"Aging in America" on HealthSmart

The half-hour program, HealthSmart: Aging in America, broadcast initially on WITF-TV (Public Television; Harrisburg, PA) on November 24, 2010, asks the question: "What does a senior citizen look like in today's world?"

This program's response:  "We all know someone who is over the age of 65 and living life to the fullest."  The program examines the demographic wave of new 65+ citizens, and then considers their lifestyles and challenges.

The HealthSmart series of broadcasts is produced and hosted by Keira McGuire:

WITF's Mid-Atlantic Emmy nominated, in-studio, locally produced 30-minute health show features the medical topics that are on everyone's mind.

Local experts give practical advice on how to beat the odds and live healthier and happier, everyday. And local survivors share their touching stories to help our audience understand various diseases and conditions. 

Intended to appeal to health-conscious viewers, HealthSmart targets anyone who is looking for practical "real life" ways to live healthier every day. The focus of the series is on useful information that can be incorporated into daily life. * * *

This episode about Aging in America highlighted the expanding class of new seniors:

Soon, the first of over 75 million baby boomers will begin to earn senior citizen status.  On the next episode of HealthSmart we'll talk to baby boomers about the future.  Are they planning to slow down?  How can they stay sharp as they age?  What should they know about Medicare? * * *

If you are interested in learning why the "baby boomers" comprise "one generation that seems to be redefining the rules of aging," then watch the program online.  The graphics are pleasing, the hostess is attractive, the factual background is simply presented, the interviews of professionals (like Penn State Professor Melissa Hardy and PA Department of Aging Secretary John Michael Hall) are insightful, and the glimpses into individual lifestyles of new-age seniors are inspiring.

The theme that I derive from the program -- consistent with the Baby Boomer generation's earlier theme sung by Bob Dylan -- could be "The Times They Are a-Changin'.  The program addresses emerging challenges and opportunities, magnified due to the size of the new Senior Class.

The program is now available online for post-broadcast viewing.  The series is underwritten by Capitol Blue Cross.

Come senators, congressmen,
Please heed the call.
Don't stand in the doorway.
Don't block up the hall.
For he that gets hurt
Will be he who has stalled . . . .

-- Bob Dylan

in The Times They Are a-Changin'

(January, 1964)

PA Health Department Posts New POLST Form

On November 16, 2010, the Pennsylvania Department of Health posted on its website a new standard form for Orders for Life-Sustaining Treatment (POLST), revised 10/14/10. 

The form was listed under the website's Quick Links, but does not appear to be the subject of any press releases or further highlighted bulletins.

The concept and implementation of physician-ordered life-sustaining treatment orders is discussed in detail on the national website of that movement -- POLST.org -- which maintains this paradigm:

The Physician Orders for Life-Sustaining Treatment (POLST) Paradigm program is designed to improve the quality of care people receive at the end of life. It is based on effective communication of patient wishes, documentation of medical orders on a brightly colored form and a promise by health care professionals to honor these wishes.* * * 

Effective communication between the patient or legally designated decision-maker and health care professionals ensures decisions are sound and based on the patient’s understanding their medical condition, their prognosis, the benefits and burdens of the life-sustaining treatment and their personal goals for care.

The state-by-state implementation map on that website now needs a change.  Pennsylvania should shift from the color grey (no program), to red (endorsed programs).

The Pennsylvania POLST form is explained generally by the Explanation that accompanies it:

Pennsylvania – Orders for Life Sustaining Treatment (POLST) is a medical order that gives patients more control over their end-of-life care. The POLST form specifies the types of medical treatment that a patient wishes to receive towards the end of life.

These medical orders are signed by both a patient’s physician, physician’s assistant, or certified registered nurse practitioner and the patient or the patient’s surrogate.

Completion of a POLST form is only a small step in the process of a patient’s decision-making, and it is critical that this form be used as part of a program for end of life decisions that includes educational support and other aspects of planning for providers and patients.
 
This form was developed by the Pa. Department of Health’s Patient Life Sustaining Wishes Committee and was designed to be consistent with Pennsylvania law. There are significant advantages to using a form that contains standardized language and is produced in a distinctive and easily recognizable format. 

In order to maintain continuity throughout Pennsylvania, please follow these printing instructions: 

*** Print POLST form on 110# Pulsar Pink card stock. ***

 
See additional instructions on the POLST form related to completing and using the form.
 
As additional educational materials are developed for the POLST form and for POLST programs in Pennsylvania, they will be added to this introduction.

