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Council on Aging's annual Elder Abuse Summit set for June 12 in Gadsden

Staff reports - Gadsden Times

The “golden years” should be a peaceful, contented time for older Americans after they finish raising their families and retire from their working careers.

Way too often, that's not the case.

According to the National Council on Aging, roughly one in 10 Americans over the age of 60, about 5 million people, have experienced some form of abuse.

It can be overt or blatant: Examples listed by the NCOA include emotional, physical or sexual abuse; willful deprivation of things like medication, medical care, needed medical equipment, shelter and even food; and financial exploitation (the annual loss there is estimated at more than $36 billion).

It also can be more off the radar, like passive neglect of an older adult's needs or subjecting that person to isolation.

And the numbers in reality are likely greater: Studies have shown that only one in 14 to one in 24 cases of elder abuse ever get reported to authorities. Too many older Americans don't know how to do that and often there's no social support network in place to show them.

However, local residents will be able to educate themselves on the subject, including learning how to spot signs of elder abuse before it gets out of hand, when the Council on Aging of Etowah County hosts its annual Elder Abuse Summit on June 12.

The event will take place from 9 a.m. to 12:30 p.m. in the new Senior Wellness Center at 2829 W. Meighan Boulevard, and is free to those 55 and older, or 50 and older (and their caregivers) if they have a disability.

There will be guest speakers and information on community resources, plus attendees will receive a T-shirt and lunch. Door prizes also will be offered.

Those planning to attend are asked to RSVP to 256-543-3616 by June 5. More information on the summit also can be obtained at that number.

The event is sponsored by the Alabama Council on Economic Education, and is being held in conjunction with World Elder Abuse Awareness Day on June 15.  

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Council on Aging's annual Elder Abuse Summit set for June 12 in Gadsden

Elder Abuse Sentencing

“You essentially shut the door to her getting help.” That’s what a Judge told a Centre County woman, who is now headed to State Prison in whats termed a “Horrific case of Elder Abuse.” Loretta Stokes-McClusick of Philipsburg was arraigned in February of 2023 on charges of Elder Neglect involving a close relative who was in Stokes-McClusick’s care. That so called care, or lack of it, Police, Prosecutors, even Doctors have had a difficult time describing.

On Wednesday, Stokes-McClusick sentenced to 40-80 months in a State Prison, after earlier this year pleading no contest to two criminal charges. The 84-year-old woman in Stokes-McClusick’s home lost half her body weight and was just 89 pounds when admitted to a Hospital in 2022, where Doctors feared she would die. She had tunneling wounds on her legs, down to the bone, and her body temperature was the lowest ever seen by the medical personnel.

Police said Stokes-McClusick’s home was strewn with garbage, difficult to get a wheel chair through, and Stokes-McClusick repeatedly turned away Nurses and others from getting in the home. Prosecutors say the motive was money — financial exploitation. That Stokes-McClusick wanted continued access to the victim’s Social Security checks, even taking money out of the victim’s account months after she was hospitalized.

In Court Wednesday, Stokes-McClusick had nothing to say. Centre County District Attorney Bernie Cantorna telling the Judge she’s never shown remorse and then added — the victim has survived. That after a long rehabilitation, she’s living happily, blissfully in a Nursing Home.

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Elder Abuse Sentencing

Stealing My Mother From Me: The Horrors of Conservatorship

Theft, lies, deception, and the wrongful death of our loved ones by deceitful predators, all for the almighty dollar 

By Duane Farrant

Some states call it conservatorship. Others call it guardianship. But whatever you call it, it can be deadly. It can lead to theft, lies, deception, and the wrongful death of our loved ones by deceitful predators, all in pursuit of the almighty dollar.

Consider my mother’s story. Guardianship and the legal system stole her from me. It stole her money, my money, the money designated for my disabled brother, and the house where I took care of her for years. Because of the conservator in charge, the lawyers and judges involved, and others embedded in this toxic system, she lost any say in anything. So did I. 

