The states have long been concerned with caregiver qualifications for nursing home employees. The elderly, whose health is failing, are at high risk for abuse, neglect, maltreatment, and assault by staff and even other nursing home residents. Accordingly, each state has enacted screening procedure to conduct thorough background checks on staff, and in many cases residents, prior to granting them access to the facilities. Yet, as USA Today reports, this high degree of caution has failed to translate to office workers in nursing homes. Unfortunately, the lack of proper screening procedures, has resulted in thousands, if not millions of dollars, in fraud. Read the full story here.

This timely reminder of the vulnerability of elderly is just another reason that CLBB’s work on understanding decision-making by the elderly is essential. If you are interested in learning more, please attend our symposium on 12/12/13 on Capacity, Finances, and the Elderly: Brain Science Meets the Law.

Source: USA Today, December 1, 2013.

As the incidence of cognitive impairment increases with advancing age, a larger number of our elderly population will suffer some variety of dementing disorder.  Causes include Alzheimer’s disease, multi-infarct dementia, and a variety of other disease states.  Effects can vary to very subtle to severe.  At some point, cognitive impairment may limit an elder adult’s ability to make decisions.  These limits may be in specific domains, such as financial or medical.

Alternatively, cognitive limitations may be more global in nature.  Some elder adults had the foresight to record specific beliefs prior to any cognitive disease.  Health care proxies, living wills, or financial power of attorney document an individual’s choices at an earlier time point.

But many adults do not put their wishes in writing.  Also, adults are free to change their opinion at any point.  The question must then be asked: at what point does cognitive impairment limit a person’s capacity to make decisions?  There is not one simple answer.  The level of scrutiny varies with the task.  For example, making changes to a will generally only requires a low level understanding of one’s estate and heirs.  Other tasks, such as consenting to a complicated medical treatment, will require far more understanding.  Thus, the level of scrutiny is much higher. But where should society draw the line between protection and paternalism?

These and other issues were addressed by a panel at this year’s Annual Meeting of the American Academy of Psychiatry and the Law (AAPL), which took place in San Diego, California on October 24-27, 2013.  The panel, entitled “Impaired Medical Decision-Making in Older Patients,” included a lively discussion between Stephen Read, M.D. of the Department of Psychiatry and Biobehavioral Sciences at UCLA; Debra Pinals, M.D., the Assistant Commissioner of Forensic Services for the Massachusetts Department of Mental Health; Phillip Resnick, M.D., the Director of the Forensic Psychiatry Fellowship at Case Western Reserve; Sherif Soloman, M.D., an Assistant Professor of Psychiatry at Case Western Reserve; and Robert Weinstock, M.D., the Director of the UCLA Forensic Psychiatry Fellowship Program.

Continue reading »

After several rounds of motions and appeals looking to delay or prevent incarceration, Anthony D. Marshall, the 89-year-old son of Manhattan billionaire Brooke Astor, has begun a prison sentence for stealing millions of dollars from his mother.

Marshall was convicted in 2009, alongside Astor family lawyer Francis X. Morrissey Jr., of altering his mother’s will to leave himself tens of millions of dollars. Astor, who died in 2007 at the age of 105, was more than 100 at the time and suffering from Alzheimer’s.

The case has raised awareness of both elder abuse and the potential legal complications resulting from Alzheimer’s and dementia—and old age continues to be a theme in the case. Lawyers for Marshall, who suffers from Parkinson’s and heart problems, released a statement lamenting that the octogenarian must serve prison time. “Incarceration will simply make his final days more tortured and undoubtedly fewer in number,” it said.

Read more at the New York Times. 

ABSTRACT: The appointment of a healthcare proxy is the most common way through which patients appoint a surrogate decision maker in anticipation of a future time in which they may lack the ability to make medical decisions themselves. In some situations, when a patient has not previously appointed a surrogate decision maker through an advance directive, the healthcare team may ask whether the patient, although lacking the capacity to make a healthcare decision, might still have the capacity to appoint a healthcare proxy. In this article the authors summarize the existing, albeit limited, legal and empirical basis for this capacity and propose a model for assessing capacity to appoint a healthcare proxy that incorporates clinical factors in the context of the risks and benefits specific to surrogate appointment under the law. In particular, it is important to weigh patients’ understanding and choice within the context of the risks and benefits of the medical and interpersonal factors. Questions to guide capacity assessment are provided for clinical use and refinement through future research.

Source: The American Journal of Geriatric Psychiatry 21:4, April 2013, pp. 326-336.By Jennifer Moye, Ph.D., Charles P. Sabatino, J.D., Rebecca Weintraub Brendel, M.D., J.D.

[Read the full paper]

Recently, Massachusetts Attorney General Martha Coakley took the unusual step of warning the Massachusetts elderly about a widespread telephone scam. In these so called “grandparent scams,” someone who claims to be a relative calls to say that a grandchild or family member is in trouble and instructs the target to wire money in order to help. To back this claim, callers offer demographic information easily obtained on the internet, or information inadvertently provided by the victim while on the telephone. Continue reading »