funding distributed nationwide that year, about 20 percent went toward programs providing family supports, employment services, personal assistance and similar aid.

Almost 60 percent went toward residential settings for six or fewer people while 5 percent funded living environments with seven to 15 residents. State-run institutions with 16 or more residents received 11.5 percent of total spending and 3 percent went to institutions that were privately run.

Nearly 80 percent of government spending on people with intellectual and developmental disabilities was funneled through the Medicaid program in 2011, the report found. Other funding came from the states and federal programs like Social Security.

Full Article and Source:
Disability Spending Drops For First Time In Years

Rapper Sorry For ‘Offensive’ Autism Lyric

After making critical mentions about autism in a recently-released song, a hip-hop recording artist is apologizing.

J. Cole took heat in recent weeks from many autism advocates over a verse he contributed to Drake’s “Jodeci Freestyle.” In the song, Cole says that he’s “artistic” while his rivals are “autistic, retarded.”

Now the rapper is expressing regret.

“When I first saw a comment from someone outraged about the lyric, I realized right away that what I said was wrong,” Cole wrote in a blog post. “I should have known better.”

Cole said the criticism directed his way prompted him to read stories online about parents’ experiences raising children with autism and he is now looking to education himself more about the developmental disorder.

“To the parents who are fighting through the frustrations that must come with raising a child with severe autism, finding strength and patience that they never knew they had; to the college student with Asperger’s syndrome; to all those overcoming autism. You deserve medals, not disrespect. I hope you accept my sincere apology,” Cole wrote.

Full Article and Source:
Rapper Sorry For ‘Offensive’ Autism Lyric