She was put on at least one antipsychotic drug that, according to black-box warnings, shouldn’t have been prescribed for someone with dementia. She died. And for three days afterward, no one bothered to tell me. By then those in charge had demonized me. Shoved me aside and left me in the dark. She had been pulled away from me, the one who had looked after her best interests and held her power of attorney. 

How this all happened is a long, difficult, complicated story, and I won’t be able to tell it in complete detail. But I want to start with who she was, what she meant to all who loved her, and why she deserved decent treatment by all. 

Norma Claire Duffy Farrant was born in Kansas City, MO, on October 29, 1929. She was the youngest of six children, growing up in the Great Depression in a family of eight that struggled to survive. She and her siblings all served their country, with her mom and her three sisters all working in the munitions plants and her brothers fighting in our country’s World War II. Luck was with them, as they came out alive and uninjured—but for the terrors they envisioned. At one point my Uncle Bill was in a tank with four others, and one of them put his head out. It was shot off, ending up in his lap. Horrific. My uncle was awarded the Bronze Star. And my mother, like all of her siblings, wanted a better life for herself after the war. 

She learned accounting and then, changing course, attended a teaching college in Warrensburg, MO. Shortly thereafter, she and her sister Virginia decided to move to Hollywood, CA, where she landed a teaching job in an elementary school and at night taught English to immigrants. Mother married in 1958, giving birth to three children: me; my disabled brother, whom I’ve assisted for years; and our sister, now estranged. Ten years later, my parents were divorced, and in 1969 my mother moved us from Hollywood to Newbury Park, CA, where she purchased her first home with a Veterans Administration loan and taught in high schools. 

For roughly 45 years, until an injury forced her to retire, she gave her life to her family and teaching others. She worked hard to give us better lives while sacrificing her own happiness. Mother never remarried. She did everything for us. She cared about her family and others, putting her children first and herself last. 

That’s the kind of person my mother was.

But somehow—and this is where her story turns complicated and hard—she stopped being seen as a human being by those with power. Once she got roped into the system and bounced from one elder care facility to another, she became nothing to them. Not a veteran. Not a teacher who had spent her lunch hour with kids and then tutored them after school. Not a loving mother who had sacrificed everything for her kids. 

She became, instead, someone to exploit.

A long saga begins 

It all started the first week in April of 2015, the day after my mother and I took a trip to Salinas, KS, to pick up a grandfather clock. 

My truck broke down, and we were stuck overnight. By the time we got home she hadn’t slept well for the past few days, keeping me up, too. Back home the next day, she sliced her finger in the kitchen—all kinds of food out, an electric mixer in the sink. Just chaos. When I asked her what happened, she said she was trying to kill herself. 

Trying to kill herself? Clearly, she wasn’t. But I was doing my best to love and assist my aging mother with whatever aid I could find, and I had to take this seriously. 

So I band-aided her finger and put her to bed, figuring her past few sleepless nights hadn’t helped. 

A little while later, I checked in on her and asked again what had happened. Her reply was the same. Was my mother truly suicidal? I didn’t know. But this seemed like a cry for help. I felt I should do something about it, and so I tried to find the nearest place that might assist in a crisis. We were living in rural Missouri, and I could only find one location close enough to help. They indicated they would admit her. After we arrived we were assigned a counselor, but after about 15 minutes, the counselor said my mother could not be admitted and suggested I take her to an emergency room some 40 miles away. 

So began a nearly unending story of back-and-forth phone calls, car drives, interviews, questionnaires, assessments, and directives to this facility, then that facility. One place was maybe going to admit her, then another—all while I was removing sharp items from the home so Mother would be safe. And she was still keeping me awake. 

At one point, the counselor called back and indicated a hospital would take her. I was not ready for this, as I was so exhausted, and I asked her to call back after I had a few hours of sleep. She called again. Please, I told her, I need a bit of sleep before I drive her there, as the hospital was some 110 miles away. Okay, the woman said. But Mother was keeping me awake, so I called again and asked if she could be picked up. I was told she would be taken directly to the hospital.

Norma and Duane Farrant about eight years ago.

