New York’s New Family Health Care Decisions Act

On February 27, 2010, In Aging in America, Caregiving, Caring for an aging parent, Elder Law, By David Goldfarb

Up until now, New York, like many other states only allowed an agent or surrogate to make health care decisions for an incapacitated person, including end of life decisions, if the incapacitated person had previously signed a health care proxy appointing the agent to make those decisions.   It was a common misconception by many family members that they could act as the health care decision maker because they were the next of kin. However, all that is expected to change in New York this year under the New Family Health Care Decisions Act.  The law has been passed by the NY State Senate and Assembly and awaits the Governor’s signature.

The new law would establish procedures authorizing family members, or other persons close to patients who lack decision-making capacity, to decide about treatment, in consultation with health care professionals and in accord with specified safeguards.  It includes procedures and standards for decisions about life sustaining treatments.

The new law applies to health care decisions for care provided in a hospital.  However,  if the patient has a health care proxy designating an agent, then the health care proxy law applies. Similarly if there is a guardian (appointed in the Surrogate’s Court) for someone with Developmental Disabilities, then decisions for that patient are governed by the guardianship law.

An adult patient with capacity can make his or her own decisions. For the new law to come into effect there must be a determination that the patient lacks capacity.  First, the attending physician makes the determination.   In a residential health care facility, at least one other health or social service practitioner must concur. In a general hospital, this concurrence is required for a surrogate decision to forgo life-sustaining treatment. Hospitals must adopt written policies identifying the training and credentials of professionals qualified to provide the concurring opinion.

If there is any indication that the patient can understand the information, then he or she must informed of the determination of incapacity. If the patient objects, then the patient’s objection prevails, unless a court determines otherwise.

The list of persons who may act as a surrogate are in order of priority: A court-appointed guardian, the spouse or domestic partner, a child older than 18, a parent, a sibling or a close adult friend or relative familiar with the patient’s personal, religious and moral views regarding health care. Administrators, employees and independent contractors of the hospital caring for the patient are excluded, unless they are related to the patient, or were a close friend of the patient before the patient’s admission to the facility.

The surrogate under the new law has authority to make all health care decisions for the patient that the patient could have made for himself or herself. The surrogate will be given medical information and records necessary to make an informed decision.

Another section of the law establishes a procedure for making health care decisions for adult patients who have lost decision-making capacity and have no available family member or friend to act as a surrogate. It applies the same standards and safeguards. The section authorizes the attending physician to decide about routine medical treatment for patients without surrogates. For decisions about major medical treatment, the attending physician must consult with hospital staff directly involved with the patient’s care and at least one other physician selected by the hospital must concur in the appropriateness of the decision. However, in these instances there are special requirements for withholding or withdrawing life-sustaining treatment: The law requires approval by a court or the attending physician to determine that life-sustaining treatment offers the patient no medical benefit because the patient will die imminently, and the provision of life-sustaining treatment would violate acceptable medical standards. Where there is no court approval, one other physician must concur in this determination for life sustaining treatment to be withdrawn or with held.

This new act  if signed into law will dramatically change the health care decision-making process in New York for persons who lack capacity.

Attorney David Goldfarb of New York

Attorney David Goldfarb of New York

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Grumpy Old Man

On February 27, 2010, In Aging in America, Caregiving, Senior Living, Skilled Rehab/Nursing Homes, By SilverCensus

Later, when the nurses were going through his meager possessions, they found this poem. Its quality and content so impressed the
staff that copies were made and distributed to every nurse in the hospital. One nurse took her copy to Missouri. The old man’s sole bequest to posterity has since appeared in the Christmas edition of the News Magazine of the St. Louis Association for Mental Health. A slide presentation has also been made based on his simple, but eloquent, poem.

And this little old man, with nothing left to give to the world,
is now the author of this ‘anonymous’ poem winging across the Internet.

Crabby Old Man

What do you see nurses? . . . .. . What do you see?
What are you thinking . . . . . When you’re looking at me?
A crabby old man .. . . . . Not very wise,
Uncertain of habit . . . . . With faraway eyes?

Who dribbles his food . . . . . And makes no reply.
When you say in a loud voice . . . . . ‘I do wish you’d try!’
Who seems not to notice . . . . . The things that you do.
And forever is losing . . . . . A sock or shoe?

Who, resisting or not . . . . . Lets you do as you will,
With bathing and feeding . . . . . The long day to fill?
Is that what you’re thinking? . . . . . Is that what you see?
Then open your eyes, nurse . . . . . You’re not looking at me.

