Author Archives: richardzorza

Preparing for Dementia — An Individual and Collective Responsibility at Collington

As we move forward with operationalising our Strategic Plan, a recent New York Times article on dementia specific advance directives may be useful. Specifically:

Dr. Barak Gaster, an internist at the University of Washington School of Medicine, had spent three years working with specialists in geriatrics, neurology, palliative care and psychiatry to come up with a five-page document that he calls a dementia-specific advance directive.

In simple language, it maps out the effects of mild, moderate and severe dementia, and asks patients to specify which medical interventions they would want — and not want — at each phase of the illness.

“Patients stumble into the advanced stage of dementia before anyone identifies it and talks to them about what’s happening,” Dr. Gaster told me. “At what point, if ever, would they not want medical interventions to keep them alive longer? A lot of people have strong opinions about this, but it’s hard to figure out how to let them express them as the disease progresses.”

As a community with a commitment to individual autonomy, I think the document will speak to many of our concerns, and perhaps most specifically the fear of wanting to reject additional treatment, but no longer having the capacity to communicate that.  As the article elaborates:

For each stage of dementia, the patient can choose among four options. “Full efforts to prolong my life” and “comfort-oriented care only, focused on relieving suffering” represent two ends of the spectrum.

Patients can also opt for lifesaving treatments — except when their hearts stop or they can’t breathe on their own, precluding resuscitation or ventilators.

Or they can opt to receive care where they live but avoid hospitalization. “For someone who doesn’t understand what’s happening, going to an E.R. or being hospitalized can be really traumatic,” Dr. Gaster said. The experience can lead to delirium and other setbacks.

There is debate about whether there should be a separate dementia advance directive, but the idea of specific focus on the issue has great value.  (I personally find the Maryland MOLST utterly incomprehensible, and do achieve that this document does within the MOLST would be a great feat of editing.).

In any event, our commitment to the value of the individual challenges us, in my opinion, to do what we can to make sure that those who wish have thought through these issues, and that our entire system support people in these choices, which certainly reflect only current law, and do not represent any change from that law.

There was at one point talk to Collington working to improve the MOLST.  Maybe now is the time, reflecting the leadership goal in our strategic plan.  Surely these issue have great implications for staffing, training, staff-resident relationships, and culture building.

Thanks, Collington, for being a place where these things are as much on the table as they are on our minds.

Collingtonian Article on our “Pre-History” Raises Questions about Next Steps

Occasionally, this blog draws attention to articles in our sister publication, the Collingtonian. Peggy Latimer’s piece in the January 2018 issue is deserving of such focus. The piece, tells the history of slaves here at Collington, to the minimal extent that it can be reconstructed from wills and other documents. The story is particular present, because of the graves up on the hill, including one of Basil Warring, who had “inherited” ten slaves from his father.

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It is, of course, deeply shaming for a white person to read, and I think Peggy gets just the right combination of factual clarity and respectful perspective:

Marsham’s 1730 will listed them. All but one, however, were identified only by first name [spelling and punctuation through- out are as written in the original documents]: “One Negro Man named Caceour One Negro Man named Hercules one Negro Man named George One Negro Woman named Moll One Mulatto Boy named Charles One Mulatto boy called Robin One Negro Boy named Will Bulger One Mulatto Girl named Sarah One Mulatto Girl named Cate one Negro girl named Lucy and their Increase”

Peggy notes at the end, “With much research, we may be able to learn more of the history of these people. At the very least, shouldn’t we be honoring those enslaved persons who lived and labored on the land where we all now reside?” At the very minimum we should find public ways to recognize and honor that we enjoy the legacy of the labor of their forced and denied lives. Without in any way suggesting equivalence, the need to remember and honor reminds me that a few years ago, I went with my Polish Holocaust surviving aunt to a gymnasium (high school) in Mainz Germany, and for our visit, as part of a larger group, they had put up a mounted display of The Holocaust in Mainz, including a map showing locations.

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Here is a photo of my aunt with some of the display. The kids were deeply respectful and attentive.

Surely we can try to do as much.

Indeed, there must be much else that we could do, that not only reminds of the past, but steers us for the future in these apparently anti-historical times.

Did You Know Our Denny Klass is a Paradigm Shifter?

