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Note: Contents data are machine generated based on pre-publication provided by the publisher. Contents may have variations from the printed book or be incomplete or contain other coding.
TABLE OF CONTENTS Page Dedication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v Summary Table of Contents . . . . . . . . . . . . . . . . . . . . . . . . vii Chapter 1 AN AGING POPULATION: THE CHALLENGE TO THE LAW . . . . . . . . . . . . . . . . . . . . . . 1 A. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 B. Who Is Elderly? . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 C. Statistical Profile Of The Elderly . . . . . . . . . . . . . . . 4 D. Growth In The Population Over Age Eighty-Five . . . . . . 7 E. Aging Patterns By Gender . . . . . . . . . . . . . . . . . . . 8 F. Aging Patterns By Race . . . . . . . . . . . . . . . . . . . . . 9 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 G. Dependency Ratio . . . . . . . . . . . . . . . . . . . . . . . . . 10 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 H. The Physical Effects Of Aging . . . . . . . . . . . . . . . . . 11 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 I. The Challenge to the Law: The Unique Circumstances of the Elderly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 [1] Mortality: The Need For Haste . . . . . . . . . . . . . . 13 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 [2] Complications of Declining Physical and Mental Capacity . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 [a] Alzheimer?s Disease and Related Disorders . . . . . 14 Questions . . . . . . . . . . . . . . . . . . . . . . . . . 15 [b] Chronic Illness . . . . . . . . . . . . . . . . . . . . . . 16 Questions . . . . . . . . . . . . . . . . . . . . . . . . . 16 [c] Economic Vulnerability . . . . . . . . . . . . . . . . . 17 ix 0009 VERSACOMP (4.2 ) ? COMPOSE2 (4.43) 06/08/07 (17:45) ELDERLAW - Front Matter J:\VRS\DAT\03039\FM.GML --- LC3039FM.STY --- POST 69 Page [3] The Old Depend On The Promises Of The Young . . . 18 [a] Formal Assistance . . . . . . . . . . . . . . . . . . . . 18 [b] Family and Social Networks . . . . . . . . . . . . . . 19 Questions . . . . . . . . . . . . . . . . . . . . . . . . . 20 [c] Family Support Statutes . . . . . . . . . . . . . . . . 21 Question . . . . . . . . . . . . . . . . . . . . . . . . . 22 J. Conflicting Values: Autonomy Versus Protection . . . . . . 22 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 K. Generational Justice . . . . . . . . . . . . . . . . . . . . . . . 26 Lawrence B. Solum, To Our Children?s Children: The Problems of Intergenerational Ethics . . . . . . . . . . . . . 31 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 L. Age Discrimination . . . . . . . . . . . . . . . . . . . . . . . . 31 [1] Financial Justifications for Positive Age Discrimination . . . . . . . . . . . . . . . . . . . . . . . . 33 [2] Health Justifications For Positive Age Discrimination . . . . . . . . . . . . . . . . . . . . . . . . 34 M. The Right of the Elderly to Benefits . . . . . . . . . . . . . 35 N. Ageism and Self-Determination . . . . . . . . . . . . . . . . 36 Chapter 2 ETHICAL ISSUES AND LEGAL ASSISTANCE . . . . . . . . . . . . . . . . . . . . . . . 39 A. The Legal Needs Of The Elderly . . . . . . . . . . . . . . . . 39 B. Elder Law Practice . . . . . . . . . . . . . . . . . . . . . . . . 39 ALISON BARNES, A. FRANK JOHNS & NATHALIE MARTIN, COUNSELING OLDER CLIENTS . . . . . . . . . . . . . . . . . . 40 [1] Multidisciplinary Practice . . . . . . . . . . . . . . . . . . 41 George Steven Swan, Legal Education & Financial Planning: Preparation for the Multidisciplinary Practice Future . . . . . . . . . . . . . . . . . . . . . . . . 42 Questions and Comments . . . . . . . . . . . . . . . . . . 43 x TABLE OF CONTENTS 0010 VERSACOMP (4.2 ) ? COMPOSE2 (4.43) 06/08/07 (17:45) ELDERLAW - Front Matter J:\VRS\DAT\03039\FM.GML --- LC3039FM.STY --- POST 96 Page ALISON BARNES, A. FRANK JOHNS & NATHALIE MARTIN, COUNSELING OLDER CLIENTS . . . . . . . . . . . . . . . . . . 43 Problem: Elder-Comp Inc. . . . . . . . . . . . . . . . . . . . . 45 Questions and Comments . . . . . . . . . . . . . . . . . . 46 [2] Limited Purpose, Discrete Task Representation . . . . 46 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 [3] Paralegal Assistance . . . . . . . . . . . . . . . . . . . . . 48 ALISON BARNES, A. FRANK JOHNS & NATHALIE MARTIN, COUNSELING OLDER CLIENTS . . . . . . . . . . . . . . . . . . 48 [4] Pro Bono Assistance . . . . . . . . . . . . . . . . . . . . . 49 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 C. Counseling Older Clients . . . . . . . . . . . . . . . . . . . . 50 [1] An Overview of Issues . . . . . . . . . . . . . . . . . . . 50 ALISON BARNES, A. FRANK JOHNS & NATHALIE MARTIN, COUNSELING OLDER CLIENTS . . . . . . . . . . . . . . . . . . 50 [2] Interviewing and Recordkeeping . . . . . . . . . . . . . . 50 [3] Practical Concerns . . . . . . . . . . . . . . . . . . . . . . 51 [4] A View from Advanced Age . . . . . . . . . . . . . . . . 52 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 D. Ethical Issues For Attorneys With Older Clients . . . . . . 52 [1] Sources of the Ethical Standards . . . . . . . . . . . . . 53 [2] Who Is the Client: Family Representation . . . . . . . . 53 In re Guardianship of Lillian P. Cavey . . . . . . . . . 55 Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 [3] Confidentiality and Withdrawal . . . . . . . . . . . . . . 64 E. Mediation and Older Clients . . . . . . . . . . . . . . . . . . 65 Kevin Gibson, Promises and Problems in Alternative Dispute Resolution for the Elderly . . . . . . . . . . . . . . . 66 Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 F. The Client of Questionable Competency . . . . . . . . . . . 67 [1] The Ethics Rules . . . . . . . . . . . . . . . . . . . . . . . 67 [2] Determining Client Capacity . . . . . . . . . . . . . . . . 69 Robert P. Roca, Determining Decisional Capacity: A Medical Perspective . . . . . . . . . . . . . . . . . . . . . 70 TABLE OF CONTENTS xi 0011 VERSACOMP (4.2 ) ? COMPOSE2 (4.43) 06/08/07 (17:45) ELDERLAW - Front Matter J:\VRS\DAT\03039\FM.GML --- LC3039FM.STY --- POST 122 Page Steve Fox, Is It Personal Autonomy or a Personal Disorder? . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 [3] Confidentiality and the Incapacitated Client . . . . . . 