A plea to Elder Law attorneys and others who are writing people’s Advance Directives

For the record, I am a fan of lawyers and am incredibly grateful for all the ways they take care of us and protect us.

When someone wants to document their wishes in an advance directive, living will or durable power of attorney, the person who will be signing the form must have the ability to think for themselves. This is called decisional capacity or competency. Although a person doesn’t need to use a lawyer for these forms many people do. When someone brings in a form, which was completed by a lawyer, healthcare professionals assume that the lawyer made sure that the person had the capacity to think before allowing them to sign the form.

I don’t know if other people are aware of this issue but it has been recently brought to my attention that there is an industry practice within elder law community where lawyers are writing advance directives for people without capacity. They work with the family to determine what the person would have said, then proceed to have the person, who has limited or no capacity, sign the advance directive. (Not every attorney does this, but many do. There are many fine lawyers out there who are protecting the public.)

Their justification is that it is actually protecting the family from having to go to court to establish conservatorship later on. Their intentions are good, but their practice is illegal. When I brought this to some elder law lawyer’s attention, they had no defense. And when I explained that it now brought doubt to the validity of all legally prepared advance directives, I only got blank stares.

I have asked around and this is not an isolated incident. It makes me now question if I can even believe a lawyer prepared document that the family brings in. As an ethicist and healthcare professional, I am asking those of you who work in the industry to make sure you are only having those who understand what they are signing, sign their documents. The skilled nursing home community has a legal protection in place by mandating that an outside ombudsman witness the signing of legal documents to make sure those with disabilities aren’t being taken advantage of. I would hate to see the legal community need to have a similar watchdog in place. I need all of you to do the right thing so I can then use these documents to advocate appropriately when these individuals are in my hospitals.

Have a kind and respectful day.

Long Term Care Ombudsman of St. Louis will be hosting a presentation on empowering Caregivers to Make Better Decisions on July 22, 2010

Long Term Care Ombudsman of St. Louis will be hosting a presentation on empowering Caregivers to Make Better Decisions on July 22, 2010 from 10am to 12pm.

The Long Term Care Ombudsman Program of Saint Louis (LTCOP), a United Way agency, is part of a nationwide program which began in 1971 in response to public outcry over abuse and neglect in long-term nursing home facilities. Since its inception there are now over 500 Ombudsman Programs across the United States. LTCOP is the area’s most comprehensive resource that serves residents of licensed long-term care nursing homes and their families.

The St. Louis Long-Term Care Ombudsman Program is comprised of professional and specially trained staff and volunteer ombudsman who are assigned to long term care nursing home facilities weekly, getting to know residents and providing advocacy, support, and education about their rights. When requested, ombudsmen act as a voice for resident treatment and care. Ombudsmen can help mediate resolution of grievances and disputes, make referrals and monitor the referrals to see that the problems are resolved. Ombudsman listen to nursing home residents concerns and complaints and work to educate residents about their rights while working with families and facility staff in resolving care and treatment plan issues.

Their mission is “To preserve the quality of life for long-term care residents by empowering residents and their families through education, advocacy and support.”

Have a kind and respectful day.

n4a Annual Conference & Tradeshow 7/18/10 and 7/19/10 in St. Louis

Viki will be attending the n4a’s Annual Conference and Tradeshow all day on July 18th and will be presenting on July 19th from 3:15-4:15pm.

The National Association of Area Agencies on Aging (n4a) is the leading voice on aging issues for Area Agencies on Aging and a champion for Title VI Native American aging programs. Through advocacy, training and technical assistance, they support the national network of 629 AAAs and 246 Title VI programs.

They advocate on behalf of their member agencies for services and resources for older adults and persons with disabilities. Action characterizes how they move their agenda forward, and when there is a question about aging, they have the Answers on Aging. They work with their members in achieving their collective mission of building a society that values and supports people as they age.

The n4a 2010 annual conference and tradeshow that runs from July 17-21, 2010 at the Hyatt Regency St. Louis at The Arch in St. Louis, MO will celebrate, showcase and facilitate the replication of the most innovative policies, programs and services that assist older adults and people with disabilities.

Have a kind and respectful day.

“Protecting the Nursing Home Resident – The job of the ombudsman” Interview with Molly Davies, August 18th, at 10AM pacific.

“Protecting the Nursing Home Resident – The Job of the Ombudsman” Interview with Molly Davies, August 18th, at 10AM pacific. Call in to listen live at (347) 945-5152 or listen online at blogtalkradio.com/kindethics.

After serving more than two years as a regional manager for the Long-Term Care (LTC) Ombudsman Program, two years as an Ombudsman care manager, and two years as a volunteer Ombudsman, Ms. Davies was named Program Director of the LTC Ombudsman Program in October 2006. She manages the Los Angeles County and City LTC Ombudsman programs and serves as the designated LTC Ombudsman “program coordinator” per state contract requirement.