Many at Collington have had a major impact on thinking in their fields.  I had not till now realized the impact that “our” Denny Kass has had on the field of bereavement studies.  As the extract from the forward, written by professor Neil Thompson, at Wrexham Glyndwr University, for a new book Denny has co-authored states:

In the 20 years after Dennis Klass, Phyllis Silverman, and Steven Nickman introduced the concept into bereavement studies in Continuing Bonds: New Understandings of Grief, continuing bonds went from being dismissed and pathologized to being a fully recognized and accepted phenomenon in bereavement scholarship and practice. Indeed, continuing bonds can now be seen not just as a phenomenon in grief but as a way of characterizing and expanding on grief itself.

The concept of continuing bonds allows us to enrich therapeutic techniques that help the bereaved, to expand our ability to understand bereavement in other cultures, to focus the philosophic questions in bereavement studies, to transfer what we learn about bereavement to how we study other significant losses, as well as to begin to include a wider range of academic disciplines in the study of grief.

Contributors in Continuing Bonds in Bereavement: New Directions for Research and Practice provide a comprehensive overview of developments in the two decades after its inception. Clinically-based contributors show psychological counseling can be more effective when continuing bonds are included. Other chapters report on grief in different cultural settings, open the discussion about the truth and reality of our interactions with the dead, and show how new cultural developments like social media change the ways we relate to those who have died. .  .  .

In sum, in Continuing Bonds in Bereavement, Klass and Steffen offer a sweeping and substantial successor to the pioneering volume that initiated a paradigm shift in the study of grief and its therapeutic implications, consolidating a perspective that is likely to remain ascendant as the field of bereavement matures

While Denny developed these approaches before coming to Collington, the resonace with repect to the values and approach of our cmmunity is obvious.  Here we create bonds in a network, and nurture them when the network suffers a gash.  Smething to think about as we move forward with the relevant elements in our Strategic Plan.

The book is titled Continuing Bonds in Bereavement: New Directions for Research and Practice, Edited by Dennis Klass and Edith Maria Steffen.  Here is the Amazon link.

Richard Zorza’s Legal Blog Gets ABA Award

The American Bar Association Journal now does a Web 100 list honoring “the best of lawyers and the law on the web.”  For whatever it is worth, they have included my (Richard’s) Access to Justice blog this year on their list. Here is the link to the blog itself.

Quoting the blog, they describe it as follows:

“We define access to justice broadly to include innovations in courts, the bar, legal aid and community that make it easier for people to obtain access to justice institutions, and to just results within those institutions.” Posts cover a broad range of subjects, including access to counsel, foreclosures, self-service, law schools and technology.

Remember, all my blogs are listed here.

To whet your appetites, here is the begining of the list of topics covered.

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I know I am not alone in wanting to hear more about other resident’s milestones.

Leading Age Action Alert On Threat to Medical Deduction

This action alert from Leading Age may be of interest. It stands for itself:

Medical Expense Deduction and Tax-Exempt
Financing on the Chopping Block

Major tax reform legislation, H.R. 1, has been introduced in the U.S. House of Representatives and will soon come to a vote.

The bill contains 2 provisions of serious concern to aging services providers and the elders they serve:

  1. Elimination of the tax deduction for medical expenses.
  2. Elimination of tax-exempt financing for the development and preservation of affordable senior housing and life plan communities/CCRCs.

This radical legislation would disproportionately affect older adults, many of whom have higher than average medical costs and/or need affordable housing.

Congress needs to hear from you today. Tell your lawmakers to protect the medical expense deduction and tax-exempt financing for senior housing and life plan communities/CCRCs. Tell them older adults need this. Tell them protecting these tax provisions is the right thing to do.

How You Can Help

  • Call your lawmakers TODAY at 855-837-6894. We’ve set up this toll-free number to connect you directly to their offices.
  • Share this information with the residents in your community and suggest that they call as well. The proposed changes will directly impact them.
  • Forward this action alert to your network.

Steps for Making a Call

  • Dial this toll-free number 855-837-6894.
  • Feel free to use the sample script below when you talk to the staff person who answers the phone.
  • After talking with the staff person, do not hang up. The automated system will connect you to your representative and then to each of your senators.

Background

My name is _______ and I am a constituent. I urge Representative/Senator ____ to oppose provisions of H.R. 1, tax reform legislation that would eliminate the medical expense deduction.

Also, please preserve tax-exempt financing for the development and preservation of affordable senior housing and retirement communities, which would be eliminated under H.R. 1.

I hope Representative/Senator ____ will stand up for older adults and protect these crucial tax benefits for seniors and middle-income families.