In recent years, the Department of Health has actively addressed end-of-life issues affecting Pennsylvanians through study groups and reports.  See:

• End of Life Experiences in Pennsylvania -- A Background paper (May, 2005; PDF, 38 pages); and
• Improving End-of-Life Experiences for Pennsylvanians (2006; PDF, 40 pages) -- Report and Recommendations to the Governor by the Task Force for Quality at the End of Life.

A new POLST form for Pennsylvania was contemplated by the most recent study report, End-of-Life Care in Pennsylvania -- Final Report (2007; PDF, 121 pages), which attached as Appendix "F" the POLST form used in Oregon, which has become standardized nationwide.

The new Pennsylvania POLST form is virtually identical, except for layout and explanations, to the sample form contained in the 2007 Final Report.

Administrative issuance of a POLST form for Pennsylvania was authorized by Act No. 169 of 2006, effective January 29, 2007 (replacement Chapter 54 in the PA Probate, Estates & Fiduciaries Code), pursuant to its Section 5548.

The new POLST form is not the same as an Out-of-Hospital Do Not Resuscitate Order authorized by Chapter 54 of the PA  PEF Code (as explained by the PA Department of Health); nor is it, alone, a Health Care Directive under Chapter 54 of the PEF Code (as explained by the Pennsylvania Medical Society).  See: PA HealthCare DecisionMaking website; "Understanding Living Wills and DNR Orders" posted by the Pennsylvania Patient Safety Authority.  However, a POLST Order could be used in conjunction with both, or either.

End-of-life decision making is a difficult, emotional subject.  On November 8, 2010, an article entitled Facing death: Questions to consider when making medical decisions, by John Luciew, was posted by the Patriot News (Harrisburg, PA).  He addressed this topic using source material from the Pennsylvania Medical Society's Family Health & Wellness website, which had not yet referenced the pending POLST form.

The law and medical privacy rules consider friends and non-married companions less than “real” family.

In order to involve them in one’s own medical decisions, specific legal declarations must be made. These are known as advance health care directives, or simply, advanced directives.

There are two main types: a health care power of attorney and a living will. Most people should consider having both. * * * 

Here are some questions to consider when making advance directives:

• Who would you trust to follow your wishes? Who can make tough choices? Who is willing and able to serve as your health care agent?
• How you would like to be cared for if you can no longer speak for yourself? What life-sustaining treatment and other care you would want at the end of your life?
• What personal wishes and values do you want your health care agent to consider when making decisions about your care?

Perhaps it is the emotional aspects that explain the Department's low-key implementation of the fairly standardized POLST form in Pennsylvania.

Now there is another mechanism through which such medical treatment preferences and directions can be memorialized and then  implemented in Pennsylvania.  It will change the way end-of-life decision making will be conducted.

Updated: 11/19/10:

My friend, Attorney Robert B. Wolf, of Pittsburgh, PA, noted my posting in one of his P&T Hot Tip Emails, which was reposted online by Smithfield Trust Company.

Bob served on the group that prepared the new PA POLST form:

I was privileged to serve on the Patient Life Sustaining Wishes Committee, and to work with leaders in Pennsylvania, such as Dr. Judy Black and Marian Kemp of Highmark and David Barnard, of the University of Pittsburgh in this effort.

He advised further:  "We are currently working on educational materials for healthcare providers, and after that for patients and families."

For a comprehensive list of currently-available POLST resources, see: Resources: Pennsylvania Physician Ordered Life-Sustaining Treatment (POLST), posted by the University of Pittsburgh's Institute on Aging.

Video: Getting Started in Estate Planning

Forbes' video network online posted, on September 15, 2010, a short segment entitled Estate Planning:  How to Get Started, starring Deborah L. Jacobs, the author of the recently-published book Estate Planning Smarts.

Her advice during the interview impresses the need for personal planning, and urges that this not "be done at home" due to the pitfalls and pain that can result.  Pain avoidance is a real motivator, since "[a]bove all, estate planning is a way to take care of yourself and the people you love."

Her book's website notes that, "[r]egardless of your net worth, a good estate plan should accomplish these essential goals:

• Caring for yourself by authorizing people to handle your affairs if you no longer can because of illness or disability

• Specifying who gets what after you pass away

• Providing for children who are minors or who have special needs.

In my blog posting on September 29, 2010, I noted an article written by Deborah L. Jacobs entitled Do-It-Yourself Wills, a No-No.  I agreed with Deborah that "DYI" should not be an option in personal and estate planning.

However, thorough preparation -- in learning about this area of the law, in listing your personal goals and obstacles, and in summarizing your situation (your holdings & income, versus your debts & commitments) -- is very important.

