What
is Palliative Care?
Written By: Dr.
Alexander Nesbitt
, Medical Director of Susquehanna
Hospice and Palliative Medicine
Despite
the fact that the
US
healthcare system is one of the most advanced in the world, there is
evidence of significant gaps or areas of weakness. One of these
involves the care of patients with advanced disease such as cancer,
heart or lung disease, dementia or others. Over the last 10 years,
studies have shown that such patients often suffer from inadequately
treated physical symptoms such as pain, nausea, shortness of breath,
or confusion. Patients and their families often struggle with making
difficult decisions about treatment options such as feeding tubes,
ventilator use, or cardiopulmonary resuscitation. Often the patient
and family report problems in communicating with the staff in our
complex medical system, and consequently feel an inadequate
understanding of the prognosis and expected outcome of the illness.
Palliative care is a developing specialty
within medicine designed to address these problems. It involves an
interdisciplinary team including a physician, nurse, social worker
and chaplain, working together to address the needs of the patient
and their family as they go through advanced illness. Unlike
hospice, such team help is not limited to terminally ill patients,
but is offered to anyone with advanced disease with appropriate
needs. Also unlike hospice, palliative care can be given
concurrently with any aggressive or curative treatment, no matter
how complex or expensive. For example, a patient hospitalized for
their chronic congestive heart failure, or another undergoing
skilled nursing care for their fractured pelvis would NOT be
appropriate for hospice care, but would be appropriate for
assistance by the palliative care team if they and their family
desired. Consultation by palliative care is ordered by the attending
physician, and is reimbursed by insurances as any other consultative
service would be.
Studies looking at outcomes show that symptoms
are more effectively managed, patients and families report higher
levels of perceived support and satisfaction, and care is more
likely to be consistent with patient wishes when palliative care is
involved. The palliative care consult service has been operational
in
Williamsport
Hospital
for over two years, and is being extended to certain nursing homes
in the area who wish to participate in this service.
Dr. Nesbitt is the Medical
Director of Susquehanna Hospice and Palliative Medicine in
Williamsport, PA. He is
Board Certified in Hospice and Palliative Medicine and works
full-time overseeing hospice care.
Dr. Nesbitt will discuss local issues affecting end-of-life
care at
Marshall
,
Parker & Associates’ Professional Update on
May 10, 2007
.
He can be contacted at 570-326-8040.
Attorney Brenda Colbert
Joins Marshall, Parker & Associates
By:
Melissa Bottorf, Director of Marketing & Public Education
Marshall
, Parker & Associates is pleased to announce the addition of
Attorney
Brenda D. Colbert
to its professional staff of Elder Law and Estate Planning
Attorneys.
Attorney Colbert has extensive experience
preparing estate and long term care plans and counseling clients
regarding long term care planning issues including Medicaid
eligibility & home care options.
She is a 1990 graduate of
Mansfield
University
where she received a degree in Social Work.
After working for several years as a social worker in nursing
facilities she went on to law school, receiving her JD magna cum
laude from the
Touro
College
Law
Center
. Ms. Colbert then
proceeded to the University of Miami School of Law where she
received a postgraduate Master in Laws (LLM) in Estate Planning.
Since 2002, Attorney Colbert has been practicing law as an
elder law and estate planning attorney in
Wilkes-Barre
and
Scranton
. She and her husband,
Mark, a teacher, reside in Moosic.
Attorney Colbert is a frequent speaker to
community and professional groups on issues affecting the elderly.
She is a member of the elder law section of the Pennsylvania
Bar Association and the National Academy of Elder Law Attorneys.
She also serves on the Allocations Committee for the
United Way
, is co-chair of the Wilkes-Barre Law & Library Elder Law
Committee and is a member of the Alzheimer’s Association Planned
Giving Advisory Committee.
“Brenda is a great addition to Marshall,
Parker & Associates,” said Managing Attorney, Jeffrey
Marshall. “She is the
kind of caring, attentive lawyer who fits well with our existing
staff. And Brenda is one
of the relatively few lawyers in
Pennsylvania
with an advanced legal degree in Estate Planning.