I’ll tell you who I am. . … . . . As I sit here so still,
As I do at your bidding, . . . . . As I eat at your will.
I’m a small child of Ten . . . . . With a father and mother,
Brothers and sisters . . . . . Who love one another.

A young boy of Sixteen . . . . With wings on his feet.
Dreaming that soon now . . . . . A lover he’ll meet.
A groom soon at Twenty . . . . . My heart gives a leap.
Remembering, the vows . . . . . That I promised to keep.

At Twenty-Five, now . . . . . I have young of my own.
Who need me to guide . . . . . And a secure happy home.
A man of Thirty . … . . . My young now grown fast,
Bound to each other . . . . . With ties that should last.

At Forty, my young sons . . . . . Have grown and are gone,
But my woman’s beside me . . . . . To see I don’t mourn.
At Fifty, once more, babies play ’round my knee,
Again, we know children . . . . . My loved one and me.

Dark days are upon me . . . . . My wife is now dead.
I look at the future . . . . . Shudder with dread.
For my young are all rearing . . . . . Young of their own.
And I think of the years . . . . . And the love that I’ve known.

I’m now an old man … . . . . And nature is cruel.
Tis jest to make old age . . . .. . Look like a fool.
The body, it crumbles . . . . . Grace and vigor, depart.
There is now a stone . .. . . Where I once had a heart.

But inside this old carcass . . . . . A young guy still dwells,
And now and again . . . . . My battered heart swells.
I remember the joys . . . . . I remember the pain.
And I’m loving and living . . . . . Life over again.

I think of the years, all too few . . . . . Gone too fast.
And accept the stark fact . . . . That nothing can last.
So open your eyes, people . . . . . Open and see.
Not a crabby old man . . . Look closer . . . See ME!!

Remember this poem when you next meet

An older person who you might brush aside

Without looking at the young soul within.

We will all, one day, be there, too!

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Age, Experience, and Wisdom

On February 24, 2010, In Aging in America, Caregiving, Uncategorized, By Steffan Lozinak

One thing that cannot be argued is the more years a person has under their belt the more opportunity for experiences they have encountered. I at my current age find it almost beyond comprehension to see world move from generation to generation, even though I have seen it a little bit. I still get nostalgic when I think about the TV shows I used to watch when I was a kid. I laugh at the thought of life without the internet, though, I didn’t always have it. Even my computer has become a near inseparable part of my life.

Yes, there is no doubt that time grants an individual the opportunity to experience so much, and gives them the opportunity to learn from each and every one of those experiences. This brings me to my main point of this particular blog, and that is wisdom. Though age plays a big part into the opportunity to learn, it definitely only plays a part. In fact, there are 4 major factors that go into how wise a person is.

Factor Number One: AGE
The amount of time an individual has been around granting them the opportunity to gain so many experiences. Oh the stories to be told from 50 years back. Can I even imagine life where candy is a dime? Or how scary it would be to be drafted? Even if a person is lacking in the other factors I will discuss, this factor alone gives a person a wide range of experiences and the ability to see the world transform, right in front of their eyes. This is an incredible opportunity.

Factor Number Two: ABILITY TO PERCIEVE
This factor is a little more difficult to understand, but it is essentially saying that each person takes in a different amount of information every second. In this way, the actual physical age is somewhat deceiving. Let’s say that person A has the ability to perceive twice as much as person B. What this means is that in an equal time of say 4 years.. Person A will have essentially lived twice as much as person B. Person A will have had the opportunity to experience twice as much as person B, granting him that much more opportunity to learn.

Factor Number Three: Ability to Learn, Comprehend, Understand, and Grow, from their experiences
This factor can essentially be compared to the idea of an IQ, though it is so much more than just that. This is a person’s ability to actually learn from the things they go through. Without this, the first two factors are completely null and void. Sure a person may have a great deal of stories, but this doesn’t necessarily mean they learned from them. I am sure we can all relate with knowing somebody that has the same experience over and over again, because they never learn from it. This is an incredibly important factor, and just like factor two… makes a person age deceiving. A person that learns twice as quickly as another will essentially have twice the wisdom from the same amount of experiences.

