I would like to share a summary of the ABA Commission on Law and Aging (COLA) meeting written by Jennifer Moye, PhD. Dr. Moye is a current member of the Commission, “a 15-member interdisciplinary body of experts in aging and law, that including lawyers, judges, health and social services professionals, academics, and advocates.” She is also the APA Liaison to COLA. More information about COLA is available at: http://www.abanet.org/aging/
American Bar Association Commission on Law and Aging (COLA)
Summary of May 16, 2008 Commission meeting.
1. Social Security
Attorney Holly Robinson reported that a major issue of concern in Social Security Disability is the backlog of cases waiting review, and also the problem obtaining medical records, bringing these records forward into the cases, and the quality of the psychological (and other reports) based on these records. ABA COLA will continue to join with others on trying to identify solutions to this.
2. Dementia
Attorney Leslie Fried reported on work being done by the Alzheimer’s Association regarding early onset dementia – there are special concerns re loss of employment, and associated insurance, long back log of getting SSD (see above), and psychological effects on children (who are not adults and have a 40-50 year old parent at home with dementia). Education and advocacy efforts are ongoing
3. Medicare
Attorney Leslie Fried discussed her recent efforts focusing on Medicare payment for hospice services for individuals with dementia. Concern was expressed in the past about the under-use of hospice and its use only for cancer. Following education to clinicians, the Medicare hospice benefit is now being used earlier and for non cancer conditions such as dementia. Now, questions are being raised about the cost, and suggestions of limiting hospice to only certain diagnoses (e.g., excluding dementia?).
4. Guardianship
Attorney Erica Wood reported that ABA COLA has completed a study of guardianship monitoring and is now disseminating to judges and courts, encouraging better monitoring of guardianships after appointments. States are developing pilot monitoring programs – and expanding the disciplines who might be used as monitors. For example, ABA COLA is working with Commissioner Barbara Soniat, Associate Professor of Social Work at National Catholic School of Social Service, to pilot the use of social work interns as guardian monitors.
Another major initiative is the Uniform Adult Guardianship and Protective Proceedings Jurisdiction Act, which has been approved as a uniform act, which means that states can use it as a model in passing their own laws (e.g., how guardianships are managed as wards/guardians move across state lines).
5. International Elder Law
ABA COLA is working with interested persons in the UK, Israel, and Australia, as recorded in the International Journal of Aging Law and Policy to link around developments in elder law in respective countries. The assessment of decisional capacity is an issue of interest internationally. Also, the UN and others such as Global Action on Aging – are aspiring to develop a UN Convention on the Rights of Older Persons.
6. Capacity Handbooks
ABA COLA is working with APA to develop a capacity assessment handbook for psychologists. ABA COLA is also working with a physicians group to develop a handbook and online educational materials.
7. Healthcare Decisions
Attorney Charles Sabatino reported that the Physicians Orders for Life Sustaining Treatment (POLST) is a new approach for individuals to post medical orders (e.g., full code/dnr) in their homes and carry it with them to hospitals to facilitate care consistent with wishes.
COLA supports the recommendation “to establish and support decision making protocols to ensure that the wishes of those who have advanced chronic progressive illness are appropriately translated into visible and portable medical orders, or POLST, that address higher probability medical contingencies including hospitalization, cardiopulmonary resuscitation, artificial nutrition and hydration, antibiotics, and ventilation.”
See Hickman, Sabatino, Moss, and Nester (2008). The POLST paradigm to improve end of life care: Potential state legal barriers to implementation. Religion and cultures of east and west: perspectives on bioethics Spring, 119-139.
A legislative update on health decisions laws enacted in 2007 is available at www.abanet.org/aging/legislative updates/home.shtml.
6. Mental Health Advance Directives
Attorney Charles Sabatino reported that 25 states have Mental Health Advance Directive MHAD laws, and there is consideration whether a “uniform law” should be developed to guide uniformity across states. MHAD are a special type of advance directive used by persons who have been diagnosed with serious mental health disorders, the purpose is to make an advance choice of medication or treatment to be provided when the person is experiencing a relapse of symptoms and is refusing appropriate treatment because of their illness. What is unique as compared to medical advance directives is they are “irrevocable” upon a medical determination of being “incapable” of deciding—even if actively refusing treatment. The MH AD cover treatments that often otherwise must be authorized by a court appointed guardian – e.g., admission to health care facility, and ECT. Thus, serious legal issues are presented, such as protection of the constitutional right to refuse medical treatment. More information at www.nrc.pad.org
7. Voting and Cognitive Impairment
In January the Senate Special Committee on Aging had a hearing on older voters. One outcome is that the Election Assistance Commission is developing voluntary guidelines to help states facilitate voting within long term care facilities. Research is planned to survey election policies and activities addressing accommodations for persons with cognitive impairment and other issues such as “mobile polling” to long term care facilities. Concern was also expressed for possible voter ID requirements and their unfairness to older adults – for example individuals in long term care may no longer have a drivers license or state issued ID – or the means to obtain one (e.g., transportation, birth certificates).
8. Emeritus Attorney Practice
Attorney Holly Robinson reported that COLA is active in investigating rules of practice for Emeritus attorneys who wish to provide pro bono legal services to individuals who need it following retirement from active practice.
Deborah DiGilio, MPH Director, Office on Aging American Psychological Association 750 First Street, NE Washington, DC 20002-4242 (202) 336-6135 (202) 336-6040 FAX DDiGilio@apa.org http://www.apa.org/pi/aging
