Monday, July 27, 2009

Memory loss diagnosis on older adults may have legal importance for caregivers

Some anecdotal conversations have uncovered the notion that family caregivers must be very careful about parents (or anyone) with a diagnosis of “memory loss” (or “short term memory loss”) anywhere in the medical records. Some people have told me that reckless endangerment laws in some states could make caregivers liable to prosecution for leaving people with mentally documented memory incapacity alone, even for very short periods. The concept is thought to be similar to leaving a child under a certain age home alone or even alone in a car, which has led to prosecutions in some states after some tragedies (as with parents who forgot that the child was in the car).

Memory loss (at any level, not just Alzheimer's as usually defined) is considered a very serious incapacity in disability law in some states (especially if it requires heavily promoted medications), and may not be flexible enough to vary that it varies widely from patient to patient. Some states may have judicial or administrative procedures to establish guardianship or conservatorship, and sill require caregivers without such powers to act as if they had them, a situation that could lead to future litigation.

Of course, the caregiver may not have taken on the responsibility in such a legally clear cut way that occurs when some “chooses” to have or adopt children. Adult social services often interpret laws according to circumstances or political climate, and even if in one state, different counties might implement laws differently. The recent health care public debate may be making the issue more sensitive, but Congress has not really taken on the sustainability problems of our eldercare future.

The availability of home health may become an issue, as may the willingness of the adult to move into assisted living or the ability to afford it (given the loss of home).

While adult children want to help their parents, the speed with which demographics and medical practice has led to an increase in disabled parents with fewer adult children to care for them can produce a public health and social crisis that Congress seems to have overlooked. The president has not yet addressed this aspect of the crisis directly, although I think he probably will soon. Adult children today need to plan for filial responsibility, both financially and in terms of personal attention, well in advance of need, and this particularly applies to singles and the childless (and often the LGBT population).

Memory loss, as the medical world establishes it, may even be partially a cultural problem. Today’s “Smallville” and markedly individualistic world requires mental multi-tasking and heavy use of abstraction that some seniors from past generations were never trained or expected to do; in the past there were more stable and numerous social connections within the extended family (expected from those who did not marry on their own) to maintain a safe and reasonable environment for some elderly, who also did not live as long with some kinds of problems. Some memory loss may actually result from some misused medications; remember that under Medicare physicians still do not have automatic record keeping for cross-checking for drug interactions among different providers. Today’s caregivers deserve better.

Here is a Doctor's Guide story on the reported effectivness of Aricept in some people. The title is "AAGP: Alzheimer’s Drug Aricept (Donepezil) May Delay Need For Nursing Home Placements."

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