Factor Number Four: COMPASSION“An intelligent man will learn from all he experiences. A wise Man will learn from all that is experienced”
This factor alone may be cause to the greatest disruption between the correlation of age and wisdom. This factor is greatly related to factor 3, and without factor 3 existing strongly, this one cannot be. But say a person is able to put himself into the figurative shoes of another. To quite essentially go through the experiences of another, and learn from them as if they were his own. To read a history book and feel everything each character goes through. To grasp the moral at the end of each story, even when there appears to be none. This multiplies a person ability to experience by essentially a countless number, as they are living through everyone.
So as we can see, a person with age may not always be the wisest person, though they certainly carry with them a great opportunity to be amongst the wisest. In addition to this, there is one gift age grants that cannot be gained by factors 2 or 3, and that is range. And with range, comes a great deal of interesting stories, of which children that contain a great deal of factor four, can greatly learn from.

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Medicare and its Future

On February 23, 2010, In Market Trends, Retiree, Uncategorized, By Steffan Lozinak

I recently read an article and watched a video about Medicare, in specific giving to the wealthy,(the links for the video and article are included at the bottom of this blog). To sum it up in short, what the article was saying is that Medicare is helping senior citizens who are living in resorts with entry values of $350,000 and greater, covering much of their costs. It also goes on to talk about how Medicare seems to be a failing ponzee scheme that is getting worse as time goes on, as the population is supposed to cover grows in number.
I will tell you this article peaked my interest, and perturbed me a little bit. I honestly feel that every person in this country should be guaranteed certain rights from birth including; basic food, basic shelter, and basic medical care. In this aspect, I think programs like food stamps and Medicare are wonderful in idea, but should cover everybody. In addition to this, they should only cover the basics. This still grants plenty of diversity in what people could do as private practices and bigger houses could still exist. Of course preventing the “public” granted items from turning into slums would take a great deal of effort and care in and of itself.
To being this back to point, I feel Medicare is a great thing. However, just as I said with the rights above, it should only cover the basics, guaranteeing senior citizens at least (if not everybody), the right to proper medical care, and yes, assistance when it is needed.
The problem here then occurs with the idea of, “What is basic?” Many people live many different lifestyles varying significantly in range of cost. To someone in the upper fringe of society, they may consider there nightly appetizer of king shrimp and caviar basic. They may consider that 1 million dollar a year resort, basic.
Well I propose a very simple definition of basic. Basic equals what the average American is getting. What is actually NEEDED to survive, of course taking into account ethical issues, (A vegetarian shouldn’t be forced to eat meat). However, inability to do something, eat something, or live somewhere just because it doesn’t meet your “standard” is not ethical, and is beyond basic.
In the video, many seniors suggest it is our healthcare system that needs reformed, and not Medicare. The truth of the matter is it is probably a good mix of both. I am sure there is also a good deal of corruption involved considering the amount of lobbying that is done on behalf of much of the elderly, but this is an issue with lobbying and not with Medicare.
Do I think Medicare is a good idea? I most certainly do! Do I think people are taking advantage of it? Yes I do. Do I think our healthcare needs reform? Again, a big yes! But to change things in government, first we need to want that change, not just the people getting taken advantage of, but those taking advantage. Let’s all help each other, and come up with the best possible solution, medical and all, for each of us, at all ages. We need to work to make our country the best it can be for everyone, of all ages, now, and to come.

http://abcnews.go.com/video/playerIndex?id=7541159

http://abcnews.go.com/2020/Stossel/story?id=7522306&page=1

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Prosperity Oaks – Palm Beach Gardens, Florida Tour Review

On February 23, 2010, In Aging in America, Assisted Living, Caregiving, Independent Living, Senior Living, Senior Tour Reviews, By SilverCensus

Prosperity Oaks of Palm Beach Gardens displayed a “resort style” type of care home. As I pulled into the community, the cascading trees that surrounded the glassy black pavement already made me feel as if I was no longer in West Palm Beach. The vast and flourishing habitat that confined the establishment gave me a sense of comfort and relaxation. When I entered into the concourse at Prosperity Oaks I couldn’t believe how elegant and spacious it was. Surrounding the concierge desk were easily accessible common areas, a grand piano (which one of the residents was displaying his talent), flat screen televisions and a marketplace convenience store. After meeting with Wendy Paige; the wonderful community relations coordinator at Prosperity Oaks.  She showed me the variety of features that Prosperity Oaks provides. One of the most attractive facets are the apartments. The bedrooms are large and the living areas more expansive than most college rentals I’ve quartered in. The services and activities that Prosperity Oaks offer seemed very suitable and amusing for the residents. The facility sits on over 28 acres and is full of outdoor enjoyment, including a personal garden that each resident can grow, maintain, and harvest. This provides an extraordinary freedom for the residents that I found fantastic. Prosperity Oaks offers each individual and their families a much needed peace of mind.
1-888-797-7734 To Schedule a Tour Today!

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