Instead, a case worker arrived and about 10 additional people, most of them just gabbing away on my porch. While my mother was trying to take a shower, several barged in. The lack of thoughtfulness in their behavior alarmed me. And why send all these people? I felt lied to, as my mother and I were both disrespected by their presence. She had been through hell, and these unwanted people were making the situation much worse. 

Two days later, after yet more complications, mother was settled into the hospital. But before long, her insurance announced they wouldn’t cover it (my mother “didn’t meet the criteria”), and so I went home and—following the hospital’s guidelines—secured the windows, the doors, the fridge. I also informed Senior Services of my actions. I told Mother if she wanted to go outside, we would have to go together. 

A friend helped me out, but there were problems. Mother kept spitting her pills out, over flowing the toilet, tossing her camera and glasses into the trash and she told me she was blind, then later apologized and said she wasn’t.  “I knew that,” I said. 

Clearly, my mother needed help. I needed help, too. I couldn’t do this alone. But where could we find that help? What were we to do? 

Becoming the bad guy

Less than two weeks after picking up Mother from the hospital, I had made multiple calls in search of someplace, somewhere, that could provide some kind of aid. No return calls. Spent and tired beyond description, I did what so many people caring for loved ones in distress do with no other recourse, not anticipating the harm it can cause: I dialed 911 and requested an ambulance and specifically told them to keep it to a minimum of people. 

It was my last option. Initially, it seemed like a good move. A sheriff showed up—a decent man—along with the paramedics. Two hours later she was settled in at a hospital, a different one from the previous place. They said she would be there for two days before being moved to a residential center I’d suggested. I told them I had a POA health directive for her, and I’d be there in the morning. Great! She was getting some help, or so I thought. 

When I showed up the next morning, she wasn’t there. Without my permission or even knowledge—without even calling me, though they later lied about that—they’d shipped her off to an entirely different hospital some 90 miles away. Off I went to this other hospital, where I was allowed just half an hour with my mother. 

From there, things only got worse. And worse. And worse. 

In the subsequent days I made so many phone calls, and got so frustrated, that finally a caseworker took my frustration the wrong way… and called someone to report that I was suicidal. 

Suicidal?

Angry, yes. Fed up with this system that was built to (supposedly) help people in distress but only makes things worse for their families and themselves, absolutely. But, no, I wasn’t suicidal. 

When a cop showed up with a caseworker, he said they wanted to talk to me about suicide. I told them to leave, as I’d had enough of their kind. When I tried to shut my door, the cop wrestled with me, trying to keep me from going inside. Over the next 10-plus hours they terrorized me, shutting off my power and—according to reports I later dug up—surrounding my 19-acre property with six police cars that flashed their lights and blasted their PA system into the early hours of morning. 

According to these same reports, guns were drawn and pointed in my direction. 

Throughout the night, the 911 operator called repeatedly, maybe 100 times. I told them to stop. I told the cops to leave me alone. They were trespassing and terrifying me, as I had no intentions of harming myself. I even called a news station, as I was in fear. 

Finally, around 4:30 a.m. I agreed to see a psychologist; a nice woman who agreed there was nothing wrong with me and sent me home. But that wasn’t the end of it—not the demonization and even criminalization of me as I tried to help my mother, and not the end of her ordeal, either. It was only the beginning. 

With no sleep and a sick chihuahua to boot, I called the hospital to check in and see when I could pick up my mother. They told me I couldn’t, not after what happened the night before. When I demanded to know why and requested a meeting to discuss Mother’s condition, they refused. The next day, speaking with a lawyer in legal aid offices, I learned of a court hearing. This was news to me. Why wasn’t I told? According to the lawyer, they had me down as the “bad guy.”

That was me: the bad guy. The guy trying to get answers. The guy trying to get some help for his mother. 

No one would give me any information. Not the hospital, family services, or the courthouse where I’d filed a petition for a hearing. What the hell was going on here? I wasn’t allowed to bring my mother home and had no clue what was going on, which was destroying whatever sanity I had left. And my mother, too, had no idea what was going on, as I hadn’t picked her up. She was there alone. 