75 Edward D. Spurgeon & Mary Jane Ciccarello, Lawyers Acting as Guardians: Policy and Ethical Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 G. Subsidized Legal Services . . . . . . . . . . . . . . . . . . . . 78 [1] Older Americans Act Legal Services . . . . . . . . . . . 78 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 [2] Issues in Legal Assistance to the Poor . . . . . . . . . . 82 Chapter 3 AGE DISCRIMINATION IN EMPLOYMENT . . . 85 A. Legislative History of the Act . . . . . . . . . . . . . . . . . 85 Equal Employment Opportunity Commission v. Wyoming . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 B. The Failure of a Constitutional Solution . . . . . . . . . . . 87 Massachusetts Board of Retirement v. Murgia . . . . . . . . 88 Note: ?Reverse? Age Discrimination in Employment . . . . 89 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 C. Who Is Protected? . . . . . . . . . . . . . . . . . . . . . . . . 90 [1] The Twenty Employee Requirement . . . . . . . . . . . 90 Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 [2] Partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Caruso v. Peat, Marwick, Mitchell & Co. . . . . . . . . 91 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 [3] Government Employees . . . . . . . . . . . . . . . . . . . 95 [4] Foreign Employers and United States Employees Out of Country . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 [5] Unions And Employment Agencies . . . . . . . . . . . . 96 Note: Aging, Disability and Discrimination . . . . . . . 96 M. Levine, Age Discrimination and the Mandatory Retirement Controversy . . . . . . . . . . . . . . . . . . . . . 92 xii TABLE OF CONTENTS 0012 VERSACOMP (4.2 ) ? COMPOSE2 (4.43) 06/08/07 (17:45) ELDERLAW - Front Matter J:\VRS\DAT\03039\FM.GML --- LC3039FM.STY --- POST 152 Page D. Exceptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 [1] Fire Fighters And Law Enforcement Officers . . . . . . 97 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 [2] Executives and Policymakers . . . . . . . . . . . . . . . . 97 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 E. Proving The Case of Discrimination in Hiring . . . . . . . . 99 F. Proving Termination on Account of Age Discrimination . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 [1] Direct Evidence Of Discrimination . . . . . . . . . . . . 100 Naton v. Bank of California . . . . . . . . . . . . . . . . 101 Glanzman v. Metropolitan Management Corporation . . . . . . . . . . . . . . . . . . . . . . . . . . 102 [2] Prima Facie Case . . . . . . . . . . . . . . . . . . . . . . 106 [3] Pretextual Reasons For Termination . . . . . . . . . . . 107 Gilkerson v. Toastmaster, Inc. . . . . . . . . . . . . . . . 107 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Reeves v. Sanderson Plumbing Products, Inc. . . . . . . 110 [4] Summary Judgment . . . . . . . . . . . . . . . . . . . . . 117 Hartung v. Cae Newnes, Inc. . . . . . . . . . . . . . . . . 117 Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 [5] Relevance of Age of Replacement Employee . . . . . . . 122 G. Reduction in Force . . . . . . . . . . . . . . . . . . . . . . . . 123 [1] Proving the Claim of Age Discrimination . . . . . . . . 124 Bialas v. Greyhound Lines, Inc. . . . . . . . . . . . . . . 124 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 [2] Termination of Higher Paid Employees . . . . . . . . . 127 Hazen Paper Co. v. Biggins . . . . . . . . . . . . . . . . 127 H. D13is0p Sarmaitteh Ivm. pCaictty o. f .J .a c. k.s o.n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 I. Reasonable Factor Other than Age (RFOA) Defense . . . . 134 Jeff Morneau, Too Good, Too Bad: ?Overqualified? Older Workers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 J. The Bona Fide Occupational Qualification (BFOQ) Exception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 TABLE OF CONTENTS xiii 0013 VERSACOMP (4.2 ) ? COMPOSE2 (4.43) 06/08/07 (17:45) ELDERLAW - Front Matter J:\VRS\DAT\03039\FM.GML --- LC3039FM.STY --- POST 181 Page Rasberg v. Nationwide Life Insurance Co. . . . . . . . . . . 137 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 K. Employee Benefit Plan Defense . . . . . . . . . . . . . . . . 139 L. Early Voluntary Retirement Plans . . . . . . . . . . . . . . . 139 Smith v. World Ins. Co. . . . . . . . . . . . . . . . . . . . . . 140 Vega v. Kodak Caribbean, Ltd. . . . . . . . . . . . . . . . . . 142 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 M. Waiver And Release . . . . . . . . . . . . . . . . . . . . . . . 144 Oubre v. Entergy Operations, Inc. . . . . . . . . . . . . . . . 145 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 N. Enforcement Procedures . . . . . . . . . . . . . . . . . . . . . 148 O. Remedies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 P. State Law Remedies . . . . . . . . . . . . . . . . . . . . . . . 149 Chapter 4 INCOME MAINTENANCE . . . . . . . . . . . . . . 151 TOPICS IN AGING: INCOME AND POVERTY AMONG OLDER AMERICANS IN 2005 . . . . . . . . . . . . . . . . . . . . . . . . 151 A. Social Security: Past and Present . . . . . . . . . . . . . . . 154 [1] History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 Martha A. McSteen, Fifty Years of Social Security . . . 155 David Schwartz & Herman Grundmann, Social Security Programs in the United States . . . . . . . . . 155 [2] The Current Need for Social Security . . . . . . . . . . 158 [a] Introduction . . . . . . . . . . . . . . . . . . . . . . . 158 [b] Lack of Personal Savings . . . . . . . . . . . . . . . . 158 Questions . . . . . . . . . . . . . . . . . . . . . . . . . 159 [3] Current Status . . . . . . . . . . . . . . . . . . . . . . . . 160 [a] The Statute . . . . . . . . . . . . . . . . . . . . . . . . 160 [b] Program Policy Sources . . . . . . . . . . . . . . . . . 160 [c] Overview of Benefits . . . . . . . . . . . . . . . . . . 160 [d] Coverage . . . . . . . . . . . . . . . . . . . . . . . . . 160 [e] Financing . . . . . . . . . . . . . . . . . . . . . . . . . 161 Questions . . . . . . . . . . . . . . . . . . . . . . . . . 163 xiv TABLE OF CONTENTS 0014 VERSACOMP (4.2 ) ? COMPOSE2 (4.43) 06/08/07 (17:45) ELDERLAW - Front Matter J:\VRS\DAT\03039\FM.GML --- LC3039FM.STY --- POST 212 Page [f] Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . 163 [i] Earnings Record . . . . . . . . . . . . . . . . . 163 [ii] Quarters of Coverage . . . . . . . . . . . . . . 164 [g] Insured Status . . . . . . . . . . . . . . . . . . . . . . 164 [h] Benefit Recipients . . . . . . . . . . . . . . . . . . . . 