Her experience and educational attainments in the estate
planning field allow her to provide high quality legal services to
those clients facing extremely sophisticated planning issues.”
Attorney Colbert can be contacted at
1-800-401-4552 or at webmail@paelderlaw.com.
Melissa
can be contacted at webmail@paelderlaw.com
or at 1-800-401-4552
Providing
for Pet Care Needs in the Event of Death or Incapacity
Written By:
Brenda D. Colbert
, Esquire
Pet
owners spend a small fortune on food, toys, veterinary care and
other expenses to ensure that they have a healthy and happy pet.
Pet owners worry about the safety and well-being of their
little (and sometimes not so little) friends and will go to extremes
to provide comfort and security to their pets.
I know, I’m one of them.
Often times, however, too little thought is given to what
will become of the animal if the pet owner passes away or becomes
incapacitated and unable to care for the pet.
Who will take care of the pet and will that person provide
the same loving care that the owner did?
This is an old problem that now has a new solution.
It used to be that
the only way to provide for the perpetual care of a pet upon the
death or incapacity of the owner was for the pet owner to find a
person to agree to become the pet’s caregiver and hope that the
future caregiver would make good on the promise.
Even if the pet owner left money to the future caregiver
under his or her Last Will and Testament or gave money to the
caregiver outright, there was no way to guarantee that the caregiver
would use the money to care for the pet.
On
November 6, 2006
, the Pennsylvania Uniform Trust Act went
into effect in
Pennsylvania
, which, among other things, allowed for
the creation of a trust to provide for the care of a pet of a
decedent or incapacitated person.
Prior to the enactment of the Pennsylvania Uniform Trust Act,
such a trust would not be enforceable under
Pennsylvania
law.
Pursuant to Section 7732 of the Pennsylvania Uniform Trust
Act, a trust created for the care of animals will be considered a
valid trust if it meets certain requirements.
For instance, the trust may be created to provide for the
care of an animal that is alive during the lifetime of the
individual who established the trust (known as the Settlor).
Further, the terms of the trust must provide that the trust
will terminate upon the death of the animal for which it was
created.
This type of “Pet
Trust” has many advantages over giving money outright or under a
Will to a future caregiver. The
Settlor may fund the trust during his/her lifetime, upon death, or
may even authorize another individual to fund the trust if the
Settlor becomes incapacitated. The
Settlor can stipulate that the funds in the trust are to be used for
the care of the pet and can dictate the manner in which the pet is
to be nurtured, for example, naming the preferred veterinarian and
providing care instructions. The
Settlor will name a person in the trust instrument, known as the
Trustee, who will be responsible for the management of the trust
funds and to ensure that distribution is made to the caregiver as
outlined in the trust. The
trust may even provide for compensation to be paid to the caregiver
as an added incentive for the caregiver to tend to the pet.
Further, the Settlor may name a third party responsible to
ensure that the terms of the trust are being carried out and to
enforce, when necessary, the terms of the trust on behalf of the
animal.
The Pet Trust is an
excellent tool to ensure that the pet is not overlooked in the event
of an unexpected illness, accident or death of the pet owner.
With proper planning, the pet owner can ensure that the
health and well-being of the pet are provided for even when the pet
owner has passed away or becomes incapacitated.
Attorney Colbert can be contacted
at webmail@paelderlaw.com
or at 1-800-401-4552
Inappropriate
Discharges from Nursing Facilities on the Rise
Written
By:
Jeffrey A. Marshall
, CELA*
We
are beginning to see an increase in the number of cases of
involuntary discharges of nursing facility residents.
Due to low government reimbursement rates, some nursing
facilities may seek to discharge residents who have exhausted their
assets and become financial eligible for Medicaid.
Unfortunately, we can expect to see the
incidence of inappropriate discharges increase even more as the
harsh transfer of asset penalties contained in the Deficit Reduction
Act of 2005, begin to affect residents.