Again, things got worse. And worse. And worse. 

The rules didn’t matter

For 11 months, my mother was held in a toilet of an institution. For 11 months, I could not see her or hear her voice. For 11 months, she was on a “no call” list, and she wasn’t allowed to speak with any family or friends, the cruelest punishment for a woman who did not deserve it. Who does this to people? And why? 

Eventually, my mother was ordered to California to live with my estranged sister. Five months later, she came back to Missouri. Soon after that, my sister filed for conservatorship. Instead, professional conservator Angelique Friend was appointed, and thereafter the California probate courts stepped in—despite the fact that we were in Missouri, and despite my power of attorney—and took my home, which mother had signed over to me in a quitclaim years before, though her name was erroneously never removed from the deed. They took my mother’s interest in another home and, over time, depleted her estate down to zero. (Poppy Helgren, who wrote about her late father’s own nightmare experience, endured under the same conservator.)

Around that time she was placed in an elder-care residential facility that I could tell, right from the start, was a house of horrors. On my first visit there, I found her with her hair completely shaved off, with scabs and bruises on her face. Mother was wearing hand-me-down clothing. She had no cane, no walker, no hearing aids, no glasses. People aren’t supposed to be placed in facilities without such things. But the rules didn’t matter, or so it seemed. 

All of this was done against my objections and against the wishes and instructions of my mother. She never asked or wanted to be under the control of a conservator and expressed her desires in a video, in the paperwork, and on the phone with me, pleading with me to pick her up time and time again. But she wasn’t heard by anyone in charge. She wasn’t even allowed to appear in court. Also disregarded: the Farrant family living trust with a “special needs” clause, intended to help my disabled brother in his time of need. Unknown to me, a judge allowed her trust to be modified, by proxy—drastically changed it—and the estate was completely depleted. I ask: How do you find a person incompetent, mentally ill, but then change her living trust, indicating she agreed to said changes? What a joke the legal system is. 

Aside from a couple of emails in late 2015 or so, Angelique Friend never communicated with me. I had virtually no knowledge and no say, any longer, about anything involving my mother’s care. 

This felt so strange to me. I’d taken care of my mother’s bills for about 13 years, and looked out for her person for more than 11. From that day forward, she never had a late payment or did without food, housing, or anything else. I helped take care of her bills as well as my brother’s, and I kept close tabs on her health. 

After she was removed from me, I couldn’t. Again, I had no say. When she was placed on the antipsychotic Risperdal, she became a zombie, of sorts; she would not talk much at all. According to the drug’s black-box warning: “Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death.” But they put her on the antipsychotic anyway—possibly others, too—and no one was telling me anything. No one informed me of the risks. 

And in the 88-plus years of Mother’s life until then, she was never diagnosed with schizophrenia, traumatic seizures or heart troubles, all three of which were mentioned on her death certificate alongside breast cancer. She did have a history of that. The rest of it was not the truth. No hallucinations or cardiac problems, at least, not until she was prescribed antipsychotics. And seizures? She never had those. Not that I knew of, so I assumed this was a lie, too. But then again, did they ever tell me what was going on? NO!

She left the world, and I was left in the dark

This is what I knew: My mother wasn’t broken until she was kidnapped and trafficked by the court system and fed black-box drugs. Before that she was a present, caring person. Before that she was loved. She wasn’t neglected. She didn’t have bruises and cuts and scabs on her face. She didn’t have an infection in both eyes. She wore clothes that were clean, that fit her, that weren’t worn thin. She had a home. She wasn’t moved from facility to facility, state-to-state, becoming yet more controlled and neglected and ill treated along the way. At one point she was housed in a center that was later revealed to employ a rapist. 

An anonymous staff member at one of the facilities did inform me, near the end of her life, that she had suffered several falls and had only seen a dentist a couple of times. No work was done on her teeth except to remove them all. And at no point did the conservator inform me of anything—not the falls and E.R. visits, not the doctor or dental visits. Not her life-threatening bout of COVID. Nothing. 

