Everybody Has a Plan, so Why is There Guardianship?

In a perfect world, everyone would have a plan, and every part of it would come into effective play as we age and become less able to manage our own affairs. Those who are named as Trustees and Powers of Attorney for Health Care and Property would be alive, well, and ready to serve at the appointed time.

Real life can, however, offer some exceptions to this ideal. Sometimes the family members or friends designated to oversee our affairs are encountering health problems of their own, at precisely the time we need them. Occasionally, they pass away before we do. In some terrible instances, they will take our money and use it as their own. And, surprisingly, many people arrive at old age without ever having made a plan.  Read more…

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Day Program and Residential Placement Options and Related Funding Issues

In the process of assessing the circumstances surrounding the person with special needs, the individual uniqueness, particulars, peculiarities, and preferences, including the defining goals, values and beliefs of the person and the family unit will begin to come to light.   Undoubtedly each case presents differently.  One universal truth however, is that regardless of the type of disability, the person with special needs will have care requirements that span their entire lifetime.  While the nature of the needs may, and indeed in most cases probably will change over time, they will never go away.  These care needs are met via a combination of help and assistance provided at the home and community levels.  This chapter will focus on the two most commonly utilized community-based care options of day programming and residential placement.  These will be discussed from the perspective of the available programs across the lifespan, and the general accessibility issues related to the programs, including qualification criteria and funding.  Read more…

Home Design and Adaptations for Use for a Person with Special Needs

Home is the primary choice for all people regardless of age or disability.  Home provides the basis for interaction with the rest of the world; it is a starting point for the day, the place where relationships are built, and where long term physical and emotional healing occurs.  The primary motivating factor behind the healing work that patients engage in while hospitalized or in rehabilitation facilities is the motivation to return to their home.  Parents aim at the home as a goal for their young children, spouses for one another, and adults for themselves.  The physicians, nurses, therapists, and other staff also have the goal of their patients’ ability to return home as one the major factors that motivates their daily work and gives it meaning.  No one chooses to abandon the option of living at home just because their home does not readily accommodate their special needs.  Read more…

Medical and Nursing Care

Almost 50% of all individuals over the age of 65 will spend some time in a long term care facility in their lifetime.  Nursing homes serve the dual function of providing care as well as shelter.  The primary reason for admission into a facility is the need for care that the person is unable to obtain in an alternative setting. The care that is provided can be both low tech as well as more sophisticated at levels that can only be provided by licensed professionals.  Long term care encompasses help with activities of daily living (ADLS) such as bathing, dressing, eating, and toileting.  Services also include instrumental activities of daily living (IADLs) such as: shopping, managing medication, meal preparation, household chores, money management, and transportation.  The clients that are in nursing homes today generally need help in three or more activities of daily living and have multiple medical diagnoses. Read more…

Medical Issues and Terminology in Long Term Care

Long term care has evolved into a “catch all” phrase that is confusing to the lay as well as the professional community.  The boundaries among primary, acute, and long term care have blurred.  Instead of concentrating on acute care in hospitals, our health care system’s focus has switched to managing chronic conditions in a variety of settings from home to rehabilitation hospitals.  The long term care goal switches from curing illness to helping individuals function as well as possible while maintaining dignity and independence.   Individuals that require long term care have a compromised ability to live on their own due to their condition.  Long term care encompasses help with activities of daily living (ADLS) such as bathing, dressing, eating, and toileting.  Services also include instrumental activities of daily living (IADLs) such as shopping, managing medication, meal preparation, household chores, money management, and transportation.  The services provided are primarily low tech services that are designed to rehabilitate or compensate for loss of physical and/or mental functioning.  The IRS utilizes these same terms to outline long term medical care deductions for the chronically ill. They define qualified long term care services as when a person is unable to perform at least two activities of daily living without substantial assistance or they need substantial supervision to be protected from threats due to severe cognitive impairment. Read more…

Hoarding: When is an Alternate Decision Make a Prudent Choice?

The prevalence of hoarding is underestimated in our society, as is the impact to the person, their families, and to the community. Is hoarding an illness? Many say “yes”, therefore an understanding of this phenomenon is essential when working with those afflicted. Greater understanding leads to more effective treatment options and successful outcomes, improving the quality of people’s lives and decreasing the negative impact on society. The guardianship courts are challenged with these clients on a daily basis and yet a conceptual framework for addressing the needs of these distinctive wards is missing. As we gain knowledge we will be more equipped to find meaningful assessment tools, and affect outcomes for this population. Read more…

The Hoarding Dilemma: When and How to Help

The problem of hoarding has recently garnered a great deal of attention, particularly since becoming the subject of an A&E television show.  It is not, however, a new problem.  It pre-dates the Depression (and is not caused by Depression-Era upbringings), has been documented all over the world, and is believed to afflict 15 million Americans to a clinically-significant degree.  Hoarding causes trouble not just for the hoarder, but for everyone in their lives.  Paradoxically, allowing a hoarder to get into trouble rather than working to get them out of trouble may just be the key to lasting change. Read more…

Diversion: How to Combat Criminalization of Persons with Mental Illness

It is fairly safe to say that the U.S. mental health crisis is official.  From stories of young soldiers returning from Iraq to the elderly in nursing homes, tales of woefully insufficient programming are easy to find in the news today.  This has been increasingly the case, sadly, for several decades; and things are only getting worse.  While the plight of some mentally ill persons is deemed by the media to be more newsworthy, one group, those with mental illness and justice system involvement, escape much of the media attention.   America’s desire to punish instead of treat is so strong, that the mentally ill who get arrested, even for relatively petty, non-violent offenses, rarely have their stories told.   Further, they rarely have their needs met.   In this brief article, we will highlight the main issues, and then offer one perspective regarding what type of programming can provide a humane, cost efficient, and more effective piece of the solution. Read more…

HIPAA and Emergency Guardianships

Changes int he way private insurance companies, Medicare, and Medicaid pay for hospitalization has dramatically decreased the average Length of Stay (LOS) over the last two decades. Hospitals are required to transfer clients to levels of care that are less expensive as expeditiously as possible-if not, they will not be paid. In this task, they are required to make safe and appropriate discharges for all of their patients. Read more…

Life Care Planning – The Facts of Life

Ben Neiburger, JD, CPA

Shay Jacobson RN, MA, NMG

Trends in the Practice of Elder Law

We are finding two fact patterns converging: baby boomers are aging and medical care is continuing to evolve – expanding the length of life. At the intersection, we find the “New Age Old,” a population that is living longer with more conditions. As the baby boomers age, there will be a large segment of our population for whom chronic conditions become a fact of life. We used to call these people elderly, but we know that Baby Boomers will never consider themselves old no matter what is going on. Self-denial aside, as people age the estate plan becomes multidimensional as mapping out future needs must include the conglomeration of chronic conditions that challenge the individuals and their families. Long term planning takes on new meanings in this environment and the Elder Law Practitioner must adapt their practices to meet these needs.Read more…