164 [i] Retired Workers . . . . . . . . . . . . . . . . . 165 [a] Retirement Ages . . . . . . . . . . . . . . . 165 [b] Earnings Test . . . . . . . . . . . . . . . . 166 Questions . . . . . . . . . . . . . . . . . . . 166 [ii] Spouses and Dependents of Retired Workers . . . . . . . . . . . . . . . . . . . . . . 167 [iii] Divorced Spouses of Retired Workers . . . . . 168 Questions . . . . . . . . . . . . . . . . . . . . . 169 [iv] Dependents of Disabled or Deceased Workers . . . . . . . . . . . . . . . . . . . . . . 170 [v] Survivor Benefits . . . . . . . . . . . . . . . . 170 [i] Benefit Computation . . . . . . . . . . . . . . . . . . 170 Kathryn L. Moore, Redistribution Under the Current Social Security System . . . . . . . . . . . . 171 [j] Application for Social Security Benefits . . . . . . . 173 [k] Representative Payees . . . . . . . . . . . . . . . . . 173 [l] Overpayments . . . . . . . . . . . . . . . . . . . . . . 174 [m] Taxation of Benefits . . . . . . . . . . . . . . . . . . . 174 [4] Administrative and Judicial Review Process . . . . . . 174 [a] Initial Determination . . . . . . . . . . . . . . . . . . 175 [b] Reconsideration . . . . . . . . . . . . . . . . . . . . . 175 [c] Right to a Hearing . . . . . . . . . . . . . . . . . . . 176 [d] Appeals Council Review . . . . . . . . . . . . . . . . 176 [e] Judicial Review in Federal District Court . . . . . . 177 [f] Nonacquiescence Policy . . . . . . . . . . . . . . . . . 177 [5] Representation and Attorney?s Fees . . . . . . . . . . . . 178 [6] Social Security Disability Benefits . . . . . . . . . . . . 179 David Schwartz & Herman Grundmann, Social Security Programs in the United States . . . . . . . . . 179 B. Public Attitudes Toward Social Security . . . . . . . . . . . 179 John Burrit McArthur, Private Pensions and the Justification for Social Security . . . . . . . . . . . . . . 180 TABLE OF CONTENTS xv 0015 VERSACOMP (4.2 ) ? COMPOSE2 (4.43) 06/08/07 (17:45) ELDERLAW - Front Matter J:\VRS\DAT\03039\FM.GML --- LC3039FM.STY --- POST 242 Page Richard L. Kaplan, Top Ten Myths of Social Security . . . 182 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 C. Gender Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 C. Eugene Steuerle, Social Security: The Broader Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188 D. Racial Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 E. Other Public Pension Programs . . . . . . . . . . . . . . . . 189 [1] Railroad Retirement . . . . . . . . . . . . . . . . . . . . . 189 [2] Public Employee Programs . . . . . . . . . . . . . . . . . 190 [a] Federal Civilian Employee Retirement . . . . . . . . 190 [b] State and Local Public Employee Pension Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . 190 [c] Military Retirement . . . . . . . . . . . . . . . . . . . 191 [3] Veterans? Benefits . . . . . . . . . . . . . . . . . . . . . . 191 William L. Kerns, Social Security Programs in the United States . . . . . . . . . . . . . . . . . . . . . . . . . 191 F. Supplemental Security Income . . . . . . . . . . . . . . . . . 193 Joan Loeff, Judith Bretz & Wilmer L. Kerns, Social Security Programs in the United States . . . . . . . . . . . . 193 G. Private Pensions . . . . . . . . . . . . . . . . . . . . . . . . . 196 [1] Qualified and Nonqualified Plans . . . . . . . . . . . . . 196 [2] Defined Benefit and Defined Contribution Plans . . . . 198 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 H. ERISA Requirements . . . . . . . . . . . . . . . . . . . . . . . 200 [1] Vesting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200 [2] Retirement Age . . . . . . . . . . . . . . . . . . . . . . . . 201 [3] Spousal Benefits . . . . . . . . . . . . . . . . . . . . . . . 201 [4] Treatment of Distributions . . . . . . . . . . . . . . . . . 201 Chapter 5 HEALTH CARE . . . . . . . . . . . . . . . . . . . . . 205 A. Introduction To Health Care Policy . . . . . . . . . . . . . . 205 Note: A Brief History of U.S. Health Care Policy . . . . . . 206 xvi TABLE OF CONTENTS 0016 VERSACOMP (4.2 ) ? COMPOSE2 (4.43) 06/08/07 (17:45) ELDERLAW - Front Matter J:\VRS\DAT\03039\FM.GML --- LC3039FM.STY --- POST 274 Page Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207 B. Government Health Care Coverage . . . . . . . . . . . . . . 207 [1] Finance . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208 [2] Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . 210 [3] Medicare Benefits . . . . . . . . . . . . . . . . . . . . . . 211 [a] Parts A and B . . . . . . . . . . . . . . . . . . . . . . 211 [b] Medicare Part C ? Medical Advantage . . . . . . . 215 Note on Managed Care . . . . . . . . . . . . . . . . . 215 Problem: What Happened to the Late Medicare ` Choice . . . . . . . . . . . . . . . . . . . . . . . . . . . 215 [c] Medicare D: Prescription Drugs . . . . . . . . . . . . 218 Questions . . . . . . . . . . . . . . . . . . . . . . . . . 222 [d] Home Health Care: Parts A and B . . . . . . . . . . 222 McDonald v. Shalala . . . . . . . . . . . . . . . . . . 224 [i] Part-Time or Intermittent Requirements . . . . . . . . . . . . . . . . . . . 228 [ii] The Homebound Requirement . . . . . . . . . 229 [iii] Prospective Payment for Home Health . . . . 229 Questions . . . . . . . . . . . . . . . . . . . . . 230 Note on Manuals, Transmittals and Letters . . . . . . . . . . . . . . . . . . . . . . . 230 [e] Hospice Care . . . . . . . . . . . . . . . . . . . . . . . 231 [f] Mental Health Benefits . . . . . . . . . . . . . . . . . 231 [g] Medically Necessary Care and Exceptions . . . . . . 232 Wood v. Thompson . . . . . . . . . . . . . . . . . . . 232 Goodman v. Sullivan . . . . . . . . . . . . . . . . . . 238 Questions and Comments . . . . . . . . . . . . . . . 240 [h] Level of Care . . . . . . . . . . . . . . . . . . . . . . . 241 [i] Spell of Illness . . . . . . . . . . . . . . . . . . . . . . 242 Note: Veterans? Health Benefits . . . . . . . . . . . . 244 C. Assuring Quality Healthcare . . . . . . . . . . . . . . . . . . 245 [1] Individual Credentials . . . . . . . . . . . . . . . . . . . . 245 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 246 [2] Institutional Credentials . . . . . . . . . . . . . . . . . . 246 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 247 [4] Payments And Cost Containment . . . . . . . . . . . . . 250 TABLE OF CONTENTS xvii 0017 VERSACOMP (4.2 ) ? COMPOSE2 (4.43) 06/08/07 (17:45) ELDERLAW - Front Matter J:\VRS\DAT\03039\FM.GML --- LC3039FM.STY --- POST 303 Page [a] The Hospital Prospective Payment System: Diagnostic Related Groups . . . . . . . . . . . . . . . 