And then she left this world. Did someone tell me? The facility? The conservator? Anyone? Of course not. After three days of phone calls, checking how she was doing, I was informed that she’d died three days before. It took me years to obtain any of her medical records; I’m convinced this was a stalling tactic to prevent any lawsuit before the statute of limitations ran out. 

Over the years, my brother and I filed complaints against the conservator and others, and we petitioned for a criminal investigation into her death. I directly contacted a homicide detective in Ventura County, CA, describing my concerns and what I regard as a cover-up in her egregious abuse and lack of care. I noted that I had previously filed a complaint of elder abuse. 

Nothing has come of anything, even after some 40 plus letters and phone calls. Not one person helped, and many just didn’t bother to respond. 

Our beloved mother was mistreated, cheated, abused mentally, and alienated from her family by her conservator and the courts that pulled her away and vilified me—making me the enemy, making her more isolated, exposing her to so much harm—until she passed away on November 7, 2021. 

She is in Heaven with her family and friends. But she shouldn’t have arrived there so soon. For that I blame the black-box drugs. For that I blame the conservator, the courts, the system that made me the enemy and did enormous damage to the woman who brought me into this world—the woman I loved and looked out for, seeing to her needs. 

Instead, people in this system of “care” lied, cheated, and stole, ignoring my mother’s health, desires, and well being until it killed her. This is what happens—not just to her, but to many. Documents get ignored. Cronies get appointed, all of them enmeshed within a corrupt network that leads toward the destruction of families.

The system stole my home, too. And now, on Medicaid, I’ve got little to live on. I don’t even have the money to get my Mother a nice headstone. I pray someday I can afford one. 

God bless her. May she finally rest in peace.

Full Article & Source:
Stealing My Mother From Me: The Horrors of Conservatorship

Task force joins fight against elder abuse

A task force that includes a local county district attorney, police officer, and daughter of an elderly crime victim continues to review proposed state laws designed to strengthen protections for senior citizens and others living in care facilities.

State Sen. Lynda Schlegel Culver, R-27, whose district includes Columbia, Montour, Northumberland, Snyder and a portion of Luzerne counties, is among those working to review and revive two bills that were introduced last year and received no further action or advancement in the legislative process.

The work of these lawmakers and task force members demonstrates an important commitment to the protection of those who often don’t have the ability to protect themselves. We hope other state lawmakers take notice and help transform these proposals into new laws.

Senate Bill 261, introduced on Jan, 31, 2023, and sponsored by Sen. Culver, and Sens. Doug Mastriano, R-33, of Adams and Franklin counties, and Patrick J. Stefano, R-32, of Bedford, Somerset, Fayette and part of Westmoreland counties, would add crimes committed against non-verbal, care-dependent victims to the list of offenses that could be prosecuted at any time — not subject to statute of limitations constraints. Other crimes not subject to time limits include murder, voluntary manslaughter, violations relating to fatal accidents and crimes against law enforcement personnel or those caught in involuntary servitude, such as sexual trafficking, among others.

“Care-dependent individuals do not always have the cognitive or verbal ability to communicate crimes committed against them, such as rape, sexual assault, simple assault, aggravated assault and abuse or neglect,” Sen. Mastriano wrote in a memo. “In many cases, these crimes are discovered by family members after the statute of limitations has already run out.”

Senate Bill 885 would create a statewide registry of those found to have abused people living in care facilities.

The registry information, which would include the perpetrator’s name, Social Security number, age, sex and address, would not be made public, but would be available for reference by care facility administrators.

Those placed on the list could immediately appeal the decision and could ask to be removed from the list after five years, and annually after that, the bill states.

Sen. Culver said the task force is reviewing the provisions with the goal of making them better, if possible.

“We wanted to discuss the impacts and the consequences that we may not have intended, and then get it back to the task force for review. We will recirculate it (in the Senate) for co-sponsorship and then reintroduce it,” she said. “We really want this to be a comprehensive bill that cleans the language up so that law enforcement has the tools necessary to make arrests and the district attorney offices have the tools necessary to prosecute. Once we get this through, our plan is to look at other ways to strengthen the laws that protect our senior citizens.