Pairing a prepared client with a qualified professional should result in a good outcome.

Mediation for Elderly

Today I enjoyed participating in a seminar presented in Pittsburgh by the Pennsylvania Bar Institute entitled "Using Mediation to Resolve Disputes Involving the Elderly".

This is the description of the course:

A variety of conflicts involving elderly persons call for effective resolutions that take into consideration a multitude of varying interests and often delicate relationships. ADR, and particularly, mediation often provides the structure and process for that to occur.

This course will provide anyone -- lawyers (general practitioners, as well as elder, healthcare, estates, trusts & probate and business law specialists) and members of the other helping professions -- with the tools they need:

• to decide whether and when it is likely to be appropriate and helpful to use mediation or another type of ADR to resolve disputes in which that elderly person is involved,
• to represent a client effectively in preparation for and during an ADR process to resolve such a dispute, and
• to educate the family members of an elderly person about the conflict resolution options available to support them in maintaining positive relationships with their elderly relative.

Disputes involving the elderly arise in a variety of situations: estate planning and administration; addressing an elderly person`s changing needs or the care they are receiving (whether in a private or institutional setting); deciding on the appointment of a guardian; managing conflicts between elderly people and (of course) resolving intra-family conflicts; and conflicts within institutional settings which, if not resolved, can affect and elder's care and the liability that can accompany errors that arise when conflict is protracted.

In any of these situations, questions may arise about the ability of the elderly person to participate meaningfully in the ADR process due to his or her diminished mental capacity, and how to compensate for this condition. Sometimes, abuse of the elderly person is a factor, and almost always there are multiple parties to the conflict.

Addressing these challenges, in addition to those that typically arise in any mediation, calls for experienced and specially trained ADR practitioners. 

The course was presented previously, on October 13, 2010, in Philadelphia, where it was videotaped.

The interaction among the panel members and those in the audience today -- many with extensive mediation experiences -- set this four-hour session apart from other "lectures" I have heard (or delivered!). 

As a co-planner of the course from its inception, my contribution to written materials involved a new website hosted on Google Sites, which I entitled "Mediation for Elderly."  It remains available as a teaching tool supplementing the printed book.

On its web page entitled Article & Reports, I listed good resources to learn about mediation involving an elderly person.  One of those references is a recent article posted by the AARP Bulletin entitled "Oh, Brother! With Parents Aging, Squabbling Siblings Turn to Elder Mediation" (09/20/10), by Sally Abrahms.

Also on that web page, I referenced previous PA EE&F Law Blog postings regarding alternative dispute resolution, including mediation:

• PA ADR: A Newsletter & an OC Case (05/08/07)
• Symposium on Ethical Standards for Elder Mediation (02/01/07).
• PA Superior Court Announces New Appellate Mediation Program (10/09/06).

Key course planners Jim Rosenstein and Ann Begler, with the other Philadephia and Pittsburgh panelists, compiled a useful printed resource regarding mediation as one form of alternative dispute resolution well-suited to many seniors encountering problem settings.

Adult Protective Services to be Expanded

According to a Press Release issued on September 28, 2010, by PA Senator Pat Vance (R-Cumberland/York), the Pennsylvania House of Representatives on that date approved legislation sponsored by her "to provide protective services for adults with cognitive or physical disabilities."  The legislation (SB 699, PN 1888) was presented to the Governor on September 29, 2010, for his consideration of signing into law.

Senate Bill 699 (of the 2009-10 Session), is described as follows:

An Act providing for protection of abused, neglected, exploited or abandoned adults; establishing a uniform Statewide reporting and investigative system for suspected abuse, neglect, exploitation or abandonment of adults; providing for protective services; and prescribing penalties.

According to the Press Release, the legislation unifies a patchwork of services that currently exist for adults between the ages of 18 and 59, and reaches those adults with limited protections because they reside with families or non-regulated caregivers.

The Adult Protective Services system established by the bill clearly defines procedures for filing complaints of abuse, neglect, and exploitation. It also provides for investigations of those complaints and the development of service plans to remove the adult from imminent harm and provide for long-term needs. 

More than 40 states currently have adult protective services systems in place that provide some level of protection and advocacy for individuals with cognitive or physical disabilities between the ages of 18 and 60.  Pennsylvania, however, has had no process by which any person who knows of the abuse of an adult in this age group can offer any meaningful assistance. * * *

During the past few years, Senator Vance focused on elder law and disability issues.  Her coordination of efforts with advocacy groups -- such as those set forth in a 2-page online listing dated July 8, 2010 of organizations supporting Senate Bill 699 -- and professional associations, such as the Pennsylvania Bar Association's Elder Law Section yielded results in the Senate and the Legislature.