250 Question . . . . . . . . . . . . . . . . . . . . . . . . . 252 [b] Physician Prospective Payment: The Resource- Based Relative Value Scale . . . . . . . . . . . . . . 252 [c] Other Prospective Payment Systems . . . . . . . . . 254 [d] Dual Eligibility: Medicare and Medicaid Interaction . . . . . . . . . . . . . . . . . . . . . . . . 254 [e] Primary and Secondary Payers . . . . . . . . . . . . 257 Zinman v. Shalala . . . . . . . . . . . . . . . . . . . 258 Note on Medicare and Medicaid Fraud . . . . . . . 263 Note on Attorney Fees for Medical Claims . . . . . 266 Questions and Comments . . . . . . . . . . . . . . . 266 [5] Administration And Appeals . . . . . . . . . . . . . . . . 266 [a] The Appeals Process and Decisionmakers . . . . . . 267 [b] Expedited Appeals . . . . . . . . . . . . . . . . . . . . 268 [i] Denial of Additional Services . . . . . . . . . 268 [ii] Provider Appeals: Standard and Expedited . . . . . . . . . . . . . . . . . . . . . 269 [iii] Expedited Judicial Review . . . . . . . . . . . 269 D. Private Health Insurance Benefits . . . . . . . . . . . . . . . 270 [1] Medigap Supplemental Insurance . . . . . . . . . . . . . 270 [a] ERISA Provisions Governing All Employee Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . 274 [b] Contract Rights to Retiree Benefits . . . . . . . . . 274 Questions and Comments . . . . . . . . . . . . . . . 276 Chapter 6 LONG-TERM CARE . . . . . . . . . . . . . . . . . . 279 A. Long-Term Care: The Larger Picture . . . . . . . . . . . . . 280 [1] The Overall Cost of Long-Term Care . . . . . . . . . . . 280 [2] Policy Issues . . . . . . . . . . . . . . . . . . . . . . . . . 281 B. Long-Term Care Outside the United States . . . . . . . . . 281 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284 C. Paying For Long-Term Care . . . . . . . . . . . . . . . . . . 284 [1] Calculating Costs . . . . . . . . . . . . . . . . . . . . . . . 284 xviii TABLE OF CONTENTS 0018 VERSACOMP (4.2 ) ? COMPOSE2 (4.43) 06/08/07 (17:45) ELDERLAW - Front Matter J:\VRS\DAT\03039\FM.GML --- LC3039FM.STY --- POST 336 Page [2] Long-Term Care Insurance . . . . . . . . . . . . . . . . . 285 [a] What Triggers the Payment of Benefits? . . . . . . 286 [b] Other Policy Considerations . . . . . . . . . . . . . . 287 [3] Tax Treatment of Long-Term Care Expense . . . . . . . 288 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 290 [4] Cash Accumulation Plans . . . . . . . . . . . . . . . . . . 290 D. Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291 [1] Federal and State Administration and Finance . . . . . 292 Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292 [2] Scope of Benefits . . . . . . . . . . . . . . . . . . . . . . . 293 [a] Waivers of Fundamental Program Rules . . . . . . 293 Notes and Questions . . . . . . . . . . . . . . . . . . 295 [b] Medicaid Managed Care . . . . . . . . . . . . . . . . 295 [c] Medicaid Nursing Home Discrimination . . . . . . . 295 Question . . . . . . . . . . . . . . . . . . . . . . . . . 297 [3] Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . 297 [a] Categorically Needy . . . . . . . . . . . . . . . . . . . 297 [b] Medically Needy . . . . . . . . . . . . . . . . . . . . . 297 [4] ?Spend-Down? Income Test . . . . . . . . . . . 298 [5] ?Income Cap? Income Test . . . . . . . . . . . 299 [a] Countable and Available Income . . . . . . . . . . . 300 Mulder v. South Dakota Department of Social Services . . . . . . . . . . . . . . . . . . . . . . . . . . 300 Question . . . . . . . . . . . . . . . . . . . . . . . . . 306 [b] Treatment of Resources . . . . . . . . . . . . . . . . 306 Brewer v. Shelansky et al., and Hellebuyck et al. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306 [c] Exempt Assets . . . . . . . . . . . . . . . . . . . . . . 315 [6] Valuation of Available Resources . . . . . . . . . . . . . 315 Jackson v. Missouri Department of Social Services . . . 316 [a] Rules Governing Gifts . . . . . . . . . . . . . . . . . 317 [b] Disclaimer . . . . . . . . . . . . . . . . . . . . . . . . 318 Troy v. Hart . . . . . . . . . . . . . . . . . . . . . . . 318 Question . . . . . . . . . . . . . . . . . . . . . . 321 [7] Medicaid Planning . . . . . . . . . . . . . . . . . . . . . . 321 [a] Reactions to Medicaid Planning . . . . . . . . . . . . 321 TABLE OF CONTENTS xix 0019 VERSACOMP (4.2 ) ? COMPOSE2 (4.43) 06/08/07 (17:45) ELDERLAW - Front Matter J:\VRS\DAT\03039\FM.GML --- LC3039FM.STY --- POST 365 Page [b] Restrictions on Medicaid Planning . . . . . . . . . . 322 Questions . . . . . . . . . . . . . . . . . . . . . . . . . 324 [c] Spending Excess Resources . . . . . . . . . . . . . . 324 Question . . . . . . . . . . . . . . . . . . . . . . . . . 324 Question . . . . . . . . . . . . . . . . . . . . . . . . . 325 [d] Transfers to Trusts . . . . . . . . . . . . . . . . . . . 325 [e] Supplemental Needs Trusts . . . . . . . . . . . . . . 326 Question . . . . . . . . . . . . . . . . . . . . . . . . . 327 [f] Annuities . . . . . . . . . . . . . . . . . . . . . . . . . 327 Bateson v. Ohio Department of Jobs and Family Services . . . . . . . . . . . . . . . . . . . . . . . . . . 328 [g] Economic Protection of the Community Spouse . . . . . . . . . . . . . . . . . . . . . . . . . . . 332 [i] Treatment of Income . . . . . . . . . . . . . . 332 [ii] Treatment of Resources . . . . . . . . . . . . . . . . 333 [8] Medicaid Appeals . . . . . . . . . . . . . . . . . . . . . . 333 [9] Liens and Recovery . . . . . . . . . . . . . . . . . . . . . 334 Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335 In re the Estate of James Clifford Smith . . . . . . . . . 335 In re the Estate of Francis E. Barg, A/K/A Francis Edward Barg . . . . . . . . . . . . . . . . . . . . . . . . . 340 Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . 344 E. Appropriate Care And Quality Assurance . . . . . . . . . . 344 [1] Introduction: Cost, Choice, and Quality . . . . . . . . . 345 Eric M. Carlson, Siege Mentality: How the Defensive Attitude of the Long-Term Care Industry Is Perpetuating Poor Care and an Even Poorer Public Image . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 346 [2] Level of Care . . . . . . . . . . . . . . . . . . . . . . . . . 348 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 351 F. Nursing Facility Quality Assurance . . . . . . . . . . . . . . 351 Note: Home Care Quality Assurance . . . . . . . . . . . . . 