Resident
Rights under the Nursing Home Reform Act
Nursing facilities will sometimes seek to
discharge a resident for inappropriate reasons or without adequate
discharge planning. But,
facilities that participate in Medicare and/or Medicaid are subject
to regulatory limitations found in the nursing home reform law which
was enacted as part of the Omnibus Budget Reconciliation Act of 1987
(OBRA), as amended.1
The nursing home reform law gives a resident
the right to remain in the nursing facility unless a transfer or
discharge: is appropriate because the resident's health has improved
and the resident no longer requires the services provided by the
nursing facility;2
is necessary to meet the resident's welfare;3
is needed to protect the health and safety of other residents or
staff;4
is required because the resident has failed, after reasonable
notice, to pay the facility charge for an item or service provided
at the resident's request;5
or the facility ceases to operate.6
Before transferring or discharging a resident,
the facility must provide written notice to the resident, and if
known, to a family member or legal representative. The notice must
include the reason for transfer or discharge, the effective date,
the location to which the resident is transferred or discharged, a
statement of the right to appeal, and the name, address, and
telephone number of the state long-term care ombudsman. With limited
exceptions, the notice must be given at least 30 days before the
discharge date.7
The facility must also develop a post discharge
plan of care to assist the resident to adjust to his or her post
discharge living environment.8
When the facility anticipates discharging a resident, the facility
must have a discharge summary that includes—
(1) A recapitulation of the resident's stay;
(2) A final summary of the resident's status
and
(3) A post-discharge plan of care that is
developed with the participation of the resident and his or her
family, which will assist the resident to adjust to his or her new
living environment.9
A nursing facility must provide sufficient
preparation and orientation to residents to ensure safe and orderly
transfer or discharge from the facility.10
Each State must provide a system for a resident
of a nursing facility to appeal a notice from the SNF or NF of
intent to discharge or transfer the resident.11
Pennsylvania
has a long established appeal and intervention process to protect
residents that are improperly attempting to discharge a resident.
(See, 55 Pa.Code §1181.568 Appendix N). These rules are
applicable to any resident of a Medicaid participating nursing
facility even if the resident is not on Medical Assistance.
Neglect
of a Care Dependent Person
Employees of nursing facilities which engage in
improper discharges that result in harm to the resident could have
some potential criminal liability under
Pennsylvania
laws regarding neglect of a care-dependent person by a caretaker.
(See 18 Pa.C.S. § 2713).
A “care-dependent person” is defined
broadly as “[a]ny adult who, due to physical or cognitive
disability or impairment, requires assistance to meet his needs for
food, shelter, clothing, personal care or health care.”
A
caretaker is defined as any person who:
(1)
is an owner, operator, manager or employee of a nursing home,
personal care home, domiciliary care home, community residential
facility, intermediate care facility for the mentally retarded,
adult daily living center, home health agency or home health service
provider whether licensed or unlicensed;
(2)
provides care to a care-dependent person in the setting
described in paragraph (1); or
(3)
has an obligation to care for a care-dependent person for
monetary consideration in the settings described in paragraph (1) or
in the care-dependent person’s home.
A
caretaker is guilty of neglect of a care-dependent person if he:
(a)(1) Intentionally,
knowingly or recklessly causes bodily injury or serious bodily
injury by failing to provide treatment, care, goods or services
necessary to preserve the health, safety, or welfare of a
care-dependent person for whom he is responsible to provide care.
(a)(2) Intentionally
or knowingly uses a physical restraint or chemical restraint or
medication on a care-dependent person, or isolates a care-dependent
person contrary to law or regulation, such that bodily injury or
serious bodily injury results.
The
penalties for neglect of a care-dependent person are as follows:
(1)
A violation of subsection (a)(1) constitutes a misdemeanor of
the first degree if the victim suffers bodily injury.
(2)
A violation of subsection (a)(1) constitutes a felony of the
first degree if the victim suffers serious bodily injury.