In her capacity as program director, Ms. Davies oversees all aspects of the WISE LTC Ombudsman Program, including program development, implementing LTC policy changes, monitoring budgets and promoting the program to the public. She and her staff ensure that service delivery complies with all regulatory and contract guidelines and the policies and procedures that govern the program. She is responsible for monitoring and reporting on program performance monthly, maintaining a tracking system for reports of alleged elder abuse and assessing client satisfaction. She is also responsible for recruiting, training and evaluating ombudsmen. Ms. Davies holds a bachelor’s degree in Sociology from UCLA and is currently completing a master’s degree in Social Work at California State University Long Beach.

Have a kind and respectful day.

Ombudsman Program cut dramatically in California. With these cuts, you need to be more proactive about protecting your loved ones in nursing homes.

I don’t know if you know about a service that is provided free of charge to our nursing home residents. It is something called an ombudsman. (I have used the services of the Ventura County Ombudsman program when my aunt was in a nursing home.) The ombudsman is a specially trained person who protects the resident from being forced to sign something they don’t understand, protects them from elder abuse and protects them when they are receiving sub-standard care. I will be interviewing Molly Davies from the Los Angeles County Ombudsman Program, The WISE & Healthy Aging Long-Term Care Ombudsman Program, in August but I just wanted to let people in the Los Angeles area know about the effects of the budget cuts today. The office is down to 10 people who are protecting the 73,000 nursing home residents in Los Angeles County nursing homes. If you have a loved one in a nursing home in California, you need to be even more diligent about visiting and checking on your loved ones for the rest of this year. Hopefully, next years budget will better but for now, we all have to take on the role of the protector for our loved ones. Here is the statement from the Los Angeles County office.

Long-Term Care Ombudsman Program
Impact of the Governor’s Budget Reduction

The impact of the enacted 49% State budget cut to the local Long-Term Care Ombudsman Program (LTCOP) in California is devastating to the integrity of the services that are delivered and will negatively impact the residents that we serve. The WISE & Healthy Aging Long-Term Care Ombudsman Program is the sole contractor of Ombudsman Services in the City and the County of Los Angeles. The impact to this local program has been the loss of $1,109,783 in funding retroactive to July 1, 2008. In response we have eliminated 22 positions resulting in the reduction of staff from 32 to 10, and we have closed our Lancaster, Downtown LA, Burbank, and San Dimas regional offices. All remaining staff received a reduction in salary.

The following are conservative projected estimates of the reduction of our capability to deliver service to residents in long-term care.

Over 12,000 unannounced visits to nursing homes and board and care or assisted living facilities will not be conducted during this fiscal year, and every year thereafter.

Over 11,500 cases, including allegations of abuse and neglect will not be investigated during this fiscal year, and every year thereafter.

The LTCOP in California has three currently unfunded mandates that include the investigation of elder and dependant adult abuse investigations that occur in long-term care settings; the witnessing of advance health care directives for residents in skilled nursing facilities; and responding to the 24-hour State Ombudsman after-hours crisis line. Although these are unfunded mandates, we have managed to take on these tasks with out further compensation from the State of California, but may not be able to sustain these activities without restoration of our funding.

In the last fiscal year the WISE & Healthy Aging Ombudsman Program responded to 2,086 abuse complaints. Many elder abuse cases are identified during unannounced visits conducted by Ombudsmen, which will decrease proportionally with these enacted budget cuts.

The WISE & Healthy Aging Long-Term Care Ombudsman Program is the largest in the nation providing service to more than 1,816 facilities that have the capacity to care for 73,486 residents. The Ombudsman Program advocates for the rights of residents in long-term care facilities, and for many residents we are the only outside support they receive. The impact of these cuts effectively silences the voices of our most vulnerable constituents, residents in long-term care.

You may want to support the pending legislation AB 394 (Feuer and Jones) Protecting Vulnerable Seniors from Abuse and Neglect by Restoring Ombudsman Funding
AB 392 would use penalties paid by substandard nursing homes to help restore monitoring and advocacy by ombudsman programs. It is fitting that the penalty funds be used to support the ombudsman programs given their critical role in protecting residents’ health and safety.
Current law allows the penalty funds to be appropriated for ombudsman services. AB 392 would require that at least half of the penalty funds be allocated to local ombudsman programs each year in accordance with an existing formula.
Support AB 392 is co-sponsored by CANHR and the following organizations: AARP, Bet Tzedek Legal Services, California Alliance for Retired Americans, California Association of Area Agencies on Aging, California Senior Legislature, California Commission on Aging, Catholic Charities of California, Congress of California Seniors, and Ombudsman & HICAP Services of Northern California. Additionally, it is supported by local ombudsman programs and many other consumer organizations.

You may want to write or call your state senators.

Want More Information?
Use www.leginfo.ca.gov to find contact information for your Senator • and Assembly Member
and to keep track of AB 392’s progress.
• Visit CANHR’s website (www.canhr.org) for updates on all of CANHR’s legislation and to find
out how to become a CANHR Advocate.
• Call CANHR @ (800) 474-1116.

Have a kind and respectful day.