352 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353 [1] Licensing Requirements For Facilities, Operators, and Administrators . . . . . . . . . . . . . . . . . . . . . . . . 353 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 354 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 356 xx TABLE OF CONTENTS 0020 VERSACOMP (4.2 ) ? COMPOSE2 (4.43) 06/08/07 (17:45) ELDERLAW - Front Matter J:\VRS\DAT\03039\FM.GML --- LC3039FM.STY --- POST 399 Page Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 357 [2] Nurse Aide Training . . . . . . . . . . . . . . . . . . . . . 357 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 358 [3] Residents Bill Of Rights . . . . . . . . . . . . . . . . . . 358 Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360 Note: The Use of Physical and Chemical Restraints . . . . . . . . . . . . . . . . . . . . . . . . . . . 360 SENATE SPECIAL COMMITTEE ON AGING, UNTIE THE ELDERLY: QUALITY CARE WITHOUT RESTRAINTS . . . . . 360 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 362 [4] Administrative Sanctions . . . . . . . . . . . . . . . . . . 363 G. Contracts For Nursing Home Care . . . . . . . . . . . . . . 364 [1] Third-Party Guarantees . . . . . . . . . . . . . . . . . . . 364 [2] Solicitation of Contributions . . . . . . . . . . . . . . . . 365 [3] Duration-of-Stay Clauses . . . . . . . . . . . . . . . . . . 365 Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . 366 [4] Waivers of Liability . . . . . . . . . . . . . . . . . . . . . 366 [5] Unfair Trade Practices . . . . . . . . . . . . . . . . . . . 366 Slovik v. Prime Healthcare Corporation D/B/A Dadeville Convalescent Home . . . . . . . . . . . . . . . 367 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 371 H. Nursing Home Quality of Care Legislation . . . . . . . . . . 371 Montgomery Health Care Facility v. Ballard . . . . . . . . . 372 Parker v. Illinois Masonic Warren Barr Pavilion . . . . . . 375 Note . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378 Schenck v. Living Centers-East, Inc . . . . . . . . . . . . . . 379 Mcleod v. Plymouth Court Nursing Home . . . . . . . . . . 381 Note: An Assessment of Regulation and Quality of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 382 Marshall B. Kapp, Quality of Care and Quality of Life in Nursing Facilities: What?s Regulation Got to Do With It? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383 Chapter 7 HOUSING . . . . . . . . . . . . . . . . . . . . . . . . . 387 A. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387 B. Planning For Choices In Housing . . . . . . . . . . . . . . . 388 TABLE OF CONTENTS xxi 0021 VERSACOMP (4.2 ) ? COMPOSE2 (4.43) 06/08/07 (17:45) ELDERLAW - Front Matter J:\VRS\DAT\03039\FM.GML --- LC3039FM.STY --- POST 429 Page C. Aging In Place . . . . . . . . . . . . . . . . . . . . . . . . . . 389 [1] Payment Sources For In-Home Services . . . . . . . . . 389 [a] Reverse Mortgages . . . . . . . . . . . . . . . . . . . 389 Celeste M. Hammond, Reverse Mortgages: A Financial Planning Device for the Elderly . . . . . . 390 [b] Family Financing: Sale and Leaseback . . . . . . . 392 [c] House Sharing . . . . . . . . . . . . . . . . . . . . . . 393 Questions . . . . . . . . . . . . . . . . . . . . . . . . . 394 [d] State Property Tax Relief . . . . . . . . . . . . . . . 394 [2] Accessing and Providing Quality In-Home Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395 [a] Geriatric Care Managers . . . . . . . . . . . . . . . . 395 Abrahams & Lamb, Developing Reliable Assessment in Case-Managed Geriatric Long Term Care Programs in, CASE MANAGEMENT: GUIDING PATIENTS THROUGH THE HEALTH CARE MAZE . . . . 395 [b] Employment of Care Givers: Choices and Employer Requirements . . . . . . . . . . . . . . . . . . . . . . . 397 [c] Government Assistance to the Elderly in Their Homes . . . . . . . . . . . . . . . . . . . . . . . . . . . 398 D. Retirement Housing . . . . . . . . . . . . . . . . . . . . . . . 399 [1] Restricted Communities . . . . . . . . . . . . . . . . . . . 399 [a] Planned Unit Development and Common Interest Communities (PUDs and CICs) . . . . . . . . . . . . 400 [b] Age Restricted Communities . . . . . . . . . . . . . . 401 [2] Low Cost Housing . . . . . . . . . . . . . . . . . . . . . . 402 [a] Mobile Homes and Manufactured Housing . . . . . 402 [b] Single Room Occupancy Hotels . . . . . . . . . . . . 403 Question . . . . . . . . . . . . . . . . . . . . . . . . . 404 E. Supportive Housing . . . . . . . . . . . . . . . . . . . . . . . 404 [a] Assisted Living Residents . . . . . . . . . . . . . . . 405 [b] How Assisted Living Is Financed . . . . . . . 406 [c] The Admissions Contract . . . . . . . . . . . . 406 [d] Negotiated Risk . . . . . . . . . . . . . . . . . 408 Storm v. NSL Rockland Place, LLC . . . . . 408 [2] Board and Care Homes . . . . . . . . . . . . . . . . . . . 414 U.S. SENATE&, SPECIAL COMMITTEE ON AGING, BOARD AND CARE: A FAILURE IN PUBLIC POLICY . . . . . . . . . . . . . . . . . . . . . . . . . . . 415 xxii TABLE OF CONTENTS 0022 VERSACOMP (4.2 ) ? COMPOSE2 (4.43) 06/08/07 (17:45) ELDERLAW - Front Matter J:\VRS\DAT\03039\FM.GML --- LC3039FM.STY --- POST 458 Page [3] Continuing Care Retirement Communities (CCRCs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 416 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 419 Morris v. Deerfield Episcopal Retirement Community, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 419 [4] Legal Constraints on Supportive Housing . . . . . . . . 423 [a] Zoning and Other Restrictions . . . . . . . . . . . . 423 Erin Ziaja, Do Independent and Assisted Living Communities Violate the Fair Housing Amendments Act and the Americans With Disabilities Act? . . . . . . . . . . . . . . . . . . . . . 425 Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427 [b] Construction And Land Use . . . . . . . . . . . . . . . . 427 Rowatti v. Gonchar . . . . . . . . . . . . . . . . . . . . . 428 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 430 F. Subsidized Housing for the Elderly . . . . . . . . . . . . . . 430 SENATE SPECIAL COMMITTEE ON AGING, DEVELOPMENTS IN AGING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431 [1] Basic Eligibility . . . . . . . . . . . . . . . . . . . . . . . 431 [2] Demand-Side Government Assistance Programs: Section 8 Rent Subsidies . . . . . . . . . . . . . . . . . . 432 Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433 [a] Public Housing . . . . . . . . . . . . . . . . . . . . . . 