(3)
A violation of subsection (a)(2) constitutes a misdemeanor of
the first degree if the victim suffers bodily injury.
Nursing Facility residents who believe they are
being improperly discharged should seek legal assistance, contact
the Long Term Care Ombudsman, or file a complaint with the
Department of Health. To
locate the Ombudsman in your area, contact your Area Agency on
Aging, or call the State Ombudsman Program office at 717-783-7247.
The Department of Health Long Term Care Facility Complaints
toll-free hotline is 1-800-254-5164 or 717-787-1816.
Attorney Marshall can be contacted
at webmail@paelderlaw.com
or at 1-800-401-4552
Attorneys Weber &
Marshall Train Lawyers on Nursing Home Issues
Written
By: Melissa Bottorf, Director of Marketing & Public Education
In
April, Marshall, Parker & Associates Attorneys Tammy Weber and
Jeff Marshall
traveled across
Pennsylvania
educating lawyers about the issues involved in “Representing an
Individual Entering a Nursing Home.”
The course, under the auspices of the Pennsylvania Bar
Institute, was attended by approximately 250 lawyers in
Pittsburgh
,
Philadelphia
, and Mechanicsburg.
The day-long course included discussion of
Alternatives to Nursing Home Care, Paying for Care (Medicare,
long-term care insurance, Veterans Benefits, Medicaid, and
deductions for private payment), Getting Admitted and Getting Good
Care, and Ethical Issues for Lawyers. Attorneys Weber and Marshall
were the course planners and served on the faculty for each
presentation. Other
faculty for the course included Linda Anderson, CELA,
Robert Clofine
, CELA, Professor Lawrence Frolik, Robert Gerhard, CELA, Julian
Gray, CELA, Carol Sikov Gross, CELA, Alissa Halperin, Esq, Craig
Hatch, CELA, Thomas Lilly, JD, CLU, Diane Menio, Thomas Murphy, CELA,
Dionysios Pappas, Esq., Professor Katherine Pearson, Kemp Scales,
CELA, Lori Smetanka, Esq., and Stanley Vasiliadis, CELA.
The course book and a 6 hour audio or video of
the Mechanicsburg presentation are available through the
Pennsylvania Bar Institute, www.pbi.org
or 800-247-4724.
May is Older Americans
Month
Written
By: Joe DeLauter, Home Instead Senior Care
Since
May 1963, our nation has honored its senior citizens annually.
The tradition began when President John F. Kennedy designated
May 1963 as “Senior Citizens Month”.
Thanks to President
Jim
my Carter in 1980 the name was changed to “Older Americans
Month”. Every
President since JFK has issued a formal proclamation during or
before May to pay tribute to older adults.
In issuing his 2006 proclamation, President Bush stated:
“Older Americans represent the finest qualities of our Nation.
During Older Americans Month, we honor our older citizens,
celebrate their many accomplishments, and learn from their
experiences.” The
theme for this year’s Older Americans Month is “Older
Americans: Making Choices for a Healthier Future.”
In 1963 there were only 17 million Americans
that reached the age of 65. Today,
because of improved medical care and prevention efforts, that number
is 36 million. By 2030,
because of longer lifespans and the aging Baby Boomers, it is
estimated that 72 million people will be 65 or older, roughly 20% of
the population. This
unprecedented growth will have significant impacts at the national,
state, and community levels. Yet,
according to the National Association of Area Agencies on Aging,
only 46% of American communities have begun planning to address the
needs of the exploding population of older adults.
It’s been well documented that the vast
majority of older adults want to remain at home for as long as
possible and to have choice and control over how and where they live
as they age. Yet, our
healthcare system does not reimburse for many home care needs,
forcing economic and quality of life hardships on families and their
loved ones. These
hardships are in conflict with the stated mission of the Older
Americans Act to “provide for and protect the independence and
dignity of our older citizens.”
This year’s national theme was selected to
encourage us to think differently about health and long term care.
Let’s take time in May to encourage our federal, state, and
local elected officials to reflect on this month’s theme and begin
addressing some deficiencies in our healthcare system.
