Good Medical Care for the Elderly and How to Get It

Making Decisions about When to Stop Driving

Jane Gross wrote in the New York Times recently about the angst primary care doctors face when   confronting a patient and family about whether an aging patient should still be driving. Questions raised are:

When is it time for someone with physical or cognitive problems to give up the car keys?

Who makes that decision?

How can it safely and compassionately be enforced?

Gross provided a link to a comprehensive and thoughtful handbook published by the American Medical Association in collaboration with the National Highway Traffic Safety Administration. Recently updated, the “A.M.A. Physician’s Guide to Assessing and Counseling Older Drivers” can be accessed by doctors and also family caregivers.

Palindrome - From AARP for all generations

A palindrome is a word that may be spelled the same backwards and forwards. My last name "Hannah" is a good example. AARP has published a video on YouTube that is a little different. It is named "Lost Generation" and begins with with sentences written on a blackboard, read aloud by a teenager. This video reads the exact opposite backwards as forward.  Not only does it read the opposite, the meaning is the exact opposite. It is a brilliant assemblage of thoughts and values.

This video was submitted by a 20-year old in a contest sponsored by AARP, and titled "u @ 50"  I'm told that this video won second place, but what could possible top this? The concepts are simple, and yet they are brilliant.

See Lost Generation here:

Continue reading "Palindrome - From AARP for all generations" »

There's been a lot of focus lately on how to avoid exploitation of the elderly and also domestic violence perpetrated by caregivers and/or family members.

Josh Ard, a noted elder law attorney who practices in Williamston, Michigan called to my attention an interesting case involving aspects of both issues (if one counts financial exploitation as a form of domestic abuse. I believe that financial exploitation is a form of abuse. See the Power and Control Wheel). In this case, the adultery and perjury of the elderly nursing home resident's husband trumped the lack of notice (and a false statement about notice) required by a guardianship petition filed by a granddaughter. The case occurred in Mississippi, but the concepts are equally applicable under Michigan law. These are the facts:

---

Ruby Chism Ellis, married to Bobbie Ellis since July, 2000, entered a nursing home in June, 2006. In 2008, Ruby’s granddaughter, Stephanie Chism Turner, filed a petition to be appointed as Ruby’s conservator. Stephanie represented to the court that she served the petition on Bobbie although she had not.

The court appointed Stephanie as conservator and, according to Bobbie, his first notice of the proceeding was when Stephanie showed up at the home with the conservatorship papers, demanding that he vacate the premises. Bobbie, for his part, had been carrying on an affair over the previous eighteen months, even moving his paramour into Ruby’s home.

After Stephanie moved money from Ruby and Bobbie’s joint account, placing it in a conservatorship account, Bobbie sought to have the conservatorship set aside or, in the alternative, to replace Stephanie as conservator. Bobbie argued that he was Ruby’s appointed agent under a power of attorney. It was at this point when Stephanie’s perjury became apparent.

A guardian ad litem was appointed who prepared a detailed report quoted at length in the appellate opinion. Significantly, the guardian ad litem found that Bobbie’s loyalties had been transferred to someone else and may once again. The trial court declined to dissolve the conservatorship, but ordered Stephanie to submit an accounting. The court noted that Mississippi law does not give a spouse preference in a guardianship proceeding and that any procedural deficiency in Stephanie’s appointment was resolved by later hearings. On appeal, the judgment was affirmed. The presence of a power of attorney does not deprive the court of jurisdiction and, although the court was displeased with the conduct of each party, the determining factor appeared to be Bobbie’s shifted loyalty.

You can read the appellate court's opinion (and the GAL's accounting) here. In re Conservatorship of Ellis, 2009 Miss. App. LEXIS 873, Appeal No. 2008-CA-01993-COA (December 8, 2009)

The opinion gives you the understanding about what types of conduct may fit into the pattern that will be helpful for the court in making an informed decision.

Some seniors struggle financially while trying to age in place. The Financial Industry Regulatory Authority (FINRA) recently advised senior homeowners to proceed with caution before using reverse mortgages to access their home equity. The group warned that a reverse loan--meaning that a bank makes payments to a homeowner instead of the homeowner making payments to a bank--can be a risky financial move.

On January 30, 2008 the Wall Street journal reported an important change to the tax code. A cherished tax break is the exclusion of as much as $500,000 of gain from gross income when, as a one-time event, a couple sells their principal residence as long as they file their tax returns jointly. (The exclusion is $250,00 for a single person). Yes, there are some conditions. You aren’t entitled to the exclusion unless you owned the home -- and lived in it as your primary residence -- for at least two of the five years prior to the sale.

Caring at Home has published a valuable article about how seniors can help prevent serious medical errors by paying attention and speaking up when they have questions about their care or the medications prescribed for them.

You can read and reprint this article here.

"To Prevent Health Care Errors, Patients are Urged to SPEAK UP"

The Boston Globe today (December 3, 2007) explores the complicated subject to DNR orders -- do not resuscitate orders. When are they appropriate? What if the elderly patient waits too long? What decisions must be made and how can they be made?