433 Kevin M. Cremin, Note: The Transition to Section 8 Housing: Will the Elderly Be Left Behind? . . . . 434 [b] Section 202 Housing Assistance . . . . . . . . . . . . 435 Christine M. Cedrone, Public Housing for the Elderly in Massachusetts: How Federal and State Disability Laws and Regulations Have Created a Sense of Confinement . . . . . . . . . . . . . . . . . . 436 Questions and Comments . . . . . . . . . . . . . . . 437 Chapter 8 GUARDIANSHIP . . . . . . . . . . . . . . . . . . . . 439 A. The Need for Guardianship for the Elderly . . . . . . . . . 439 G. Webster Ross, Helen Petrovitch & Lon R. White, Update on Dementia . . . . . . . . . . . . . . . . . . . . . . . 440 B. The Development Of Guardianship Law . . . . . . . . . . . 441 TABLE OF CONTENTS xxiii 0023 VERSACOMP (4.2 ) ? COMPOSE2 (4.43) 06/08/07 (17:45) ELDERLAW - Front Matter J:\VRS\DAT\03039\FM.GML --- LC3039FM.STY --- POST 487 Page In the Matter of the Guardianship of Hedin . . . . . . . . . 441 Lawrence A. Frolik, Plenary Guardianship: An Analysis, a Critique and a Proposal for Reform . . . . . . . . . . . . . . 442 C. Fundamental Liberties And Guardianship . . . . . . . . . . 443 Dale v. Hahn . . . . . . . . . . . . . . . . . . . . . . . . . . . 444 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445 Note: The Vocabulary of Guardianship . . . . . . . . . . . . 445 D. Due Process in Guardianship Proceedings . . . . . . . . . . 446 Good & King, The Judges: Some Are Thorough, But Others Exercise Little Oversight . . . . . . . . . . . . . . . . 447 [1] Notice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 447 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 449 [2] Expert Testimony . . . . . . . . . . . . . . . . . . . . . . 450 J. STREIM, M.D., THE ROLE OF THE GERIATRIC PSYCHIATRIST IN EVALUATION OF MENTAL HEALTH PROBLEMS IN ELDERLY PATIENTS . . . . . . . . . . . . . 450 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 453 [3] Presence and Participation at the Hearing . . . . . . . 454 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 454 [4] Burden and Standard of Proof . . . . . . . . . . . . . . . 455 [5] Representation and Advocacy . . . . . . . . . . . . . . . 455 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 457 Note on Guardianship Costs and Fees . . . . . . . . . . 457 Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . 458 [6] Ongoing Oversight By the Courts . . . . . . . . . . . . . 458 E. Mediation in Guardianship . . . . . . . . . . . . . . . . . . . 459 Susan N. Gary, Mediation and the Elderly: Using Mediation to Resolve Probate Disputes Over Guardianship and Inheritance . . . . . . . . . . . . . . . . . . . . . . . . . . 459 Susan D. Hartman, Mediation of Disputes Arising in Adult Guardianship Cases . . . . . . . . . . . . . . . . . . . 460 Mary F. Radford, Is the Use of Mediation Appropriate in Adult Guardianship Cases? . . . . . . . . . . . . . . . . . . . 462 F. The Determination of Incapacity . . . . . . . . . . . . . . . . 464 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 464 [1] Functional Concepts Of Impairment . . . . . . . . . . . 465 xxiv TABLE OF CONTENTS 0024 VERSACOMP (4.2 ) ? COMPOSE2 (4.43) 06/08/07 (17:45) ELDERLAW - Front Matter J:\VRS\DAT\03039\FM.GML --- LC3039FM.STY --- POST 511 Page [2] Assessing Mental Capacity . . . . . . . . . . . . . . . . . 466 [a] Medical Assessment . . . . . . . . . . . . . . . . . . . 466 [b] Psychological Assessment . . . . . . . . . . . . . . . 467 [c] Functional Assessment . . . . . . . . . . . . . . . . . 467 [d] The Quality of the Respondent?s Decisionmaking . . . . . . . . . . . . . . . . . . . . . 468 Tennessee Department of Human Services v. Northern . . . . . . . . . . . . . . . . . . . . . . . . . 468 Questions . . . . . . . . . . . . . . . . . . . . . . . . . 470 [e] Vulnerability . . . . . . . . . . . . . . . . . . . . . . . 470 Deffenbaugh v. Claphan . . . . . . . . . . . . . . . . 470 Question . . . . . . . . . . . . . . . . . . . . . . . . . 472 G. Allocation Of Powers Between Guardian And Ward . . . . 472 [1] Personal And Property Decisionmaking Powers . . . . . 473 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 473 [2] The Doctrine of the Least Restrictive Alternative . . . 473 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 474 [3] Limited Guardianship . . . . . . . . . . . . . . . . . . . . 474 In re Boyer . . . . . . . . . . . . . . . . . . . . . . . . . . 474 Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . 475 Lawrence A. Frolik, Guardianship Reform: When the Best Is the Enemy of the Good . . . . . . . . . . . . . . . 476 [4] Representative Payee for Government Benefits . . . . . 479 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 479 [5] Conservatorship . . . . . . . . . . . . . . . . . . . . . . . 480 Harvey v. Meador . . . . . . . . . . . . . . . . . . . . . . 480 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 483 [6] Voluntary Guardianship And Guardianship Diversion . . . . . . . . . . . . . . . . . . . . . . . . . . . 483 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 485 H. Scope of the Guardian?s Authority . . . . . . . . . . . . . . . 485 In re Medworth . . . . . . . . . . . . . . . . . . . . . . . . . . 487 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 488 [1] Financial Duties and Property Planning . . . . . . . . . 488 Alison Barnes, The Liberty and Property of Elders: Guardianship and Will Contests as the Same Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 490 TABLE OF CONTENTS xxv 0025 VERSACOMP (4.2 ) ? COMPOSE2 (4.43) 06/08/07 (17:45) ELDERLAW - Front Matter J:\VRS\DAT\03039\FM.GML --- LC3039FM.STY --- POST 539 Page Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 491 [2] Specific Powers Requiring Court Order . . . . . . . . . 492 People ex rel. Yeager . . . . . . . . . . . . . . . . . . . . . 492 I. Who Should Serve as Guardian? . . . . . . . . . . . . . . . . 494 [1] Priority of Appointment . . . . . . . . . . . . . . . . . . . 494 In re Holloway . . . . . . . . . . . . . . . . . . . . . . . . 496 [2] Public and Professional Guardians . . . . . . . . . . . . 497 Alison Barnes, The Virtues of Corporate and Professional Guardians . . . . . . . . . . . . . . . . . . . 499 Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501 J. Removal of Guardians and Termination of Guardianship . . . . . . . . . . . . . . . . . . . . . . . . . . . 501 In re Harris . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501 Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 502 Chapter 9 PROPERTY MANAGEMENT . . . . . . . . . . . . . 