“We’re not going to stop until we feel our seniors are adequately protected.”

NOTE: Opinions expressed in The Daily Item’s editorials are the consensus of the publisher, top newsroom executives and community members of the editorial board.

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Task force joins fight against elder abuse

Jefferson County Commissioners proclaim June 15 as World Elder Abuse Awareness Day

BROOKVILLE — In recognition of the need to protect the county’s older residents from abuse, the Jefferson County Commissioners have proclaimed Saturday, June 15 as “World Elder Abuse Awareness Day” in Jefferson County.

Present at Tuesday’s meeting of the commissioners were Molly McNutt, executive director of the Jefferson County Area Agency on Aging, and members of the county’s Elder Abuse Task Force.

“Elder abuse can happen to anyone,” McNutt said. “In fiscal year 2022-2023 Jefferson County Area Agency on Aging (JCAAA) took 266 reports of need. This is how suspected abuse, neglect and exploitation is recorded. A person can call us 24 hours a day and make a report.”

She said in Pennsylvania “the most common report of abuse is financial exploitation. This includes family members taking money from an older adult and individuals being scammed. The second most common is caregiver neglect, followed by self-neglect.”

McNutt announced the agency’s Elder Justice Day to be held Friday, June 14, in Brockway. Speakers will include District Attorney Jeff Burkett and representatives of the Pa. Attorney General’s office, Social Security office of Inspector General, Brockway Police Department and S & T Bank. She is encouraging attendance at the event “to learn more about how you can identify and report elder abuse.”

Commissioner Scott North said, “We are all grateful for what your board does, what the staff does on a daily basis. We have an excellent, first-class group of professionals. I say that as someone who saw the work on the other side, the work that is done for people who are vulnerable. It enhances the quality of life in our community.”

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Jefferson County Commissioners proclaim June 15 as World Elder Abuse Awareness Day

Montgomery woman sentenced for senior abuse

A former employee of a Union County memory care center who with a juvenile took inappropriate pictures of elderly residents will be under court supervision for 16 years, Judge Michael Piecuch ruled Monday after rejecting a more lenient plea deal last month, PennLive.com reported.

Madison Elaine Cox, 19, of Montgomery, was ordered to spend the first three months in jail, followed by 18 months of house arrest under electronic monitoring.

The original plea agreement rejected by Piecuch recommended a prison sentence of three years to two years minus a day, followed by three years’ probation.

You failed the test of human decency – I’ll never know why,” Piecuch told Cox, questioning whether she understood the depth of her actions, warning that she may someday be in the hands of strangers, PennLive.com said.

Her actions and inactions caused lasting psychological damage, the judge said.

Cox pledged it would never happen again and told the court that she’s trying to do better every day, PennLive.com reported.

Cox and a boy also from Montgomery each worked the 4 p.m. to midnight shift at Heritage Springs Memory Care Center near Lewisburg as resident assistants.

In February, Cox admitted to taking disturbing pictures and videos of at least 12 patients between the ages of 69 and 100, while she worked at Heritage Springs Memory Care Near Lewisburg, a senior living facility for people with Alzheimer’s and other types of dementia. Some of the photos showed patients partially clothed or nude, authorities said, according to PennLive.com.

He has been adjudicated but because he is a juvenile his record is not public.

“You stole my mother’s dignity. You stole our family’s peace. I hope today’s sentence will make it clear to you that this is not acceptable to this community or to any other decent human being…,” Lynn Fiedler, whose 94-year-old mother was one of the victims, said to Cox during the hearing, per PennLive.com.

Fiedler has taken the lead in forming a task force whose goal is to strengthen state laws so that elder abuse crimes are felonies, with their sights set on revising two Senate bills, one of which would require a registry for elder abusers like the requirement for sex offenders. They hope that the bill will be named for Fiedler’s mother Alice, PennLive.com said.

A state Department of Human Services investigation resulted in the revocation of the certificate of compliance for Heritage Springs and the issuance of a provisional one, with the department finding violations including insufficient and inadequate staffing at times and staff members making sexually inappropriate comments to and harassing residents, PennLive.com reported.