"For a number of years I have advocated for this legislation, but concerns regarding funding delayed action," Vance said.

"Under the new federal Patient Protection and Affordable Care Act, it appears money will be available for this worthwhile and important program that the fills the gap between the protective service systems for children and the one for older adults."

One of the organizations on that list of supporters of SB 699 is Vision for EQuality, Inc., which announced the House adoption of it with great enthusiasm:

CONGRATULATIONS! WE DID IT!

September 28, 2010

The Pennsylvania House of Representatives today passed Senate Bill 699 to protect vulnerable adults who are abused or neglected. The House vote today was a unanimous 196-1.

SB 699 unanimously passed the Senate on July 3, 2010.

Governor Ed Rendell is expected to sign it into law. Pennsylvania is currently only one of five states yet to implement a protective services system. * * *

The advocates' years-long efforts -- now rewarded because federal funding should be available -- are noted on its home page:

Throughout Pennsylvania, there have been many cases of abuse and neglect of people with disabilities, yet there is no place to report such situations and no agency authorized to investigate them.

The PA Legislative Budget and Finance Committee (LBFC), an arm of the PA legislature, studied the issue in 2003 and concluded an adult protective services law was needed. According to that LBFC report [ An Assessment of the Need for an Adult Protective Services Program], an estimated 4,000 reports of abuse will be made statewide annually, and about 1,200 (or 30%) will be substantiated.

A House hearing held in the fall of 2006 documented a number of abuses, including a young woman with an intellectual disability who spent several days locked in a basement with her deceased sister and a woman with multiple sclerosis who was raped by her husband. Many individuals with disabilities do not come forward and press charges with traditional law enforcement because they fear retribution by the perpetrator on whom they often rely for care, food, and shelter. 

Pennsylvania has a protective services law for children and one for older adults, and now SB699 will authorize the development of a protective services system for adults ages 18 to 59. [Links added.]

Update: 11/17/10:

According to the posted Legislative History for SB 699, on October 7, 2010, Governor Rendell signed into law the legislation relating to "protective services for adults with cognitive or physical disabilities" as Act No. 70 of 2010.

According to Section 704 ("Effective Date"), "[t]his act shall take effect in six months."

Thus, the implementation date for the new law will be on April 7, 2011.

The Pennsylvania Department of Public Welfare will be responsible for administering the new adult protective services.  Searching the Department's website for references either to Act 70 or SB 699 does not yet yield results, but it would, no doubt, as the Department approaches the effective date for the new law.

Update: 02/13/13:

Nearly two years after the enactment, I still cannot find reference on the website of the Pennsylvania Department of Public Welfare to this law.  I wonder about its implementation under DPW.

PA Law Resources Available

Recently in researching, I came across a basic guide to sources of Pennsylvania law (statutory, regulatory, judicial opinions, and practice treatises) entitled "Legal Guide: Pennsylvania Practice Aids" (June, 2008; PDF, 2 pages), posted by the Widener University School of Law's library.

Such a primer should be helpful for any "newbies" to the subject of Pennsylvania law, whether first-year law students or other students seeking an overview of rules issued by Pennsylvania's three-branch system (legislative, judicial, & executive).

Widener University Law School's library in Harrisburg, PA, is listed among similar facilities at the eight Pennsylvania law schools, as compiled by HG.org, a legal information service.  Its law collections can be searched online, just like the online legal collection at the University of Pennsylvania Law School's Law Library, and many others.  Some of these resources are restricted to students, but many of the linked resources are usable by anyone.

In Pennsylvania, the most comprehensive online resource of law-related links likely remains Pennsylvania Legal Research Websites, which I reviewed previously.  I described it as "the definitive listing of legal links in the Commonwealth."  See: PA EE&F Law Blog posting "PA Legal Research Websites" Shines (05/01/08).  Younger folks would just say, "Awesome!"

For general questions in Pennsylvania, we could consider another resource:  the Ask Here PA service, which is "designed to provide fast answers to your questions, using information found on the Internet and in proprietary databases funded by libraries." 

They promise a response to a question sent by email within fifteen minutes or less.

Sounds like an oracle I might use on a tough issue.

“The ancient oracle said that I was the wisest of all the Greeks.

It is because I alone, of all the Greeks, know that I know nothing.”

 -- Socrates (Ancient Greek Philosopher, 470 BC-399 BC)