For those with older loved ones still living,
take time in May to be especially grateful to them for all they have
done in their lives and especially for bringing you into this world
and/or helping prepare you for your life journey.
If you haven’t done so yet, spend time with them and begin
writing down some of the wonderful life stories and family history
that can be passed down to future generations.
Collect all those decades of pictures and prepare a scrapbook
with them as another excellent quality way to capture life’s
precious moments. As an
owner of a home care organization specializing in senior care, I can
assure you that your loved ones will appreciate the special time you
have together as will your children, grandchildren, and future
generations.
Joe DeLauter
is the owner of the local
Home Instead Senior Care franchise, a home care organization
providing personal care, companionship and home helper services for
seniors throughout the
Susquehanna
Valley
and
Central Pennsylvania
. Visit our Web site, www.homeinstead.com,
or call 570-522-6533 for additional information.
Register
for Marshall, Parker & Associates’ Professional Update on May
10 and May 11
Marshall, Parker & Associates’ 11th Annual Elder Law
Update has been slated for Thursday, May 10th at the
Williamsport Country Club and Friday, May 11th at the Woodlands in
Wilkes-Barre
.
Each session begins with breakfast & registration at
7:30 AM
.
This
will be your opportunity to get the latest information on changes
that are of critical importance to seniors and to those of us who
provide services to them. A brochure and agenda are
available at www.paelderlaw.com/registration.asp
. (Please note: No additional registrations will be accepted for the
May 10th Update in
Williamsport
.
Registration is full in
Williamsport
.
Limited space is still available in
Wilkes-Barre
.)
The
Update is FREE and intended for professionals in the elder care and
elder services network such as individuals working in nursing homes,
hospitals, assisted living and personal care facilities, area
agencies on aging, and county assistance offices.
It will also be of great interest to social workers,
insurance and financial planners, accountants, lawyers, trust
officers, and other professionals who work with seniors.
Credits
Provided:
Personal Care Home Administrators: 3.5 Credits
(Free)
Social Workers: 3.5 Credits ($20.00 made
payable to “College Misericordia”)
Accountants: 3 Credits offered through Parente
Randolph (Free)
Attorneys: 3 Credits have been approved from PA
CLE ($4.50 made payable to “Marshall & Associates)
Marshall
, Parker & Associates
would like to thank this year’s sponsors:
•
Hospice of the Sacred Heart
•
Bayada Nurses
•
Outlook Pointe
•
Endless Mountains In-Home
Solutions
•
Valley Crest
•
Susquehanna Wealth Management
•
College Misericordia
•
C&N Trust & Financial
Management Group
•
NorthCentral Geriatric
Interest Network
•
NorthCentral Pennsylvania
Estate Planner’s Council
•
Merrill Lynch
Melissa can be contacted at webmail@paelderlaw.com
or at 1-800-401-4552
1 The Medicare and Medicaid provisions
mirror each other. See
42 U.S.C. §§ 1395i-3(a)-(h), 1396r(a)-(h).
The rules apply equally to Medicare Skilled Nursing
Facilities (SNFs) and Medicaid Nursing Facilities (NFs).
See also 42 C.F.R. §483.1 et seq.
2 42 C.F.R. §483.12
(a)(2)(ii)
342 C.F.R. §483.12
(a)(2)(i).
4 42 C.F.R. §483.12
(a)(2)(iv); 42 C.F.R.
§483.12 (a)(2)(iii).
5 42 C.F.R. §483.12
(a)(2)(v).
6 42 C.F.R. §483.12
(a)(2)(vi).
7 42
U.S.C. §1396r(b)(2); 42 C.F.R. §483.12
8
42 C.F.R. §483.12(a)(7).
10
42 C.F.R. §483.12(a)(7)..
11 42 C.F.R. §
483.204(1)
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*Attorneys
Marshall and Parker are certified
as Elder Law Attorneys by the National Elder Law Foundation under
authorization from the Pennsylvania Supreme Court.