Later inspections found the secure dementia care facility again was in compliance and its regular license was restored on April 15, per the news organization.

The facility has since revised its hiring policy, requiring all, except dietary employees, to be at least 18 years old and have a high school diploma or GED. A revised cell phone policy now requires staff to keep their devices in their vehicles or in a locked storage bin with access permitted only on break or lunch, according to PennLive.com.

In addition to her prison and home detention sentences, Cox was ordered to pay a fine of $200 and undergo 39 months of intensive probation. She is also prohibited from being unsupervised or employed in anything that involves seniors or minors.

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Montgomery woman sentenced for senior abuse

From autonomy to guardianship: Policy reviews medical decision-making options

by Dennis Z. Kuo, M.D., M.H.S., FAAP, and Renee M. Turchi, M.D., M.P.H., FAAP 

When youth with intellectual and/or developmental disabilities (IDD) reach the age of majority (typically age 18), they may need support in making medical decisions.

The process of pursuing alternative decision-making supports, including guardianship, is stressful for youth and caregivers.

The new AAP policy statement Considerations for Alternative Decision Making When Transitioning to Adulthood for Youth With Intellectual and Developmental Disabilities provides guidance for pediatricians to support conversations with youth and their caregivers.

Pediatricians are encouraged to uphold human rights and human dignity for youth with IDD. These youth have the right to be recognized as persons before the law and to enjoy legal capacity in all aspects of life on an equal basis with individuals without disabilities, according to the United Nations Convention on the Rights of Persons with Disabilities.

The policy, from the Council on Children with Disabilities and the Committee on Medical Liability and Practice Management, is available at https://doi.org/10.1542/peds.2024-066841 and will be published in the June issue of Pediatrics.

Continuum of support

Approximately one in six children (17%) between the ages of 3 and 17 years has a developmental disability (Zablotsky B, et al. Pediatrics. 2019;144:e2019081).

When these youth reach the age of majority, their ability to make health care decisions falls on a continuum from being fully autonomous to needing guardianship (legally recognized, fully substituted decision-making). In addition, states may recognize levels of supported decision-making in between these two extremes for individuals who are not fully incompetent but need assistance to make some decisions.

Youth are presumed to have the capacity to make decisions until proven otherwise, and balancing autonomy with appropriate supports is paramount. Pediatricians are encouraged to be familiar with local resources supporting youth with IDD and their autonomy, which may vary substantially by state (http://www.supporteddecisionmaking.org/).

Individuals with IDD who use supported decision-making report increased confidence in themselves and their decision-making, improved decision-making skills, increased engagement with their community and more control of their lives.

Support teams (including the youth, caregivers, teachers and pediatricians) should engage in transition planning, ideally starting between 12 and 14 years of age, to identify and develop resources to support the maturing youth’s capacity for independent decision-making.

If fully autonomous decision-making is not considered appropriate at the age of majority, the pediatrician is encouraged to raise consideration of alternative decision-making supports early enough to allow the youth and caregiver to consider different levels of supports available to them. The goal should be the least restrictive alternative, while preserving the youth’s human rights and human dignity and promoting autonomy.

The policy statement describes terms, concepts and legal requirements to help families navigate health care transition for youth with IDD. Such concepts include:

• supported decision-making, e.g., choosing a trusted person to attend medical appointments and talk through treatment options;
• other less restrictive alternatives, e.g., allowing a caregiver to access the youth’s medical record;
• health care power of attorney, a legal document that gives someone the right to make health care decisions for someone else in specified circumstances; and
• guardianship, a legal process that is the most-restrictive option when the youth is deemed unable to make decisions.

Key recommendations

• Preservation of human rights and human dignity for all youth is essential while promoting patients’ autonomy.
• Pediatricians should advocate for the least restrictive decision-making environment for their patients.
• Pediatricians can promote and support the developing autonomy of all patients by engaging them in conversations about care decisions while accounting for the youth’s intellectual or developmental ability to express preferences and understand decisions about different aspects of their care.
• Pediatricians can be aware of different levels of decision-making support for youth and partner with care teams, legal advocates, families and youth in determining the right types of support needed. They also can be familiar with local and state resources supporting disability and autonomy for youth with IDD, including medical-legal partnerships, and refer when appropriate.