The problem is, says the Globe's writer Patricia Wen, many families aren't sure about how to discuss this difficult subject. Often they wait too long, and by the time it's obvious that this decision needs to be made, the elderly loved one is not mentally competent to execute the required documents.

My book Taking Charge: Good Medical Care for the Elderly and How to Get It, discusses end-of-life decisions, the Five Wishes (called by the Miami Herald "the Living Will with a Heart"), and how and when to have this difficult conversation with your elderly loved one.

The Boston Globe article, by Patricia Wen may be read here:

For many, 'Do Not Resuscitate' too painful to discuss
Relatives, doctors often delay in offering patients the option

Today, it's not unusual for Americans to live to be 90 or even 100. Problems occur when the elderly outlive their savings. Sometimes elderly parents own their own home and a reverse mortgage can help them stay there.

And now about the Baby Boomers -- one quarter of the US population. These folks are accustomed to the idea that their parents might bail them out from time to time, contribute to a down payment on a home, etc. And last, but not least, leave them an inheritance.

Well, it's not happening. Longevity means eating into capital. Not everyone is a Rockefeller. How do baby boomers feel about their parents spending what they'd counted on as an inheritance.\?

Read Hey Folks, You're Spending My Inheritance in the Fall 2007 issue of Dissent Magazine.

Charles Duhigg reports in the New York Times Health section on September 23, 2007 that private investors have purchased groups of nursing homes, reduced staff (often below minimum requirements), and cut other expenses. As a result, profits for the owners have increased, but quality of care is down, mobility and health of nursing home residents is compromised, and complaints to regulatory agencies are higher.

Families of patients who have died as a result of alleged negligence in such nursing homes increasingly find that complex corporate structures are like mazes and act to insulate the real owners of the facilities from any negligence that might be proven.

Read More Profit and Less Nursing at Many Homes

For help in choosing a safe nursing home for your loved one, see the resources in Appendix A of Good Medical Care for the Elderly and How to Get It. This and other appendices are online and yours to use without charge.

The New York Times revealed on April 21, 2007 that the Government Accountability Office (GAO) will release a report this week about the failure of federal health officials charged with oversight of nursing home regulations to impose penalties upon nursing homes repeatedly cited for “poor quality of care.” The net result is that nursing homes that should have been closed remain open and residents of those nursing homes continue to be abused.

The report notes that federal investigators found that a Michigan nursing home (unidentified) was still open even though it had repeatedly been cited for “poor quality care,” poor nutrition services, medication errors and employing people who had been convicted of abusing patients.

The US has about 16,400 nursing homes in which about 1.5 million people live on any given day. Annually, more than 3 million people receive nursing-home care. Medicaid and Medicare pay for more than two-thirds of this care. The cost is significant. In 2005, the most recent year for which figures are available, $122 billion was spent on nursing home care. 60% of that was paid for by Medicaid and Medicare.

I’ll be watching for this report and will post a link to it when it is released.

Read the NY Times article Oversight of Nursing Homes is Criticized

Technorati tags: caregiving, caregiver, family caregiver, nursing homes, nursing home, GAO, Government Accountability Office,

Exploitation of the elderly

There's been a lot of focus lately on how to avoid exploitation of the elderly and also domestic violence perpetrated by caregivers and/or family members.

Josh Ard, a noted elder law attorney who practices in Williamston, Michigan called to my attention an interesting case involving aspects of both issues (if one counts financial exploitation as a form of domestic abuse. I believe that financial exploitation is a form of abuse. See the Power and Control Wheel). In this case, the adultery and perjury of the elderly nursing home resident's husband trumped the lack of notice (and a false statement about notice) required by a guardianship petition filed by a granddaughter. The case occurred in Mississippi, but the concepts are equally applicable under Michigan law. These are the facts:

---

Ruby Chism Ellis, married to Bobbie Ellis since July, 2000, entered a nursing home in June, 2006. In 2008, Ruby’s granddaughter, Stephanie Chism Turner, filed a petition to be appointed as Ruby’s conservator. Stephanie represented to the court that she served the petition on Bobbie although she had not.

The court appointed Stephanie as conservator and, according to Bobbie, his first notice of the proceeding was when Stephanie showed up at the home with the conservatorship papers, demanding that he vacate the premises. Bobbie, for his part, had been carrying on an affair over the previous eighteen months, even moving his paramour into Ruby’s home.

After Stephanie moved money from Ruby and Bobbie’s joint account, placing it in a conservatorship account, Bobbie sought to have the conservatorship set aside or, in the alternative, to replace Stephanie as conservator. Bobbie argued that he was Ruby’s appointed agent under a power of attorney. It was at this point when Stephanie’s perjury became apparent.

A guardian ad litem was appointed who prepared a detailed report quoted at length in the appellate opinion. Significantly, the guardian ad litem found that Bobbie’s loyalties had been transferred to someone else and may once again. The trial court declined to dissolve the conservatorship, but ordered Stephanie to submit an accounting. The court noted that Mississippi law does not give a spouse preference in a guardianship proceeding and that any procedural deficiency in Stephanie’s appointment was resolved by later hearings. On appeal, the judgment was affirmed. The presence of a power of attorney does not deprive the court of jurisdiction and, although the court was displeased with the conduct of each party, the determining factor appeared to be Bobbie’s shifted loyalty.