503 A. Durable Power of Attorney . . . . . . . . . . . . . . . . . . . 503 [1] Capacity to Create a Power of Attorney . . . . . . . . . 504 Thames v. Daniels . . . . . . . . . . . . . . . . . . . . . . 505 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 508 [2] Formalities of Execution . . . . . . . . . . . . . . . . . . 509 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 510 [3] Revocation . . . . . . . . . . . . . . . . . . . . . . . . . . . 510 Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . 511 In re Ord Brubaker . . . . . . . . . . . . . . . . . . . . . 511 [4] Determining Incapacity: ?Springing? Powers . . . . . . 513 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 514 [5] Scope and Use of the Power . . . . . . . . . . . . . . . . 515 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 516 In re Estate of Kurrelmeyer . . . . . . . . . . . . . . . . . 516 [a] Gifts By the Attorney in Fact . . . . . . . . . . . . . 521 Mower v. Eddie . . . . . . . . . . . . . . . . . . . . . 521 Question . . . . . . . . . . . . . . . . . . . . . . . . . 523 [b] Safe Deposit Box Access . . . . . . . . . . . . . . . . 523 [c] Other Issues . . . . . . . . . . . . . . . . . . . . . . . 523 xxvi TABLE OF CONTENTS 0026 VERSACOMP (4.2 ) ? COMPOSE2 (4.43) 06/08/07 (17:45) ELDERLAW - Front Matter J:\VRS\DAT\03039\FM.GML --- LC3039FM.STY --- POST 570 Page Questions . . . . . . . . . . . . . . . . . . . . . . . . . 524 Question . . . . . . . . . . . . . . . . . . . . . . . . . 525 B. Joint Ownership . . . . . . . . . . . . . . . . . . . . . . . . . 525 Kitchen v. Guarisco . . . . . . . . . . . . . . . . . . . . . . . . 526 Note, The Right of Survivorship in Joint Bank Accounts and Safe Deposit Boxes ? The Search for a Solution . . . 529 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 530 C. Revocable Trusts . . . . . . . . . . . . . . . . . . . . . . . . . 530 Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 533 Chapter 10 HEALTH CARE DECISION MAKING . . . . . . . 535 A. The Doctrine Of Informed Consent . . . . . . . . . . . . . . 535 Scott v. Bradford . . . . . . . . . . . . . . . . . . . . . . . . . 536 [1] The Emergency Care Exception . . . . . . . . . . . . . . 538 [2] Therapeutic Privilege Exception . . . . . . . . . . . . . . 539 [3] Patient Waiver . . . . . . . . . . . . . . . . . . . . . . . . 539 B. Informed Consent: Myth Or Reality? . . . . . . . . . . . . . 540 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 541 C. The Right of a Competent Patient to Die . . . . . . . . . . 541 [1] The Common Law Right To Die . . . . . . . . . . . . . . 541 Superintendent of Belchertown State School v. Saikewicz . . . . . . . . . . . . . . . . . . . . . . . . . . . 541 Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . 542 Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . 543 [2] The Constitutional Right to Die . . . . . . . . . . . . . . 544 Cruzan v. Director, Missouri Department of Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 546 D. Informed Consent: The Mentally Incapacitated Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 546 [1] Does the Patient Have the Requisite Mental Capacity? . . . . . . . . . . . . . . . . . . . . . . . . . . . 547 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 547 Payne v. Marion General Hospital . . . . . . . . . . . . 547 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 552 TABLE OF CONTENTS xxvii 0027 VERSACOMP (4.2 ) ? COMPOSE2 (4.43) 06/08/07 (17:45) ELDERLAW - Front Matter J:\VRS\DAT\03039\FM.GML --- LC3039FM.STY --- POST 602 Page Kevin R. Wolff, Note, Determining Patient Competency . . . . . . . . . . . . . . . . . . . . . . . . . . 553 [2] Incapacitated or Just Eccentric? . . . . . . . . . . . . . . 555 In re Milton . . . . . . . . . . . . . . . . . . . . . . . . . . 555 E. Terminal Illness, Brain Death, And Persistent Vegetative State . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 558 [1] Terminal Illness . . . . . . . . . . . . . . . . . . . . . . . 558 [2] Brain Death . . . . . . . . . . . . . . . . . . . . . . . . . . 559 [3] Persistent Vegetative State Or Permanent Unconsciousness . . . . . . . . . . . . . . . . . . . . . . . 560 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 561 F. Surrogate Decision Making for the Incapacitated Patient: Advance Health Care Directives . . . . . . . . . . . . . . . . 562 [1] Living Wills . . . . . . . . . . . . . . . . . . . . . . . . . . 562 [a] The Terminal Illness Requirement . . . . . . . . . . 563 Questions . . . . . . . . . . . . . . . . . . . . . . . . . 563 Questions . . . . . . . . . . . . . . . . . . . . . . . . . 565 [b] Irreversible Brain Disease . . . . . . . . . . . . . . . 565 [c] Foregoing Nutrition and Hydration . . . . . . . . . . 566 Questions . . . . . . . . . . . . . . . . . . . . . . . . . 567 [d] Formalities of Execution . . . . . . . . . . . . . . . . 568 [e] Duration of Validity and Revocation of the Directive . . . . . . . . . . . . . . . . . . . . . . . . . 568 Questions . . . . . . . . . . . . . . . . . . . . . . . . . 568 Question . . . . . . . . . . . . . . . . . . . . . . . . . 569 [f] Validity in Other Jurisdictions . . . . . . . . . . . . 569 [g] Notification and Liability . . . . . . . . . . . . . . . . 570 G. Appointment of A Surrogate Decision Maker . . . . . . . . 570 Edward J. Larson & Thomas A. Eaton, The Limits of Advance Directives: A History and Assessment of the Patient Self-Determination Act . . . . . . . . . . . . . . . . . 571 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 573 H. Termination of Life-Sustaining Treatment Without a Formal Advance Directive . . . . . . . . . . . . . . . . . . . . 573 In re Quinlan . . . . . . . . . . . . . . . . . . . . . . . . . . . 574 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 577 xxviii TABLE OF CONTENTS 0028 VERSACOMP (4.2 ) ? COMPOSE2 (4.43) 06/08/07 (17:45) ELDERLAW - Front Matter J:\VRS\DAT\03039\FM.GML --- LC3039FM.STY --- POST 630 Page [1] Termination of Life-Sustaining Treatment Based Upon Substituted Judgement . . . . . . . . . . . . . . . . . . . 577 Cruzan v. Director, Missouri Department of Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 578 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 583 Woods v. Commonwealth of Kentucky . . . . . . . . . . . 584 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 589 [2] The Future . . . . . . . . . . . . . . . . . . . . . . . . . . 