Dr. Kuo and Dr. Turchi are lead authors of the policy statement and members of the AAP Council on Children with Disabilities.

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From autonomy to guardianship: Policy reviews medical decision-making options

Apology by convicted elder abuser not accepted by victim's daughter

By Justin Strawser

LEWISBURG — An apology offered in Union County Court by the 19-year-old former resident aide who pleaded guilty to extensive elder abuse was not accepted by family of a victim.

On Tuesday, Madison Laine Cox, of Pinchtown Road, Montgomery, was sentenced to three months in jail, followed by 18 months of house arrest with electronic monitoring and 171 months of probation. Cox pleaded guilty in February to 12 misdemeanors: one count of criminal conspiracy to commit abuse of a care-dependent person and 11 counts of abuse of a care-dependent person at Heritage Springs Memory Care in Lewisburg.

Cox apologized and stated she did not have any reasons for her behavior.

“I intend to do better with my future and not make the same mistakes ever again,” Cox said to Union County Judge Michael Piecuch. “I want you to know I will work hard every day to become a better person.”

Lynn Fiedler, the daughter of elder abuse victim Alice Longenberger, did not believe her mother’s abuser.

“I feel that it was very empty,” Fiedler said. “A very empty apology.”

Fiedler and her son, Brandon Fiedler, read victim impact statements before the sentencing. Alice Longenberger is 94 and has dementia.

“It is very hard for me to be up here and not say anything unprofessional to you all on the other side, especially you, Madison Cox, in light of the last time we were all here,” Brandon Fiedler said. “Excuses and zero remorse were shown. It’s truly sickening. But you don’t care. The last time we were here, I watched as you were laughing, smiling with your friends while waiting for the judge to come out of the courtroom. The only true remorse is that you got caught.”

They said Alice Longenberger has suffered both physically and mentally due to the abuse.

“You may not care when the lights are not on you, but you will care now because the public will judge you very harshly from this day forward,” Brandon Fiedler said. “Everywhere you go it will follow you and people will know. My family can finally go back to their lives after this is over, however, we will always have a heavy wound that time will never heal.”

The victims, Lynn Fiedler said, are not only the Heritage Springs patients but their families, their friends and the community itself.

“People are horrified by what you did and are deeply hurt and emotionally distraught by the suffering you have caused,” she said. “You have hurt people, Madison. I don’t think you have any idea or understanding of how far reaching your abuse goes and how much pain you have caused for so many people. Or maybe you simply don’t care.”

Fiedler criticized defense attorney Graham C. Showalter, of Lewisburg, for saying Cox did not take nearly as many photographs as her juvenile codefendant.

“I’m wondering how many pictures of naked elders being demeaned and victimized is OK?” she said. “One? Two? Three? Because to me, and I can safely say to everyone in this courtroom with the exception of you, your family and your attorney, the answer is zero as it is to any decent human being.”

Alice Longenberger’s dignity her family’s peace were stolen, Lynn Fiedler said.

“I hope that today’s sentence will make it clear to you that this is not acceptable to this community or to any decent human being and that you are punished to the fullest extent of the law,” she said. “You deserve no leniency.”

Fiedler had mixed feelings about the sentencing.

“I’m pleased and I’m disappointed at the same time,” she said. “I’m pleased in the sentencing in that it is the most we can do under the current laws in Pennsylvania. I’m disappointed in that the laws are not stricter and there wasn’t more of a punishment.”

Fiedler thanked Piecuch, District Attorney Brian Kerstetter and friends, families and supporters. Fiedler has been working with State Sen. Lynda Schlegel Culver, R-27, as part of an elder abuse task force to change the laws, including one that would place elder abusers on lists like sexual offenders are placed on lists.

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Apology by convicted elder abuser not accepted by victim's daughter