You can read the appellate court's opinion (and the GAL's accounting) here. In re Conservatorship of Ellis, 2009 Miss. App. LEXIS 873, Appeal No. 2008-CA-01993-COA (December 8, 2009)

The opinion gives you the understanding about what types of conduct may fit into the pattern that will be helpful for the court in making an informed decision.

Seniors cautioned about reverse mortgages

Some seniors struggle financially while trying to age in place. The Financial Industry Regulatory Authority (FINRA) recently advised senior homeowners to proceed with caution before using reverse mortgages to access their home equity. The group warned that a reverse loan--meaning that a bank makes payments to a homeowner instead of the homeowner making payments to a bank--can be a risky financial move.

Aging in Place | A change in the tax law may help

On January 30, 2008 the Wall Street journal reported an important change to the tax code. A cherished tax break is the exclusion of as much as $500,000 of gain from gross income when, as a one-time event, a couple sells their principal residence as long as they file their tax returns jointly. (The exclusion is $250,00 for a single person). Yes, there are some conditions. You aren’t entitled to the exclusion unless you owned the home -- and lived in it as your primary residence -- for at least two of the five years prior to the sale.

Speak up and prevent health care errors

Caring at Home has published a valuable article about how seniors can help prevent serious medical errors by paying attention and speaking up when they have questions about their care or the medications prescribed for them.

You can read and reprint this article here.

"To Prevent Health Care Errors, Patients are Urged to SPEAK UP"

Do not resuscitate orders | A family's dilemma

The Boston Globe today (December 3, 2007) explores the complicated subject to DNR orders -- do not resuscitate orders. When are they appropriate? What if the elderly patient waits too long? What decisions must be made and how can they be made?

The problem is, says the Globe's writer Patricia Wen, many families aren't sure about how to discuss this difficult subject. Often they wait too long, and by the time it's obvious that this decision needs to be made, the elderly loved one is not mentally competent to execute the required documents.

My book Taking Charge: Good Medical Care for the Elderly and How to Get It, discusses end-of-life decisions, the Five Wishes (called by the Miami Herald "the Living Will with a Heart"), and how and when to have this difficult conversation with your elderly loved one.

The Boston Globe article, by Patricia Wen may be read here:

For many, 'Do Not Resuscitate' too painful to discuss
Relatives, doctors often delay in offering patients the option

Baby Boomers ambivalent about longevity in parents

Today, it's not unusual for Americans to live to be 90 or even 100. Problems occur when the elderly outlive their savings. Sometimes elderly parents own their own home and a reverse mortgage can help them stay there.

And now about the Baby Boomers -- one quarter of the US population. These folks are accustomed to the idea that their parents might bail them out from time to time, contribute to a down payment on a home, etc. And last, but not least, leave them an inheritance.

Well, it's not happening. Longevity means eating into capital. Not everyone is a Rockefeller. How do baby boomers feel about their parents spending what they'd counted on as an inheritance.\?

Read Hey Folks, You're Spending My Inheritance in the Fall 2007 issue of Dissent Magazine.

Choosing a good nursing home for your loved one

Charles Duhigg reports in the New York Times Health section on September 23, 2007 that private investors have purchased groups of nursing homes, reduced staff (often below minimum requirements), and cut other expenses. As a result, profits for the owners have increased, but quality of care is down, mobility and health of nursing home residents is compromised, and complaints to regulatory agencies are higher.

Families of patients who have died as a result of alleged negligence in such nursing homes increasingly find that complex corporate structures are like mazes and act to insulate the real owners of the facilities from any negligence that might be proven.

Read More Profit and Less Nursing at Many Homes

For help in choosing a safe nursing home for your loved one, see the resources in Appendix A of Good Medical Care for the Elderly and How to Get It. This and other appendices are online and yours to use without charge.

New report criticizes government oversight of nursing homes

The New York Times revealed on April 21, 2007 that the Government Accountability Office (GAO) will release a report this week about the failure of federal health officials charged with oversight of nursing home regulations to impose penalties upon nursing homes repeatedly cited for “poor quality of care.” The net result is that nursing homes that should have been closed remain open and residents of those nursing homes continue to be abused.

The report notes that federal investigators found that a Michigan nursing home (unidentified) was still open even though it had repeatedly been cited for “poor quality care,” poor nutrition services, medication errors and employing people who had been convicted of abusing patients.

The US has about 16,400 nursing homes in which about 1.5 million people live on any given day. Annually, more than 3 million people receive nursing-home care. Medicaid and Medicare pay for more than two-thirds of this care. The cost is significant. In 2005, the most recent year for which figures are available, $122 billion was spent on nursing home care. 60% of that was paid for by Medicaid and Medicare.

I’ll be watching for this report and will post a link to it when it is released.

Read the NY Times article Oversight of Nursing Homes is Criticized

Technorati tags: caregiving, caregiver, family caregiver, nursing homes, nursing home, GAO, Government Accountability Office,