612 I. Euthanasia And Physician-Assisted Suicide . . . . . . . . . 591 Tom L. Beauchamp, The Justification of Physician- Assisted Suicide . . . . . . . . . . . . . . . . . . . . . . . . . . 592 [1] Judicial Response . . . . . . . . . . . . . . . . . . . . . . 593 Washington v. Glucksberg . . . . . . . . . . . . . . . . . 593 Robert J. Burt, Rationality and Injustice in Physician- Assisted Suicide . . . . . . . . . . . . . . . . . . . . . . . 598 Marshall B. Kapp, ?Old Folks on the Slippery Slope?: Elderly Patients and Physician Assisted Suicide . . . . 599 [2] Statutory Response . . . . . . . . . . . . . . . . . . . . . 601 Edward R. Grant & Paul B. Linton, Relief or Reproach?: Euthanasia Rights in the Wake of Measure 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 601 Paul J. Zwier, Looking for a Nonlegal Process: Physician-Assisted Suicide and the Care Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . 603 Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . 604 [3] The Netherlands Experience . . . . . . . . . . . . . . . . 605 Potts, Looking for the Exit Door . . . . . . . . . . . . . . 605 Julia Belian, Deference to Doctors in Dutch Euthanasia Law . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 605 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 606 Chapter 11 ELDER ABUSE, NEGLECT, AND CRIME . . . . 607 A. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . 607 B. Defining Abuse And Neglect . . . . . . . . . . . . . . . . . . 607 Note, Elder Abuse in California . . . . . . . . . . . . . . . . 608 ELDER ABUSE: A DECADE OF SHAME AND INACTION (Report of the Subcommittee on Health and Long-term Care of the House Select Committee on Aging) . . . . . . . . . . . . . . 609 TABLE OF CONTENTS xxix 0029 VERSACOMP (4.2 ) ? COMPOSE2 (4.43) 06/08/07 (17:45) ELDERLAW - Front Matter J:\VRS\DAT\03039\FM.GML --- LC3039FM.STY --- POST 658 Page Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611 C. Who Are the Victims of Elder Abuse? . . . . . . . . . . . . . 611 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 612 D. Who Abuses Older People And Why? . . . . . . . . . . . . . 612 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 613 [1] Domestic Caregivers . . . . . . . . . . . . . . . . . . . . . 613 Estate of Kayle . . . . . . . . . . . . . . . . . . . . . . . . 614 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 618 [2] Institutional Caregivers . . . . . . . . . . . . . . . . . . . 618 E. Self-Neglect . . . . . . . . . . . . . . . . . . . . . . . . . . . . 619 Davis v. Cuyahoga County Adult Protective Services . . . . 620 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 623 Florida Department of Children and Family Services v. Kim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 623 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 625 F. Adult Protective Services Systems . . . . . . . . . . . . . . . 626 [1] Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . 626 [2] Consent to Protective Services . . . . . . . . . . . . . . . 628 [3] Nonconsensual And Emergency Intervention . . . . . . 629 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 630 [4] Mandatory Reporting . . . . . . . . . . . . . . . . . . . . 630 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 632 [5] Confidentiality of Abuse Report Records . . . . . . . . . 632 [6] Civil Constraints and Criminal Penalties for Abusers . . . . . . . . . . . . . . . . . . . . . . . . . . . . 632 People v. Heitzman . . . . . . . . . . . . . . . . . . . . . . 633 G. Financial Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . 639 Carolyn L. Dessin, Financial Abuse of the Elderly . . . . . 640 In re the Estate of Gasparac: Jack Gasparac and Katherine Ratkovich, Appellants v. Mae Schunk, Respondent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 643 In re Estate of Ostrowski: Lorraine Kostuch, Appellant v. LEA, Respondent . . . . . . . . . . . . . . . . . . . . . . . . . 646 H. Older Persons And The Criminal Justice System . . . . . . 650 xxx TABLE OF CONTENTS 0030 VERSACOMP (4.2 ) ? COMPOSE2 (4.43) 06/08/07 (17:45) ELDERLAW - Front Matter J:\VRS\DAT\03039\FM.GML --- LC3039FM.STY --- POST 683 Page [1] Elderly People as Targets of Crime . . . . . . . . . . . . 650 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 651 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 653 [2] ?Vulnerable Victim? Sentencing Standards . . . . . . . 653 United States v. Feldman . . . . . . . . . . . . . . . . . . 654 United States v. Charles Lowell Kentz . . . . . . . . . . 656 United States v. Rumsavich . . . . . . . . . . . . . . . . 658 Abrams v. Delaware . . . . . . . . . . . . . . . . . . . . . 662 [3] Elderly Criminals . . . . . . . . . . . . . . . . . . . . . . 663 William E. Adams, Jr., The Incarceration of Older Criminals: Balancing Safety, Cost and Humanitarian Concerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . 664 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 665 [4] Reduced Sentences Due to Age and Physical Condition . . . . . . . . . . . . . . . . . . . . . . . . . . . 666 United States v. Brooke . . . . . . . . . . . . . . . . . . . 666 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 669 [5] Elderly Prisoners . . . . . . . . . . . . . . . . . . . . . . . 669 William E. Adams, Jr., The Incarceration of Older Criminals: Balancing Safety, Cost and Humanitarian Concerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . 669 Patricia S. Corwin, Comment: Senioritis: Why Elderly Federal Inmates Are Literally Dying to Get Out of Prison . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 670 Nadine Curran, Note: Blue Hairs in the Bighouse: The Rise in the Elderly Inmate Population, Its Effects on the Overcrowding Dilemma and Solutions to Correct It . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 671 4 Susan Lundstrom, Dying to Get Out: A Study on the Necessity, Importance, and Effectiveness of Prison Early Release Programs for Elderly Inmates Suffering from HIV Disease and Other Terminal-Centered Illnesses . . . . . . . . . . . . . . . . . . . . . . . . . . . . 693 Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . 674 Table of Cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TC-1 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I-1 TABLE OF CONTENTS xxxi 0031 VERSACOMP (4.2 ) ? 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Library of Congress Subject Headings for this publication:
Older people -- Legal status, laws, etc. -- United States -- Cases.