I’m Here and You’re There: A Far Away Son and A Family in Need
The National Institute on Aging estimates that there are seven million long-distance caregivers in the U.S.
These are the people who receive calls in the night, at work, during a son’s soccer game, and often have no idea what to do. Their parents, once the solvers of all family problems, have developed problems of their own, all heart-wrenchingly real and difficult to fix.
Someone has fallen. There is a new diagnosis. The caregiver has vanished. The neighbor called to say Mom is wandering. Something has to be done.
This was the situation in which Brian found himself, situated in far-away Boston while both aging parents and a cancer-stricken brother rapidly unraveled in Illinois.
Something had to be done, indeed. Read More
A Moving Experience: A Special Boy On a Singular Journey
Most of us remember at least one occasion in childhood when we were the “new kid”. In this almost universal childhood story, there is a crazy casserole of new house, new room, new school, new teacher, new friends, and the unsettled feeling of not quite knowing where we belong.
These stressors were hard to measure in nine-year-old Kyle’s case. He cannot speak and can hear only a little out of one ear. His vision is poor. Walking is difficult for him and his muscles are weak. An accident at birth triggered for him a diagnosis of hypotonic cerebral palsy, which made moving from room to room difficult and moving from home to home exceptionally complex. Read More
Forgetful and Forgotten: When Hoarding and Dementia Collide
“I let things slowly get away from me.”
This is what Mildred told us as she teetered atop a pile of garbage at the front door of her suburban townhome.
Mildred, an 80-year-old woman, lived alone and had clearly experienced steady erosion in her cognitive status. She was unable to comprehend and respond to a series of overtures made by the village concerning the condition of her home. After Mildred failed to respond to several letters, a village employee paid a visit to the house. The employee attempted to discuss the violations with Mildred but it soon became apparent that she was unable to manage a clean-up that would, by necessity, be impressively large; she was in violation of countless ordinances. The village employee contacted the local Department on Aging who made a referral to LCG. Read More
Physician, Heal Thyself
The old proverb – Physician, heal thyself — while honorable in its original meaning, may not be quite so honorable in practice.
Imagine a physician, beset by psychiatric problems, who determines her best option is to treat herself.
Delusional, paranoid, in the throes of an unwanted divorce and thoroughly estranged from her children, Dr. S took out her prescription pad and went to work.
Dr. S. developed her own treatment plan for the paranoid schizophrenia that had de-railed her life and damaged her relationships. The results were disastrous. Her illness escalated and the tenuous control she once had over her unraveling life vanished entirely. Read more
Thirty Days and Counting: How Do the Medicare Readmission Rules Affect You?
The Medicare 30-Day Readmission rules have already inspired two law suits, one action filed by a class of Medicare patients (Bagnall vs. Sebelius) and the other filed by the American Hospital Association for non-payment of claims.
They have put hospitals and doctors squarely in the middle of uncomfortable government mandates and the patients who ultimately pay the bills.
The rules have further caused considerable consternation on the part of Medicare recipients, who now find themselves having to repeatedly ask what their hospital status might be (Inpatient? Observation?) on a day-to-day basis.
Suffice to say, the Medicare 30-Day Readmission rules, and the Affordable Care Act that inspired them, have only just begun to change the health care landscape. Read more
The Caregiver is Drunk and Other Stories: Auditing Care to Protect Both Client and Trust
“What do you want?”
We would learn rather quickly that this was Jane’s standard greeting. At the age of 84, her tolerance for small talk had been replaced with terse comments and plain-spoken sarcasm.
What we wanted, standing there at the door of her suburban home that day, was to audit her care. Jane had just resigned as her own trustee and her bank had taken over as successor. Not entirely certain that Jane’s level of care was still appropriate, the bank asked us to assess her overall wellbeing, care needs and living environment. Read more
It was an attorney who called and rather bluntly stated: “I have a client here in my office asking me to draw up Power of Attorney documents naming his neighbor as Agent. I told him I’m not going to do it.”
There are many clients in the world who plainly lack an appropriate, willing person ready to serve as Agent under the Powers of Attorney. There are perhaps fewer attorneys as direct as this one was about their disapproval of plans to appoint an acquaintance, such as a neighbor, a family friend or service provider, or even a geographically distant relative with whom the client has little contact. Read more
The Serious Consequences of ”Casual Care”: How Loose, Informal Arrangements Can Lead to Plan Derailment
Those who fail to plan, plan to fail.
But what about cases where the plan is carefully developed, well managed, and equipped with safeguards to prevent derailment? We like to believe our best-laid plans culminate in happy outcomes, and often, they do.
Any plan can and will fail, however, particularly when vulnerability intersects with exploitation.
Caution: When an individual is vulnerable, “casual care” can lead to disastrous results.
“Casual care” refers to the complex web of neighbors, acquaintances, service providers and others who occupy the periphery of a client’s life and then gradually or suddenly find a pivotal role for themselves in the care and oversight of a vulnerable person. They appear well meaning. They seem sincere and good-hearted. They offer to help…and help and help. If they charge for their service at all, their fees are well below industry standards. The informality of the arrangement feels familial and warm, and it’s hard to argue against nice, friendly helpers who charge next to nothing and take care of everything. Read more
Steve was a “frequent flyer”, to say the least. He called EMS service 96 times in 2011 and was on track to exceed this number in 2012. Steve, like so many others in the community, used 911 to compensate for enormous gaps in his care. Where he clearly needed a skilled facility placement, he limped along with the five daily hours of caregiver assistance the Department of Rehabilitation Services allowed him. Relatively young but mentally ill and confined to a wheelchair, Steve was not equipped to spend 19 hours alone each day. Read more
GPS for Life How Surround Care™ Leads the Way
Sammie, as he is known to all his friends, has risen to the rank of number one client – the valedictorian of his class. How has he done this? By using the most services? No. By paying the most money? No. He did this by embracing our concept of surrounding his life with care. The Surround Care™ concept brings in the services that mirror the ebb and flow of the family’s life. The Lifecare Management tracking system monitors progress and events to keep life steady. Obstacles always appear along the path – life happens and the global view is the fastest, most efficient and wisest way over, under, around or through the road hazards. Read More
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
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
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
A Welcome Diversion
George was in luck. He boarded the train to go visit his Mom in the nursing home when a bit of good fortune presented itself to him like a dollar bill on the sidewalk. There, a few seats up, was a ticket someone had left behind. George had not yet purchased a ticket, so this was like winning a small prize.
George walked over to the empty seat and took the abandoned ticket.
And then he was arrested. Read more
Dementia is a term that brings to mind a pleasantly confused, grandmotherly figure — sweet, gentle and easily re-directable. Adult children believe and trust that mom will only exhibit her most endearing qualities, be socially appropriate, and docilely follow the directions of her caregivers. But what happens when an already misfiring mind responds chaotically to the world around it, veering drastically from the peaceful path? Read more
The MetLife Study on Baby Boomers Transitioning into Retirement: Worries, Trends, and The Need to Plan
The MetLife Mature Market Institute initiated a series of studies to examine the Baby Boomer cohort in 2007. Baby Boomers, meaning those born between the years 1946 and 1964, are a significant demographic due to sheer numbers and, now, because they are reaching retirement age. Much has changed during the Baby Boomer lifespan, particularly with regard to the manner and timing of retirement, the number of years that retirement period might encompass and the degree of perceived certainty where financial resources are concerned. Where their parents may have had solid pensions and few worries about Social Security, those contemplating retirement today are thinking about whether or not to continue working longer than planned, to what degree they can count on the government, and just how long their money might last. Read more