Options for Ending Your Life When You’re A “Vegetable” Who Lacks a Power of Attorney

By Fredrick P. Niemann, Esq. of Hanlon Niemann & Wright, a Freehold, NJ Healthcare Directive and Living Will Attorney

Our topic today is one that I don’t like to talk about and no one reading probably wants to think about.  Unfortunately, what we are discussing is based from a client that came to us.  The client’s spouse was in a coma after suffering a stroke following heart surgery.  The client and the spouse are in their late-50s, and the option of having a power of attorney or a guardianship application filed years earlier never crossed their minds.  But due to the severity of the condition that the spouse is in, the doctors have discussed with our client the very likely possibility that there is no hope that the spouse will recover.  Unfortunately, with no Power of Attorney or Healthcare Directive filled out or directives filed, doctors do not know the wishes of the patient concerning medical treatment and whether or how long life-sustaining medicines should be continued for her.  Naturally they will turn to the next-of-kin for medical decisions and direction.  But, what about the decision to withhold life-sustaining treatment, in essence to end a spouse’s life? Can our client as spouse be able to make that decision, or will the client need to become the spouse’s guardian to make that decision?

It turns out that in a similar case, the Supreme Court of New Jersey in Matter of Jobes, 108 N.J. 394, 420 (1987) tackled this very issue.  It specifically stated that a guardianship for the purpose of making this decision was unnecessary, and that the ability to make that decision could be provided to the patient’s close family or friends.  The court made it clear that courts should not be in the business of making those decisions or appointing guardians for the sole purpose of withholding life-saving treatment.  Instead, it left that to others.  However, the court made clear that this decision wasn’t to be made lightly, and ordered that the decision be made subject to a confirmation procedure.  If the patient is in a hospital, like ours, a prognosis committee would need to be formed for the purpose of making a decision as to whether the patient has any reasonable hope of returning to a cognitive state. This option must be made so that the family can make its life-death decision.

If the patient is outside of a hospital and under 60 years old (the office of the Ombudsman makes the call for someone over 60 years of age), the family needs to secure two medical affidavits from independent neurologists stating that there is no hope for recovery and the patient is in a persistent vegetative state.  If this is done, no liability will incur for making this decision.  Ultimately, our client can take comfort over the fact that a judge will not get in the way of making this end of life decision, and that it will be up to the family and the team of doctors to make that decision about whether to pull the proverbial plug on the spouse.

To discuss your NJ Elder Care and Health Care Directive matter, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at fniemann@hnlawfirm.com.  Please ask us about our video conferencing consultations if you are unable to come to our office.

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A Decline in Dementia Risk

Dementia is one of the major causes of disability and dependency among older people worldwide. According to the World Health Organization, 47.5 million people have dementia and there are 7.7 million new cases every year. In the United States, more than 9 million Americans live with some form of dementia, according to the Dementia Society of America. The situation is indeed quite bleak. However, according to a recent study, the risk of dementia seems to be somewhat declining.

The study, published in the Journal of the American Medical Association- Internal Medicine, suggests a decline of the prevalence of dementia in the US between 2000 and 2012, and points to one reason for the improved outlook — an increase in education.

To reach this conclusion, the study used data gathered in two snapshots, one in 2000 and another in 2012, that each looked at more than 10,000 Americans who were at least 65 years old. In the first snapshot, 11.6% of them had some form of dementia. In the second snapshot, it was 8.8%. The snapshot of people examined in the study were ethnically, geographically and economically diverse, drawing on an ongoing Health and Retirement Study that follows about 20,000 older Americans of all backgrounds nationwide. “That’s well over a million people who don’t have dementia, who would have had it if the rates had stayed the same as 2000 rates,” says John Haaga, who directs the Division of Behavioral and Social Research at the National Institute on Aging, which funded the study.

Education as a Protector Against Dementia

Researchers in this study noticed that while the prevalence of dementia cases dropped, the average amount of education in the study population increased. For instance, in 2000, the average amount of education was 11.8 years (just shy of the 12 years it takes to graduate high school). In 2012, the average amount of education was 12.7 years, which equates to high school plus a little bit of college. Dr. Kenneth Langa, a professor of medicine at the University of Michigan and the lead author of the study, believes that there is a correlation between dementia risk and education.

These are the findings in this regard, presented by him and the other researchers:

  • Education changes the brain: According to Langa,”Education might actually change the brain itself. We think that it actually creates more, and more complicated, connections between the nerve cells so that you’re able to keep thinking normally later into life.”
  • Education affects your whole life: “Education can not only change the brain, it can change your whole life,” says Haaga.”It affects what kind of work you do, of course. It also affects who your friends are, who you’re married to, whether you’re married. All aspects of life are affected by educational attainment,” he says.
  • Education isn’t the only “X factor”: “Cardiovascular conditions believed to increase the risk of dementia — things like high blood pressure, high cholesterol, obesity, diabetes — are becoming more common,” says Haaga. “But they’re also being treated more aggressively. So it could well be that we’re getting better at managing the bad effects of these risk factors,” he says.
  • These dementia declines have been found across the US, not just in one group or one region: Langa says “(t)he ethnic, geographic and economic diversity of the subjects makes the trend shown in this study more convincing. The fact that our study also shows a decline [in the prevalence of dementia], provides additional evidence that this phenomenon seems to be going on across the United States and not in one particular geographic region.”

Unfortunately, while the risk of dementia is declining, the number of cases is still expected to rise. That’s because the population of older adults in this country is increasing (i.e. the number of people 65 and older is expected to nearly double by 2050.) Study authors suggest that continued monitoring of trends in dementia incidence and prevalence will be important to better gauge the full future societal impact of dementia as the number of older adults increases in the decades ahead.

Keeping the Brain Active to Stave Off Dementia

What if you don’t have a college diploma or a post-graduate degree? Fortunately, there are still some things that everyone can do to jog your brain and possibly stave off dementia!

Gary Small, MD, a director at the UCLA’s Longevity Center, has spent the past two decades researching the ways lifestyle choices affect memory. In his book, The Alzheimer’s Prevention Program, he argues that it is indeed possible to stave off dementia.

Small discusses the importance of non-repetitive mental Exercise. In fact, in a groundbreaking study, older adults who received as few as 10 sessions of mental training not only improved their cognitive functioning in daily activities in the months after the training, but continued to show long-lasting improvements 10 years later. According to Dr. Small, mental exercise to stave off dementia should not be repetitive, and can be as easy as changing the route you use to drive home from work every now and then.

Another similar 10-year study, cited this year in the Wall Street Journal, showed the effectiveness of brain training, particularly speed training, to stave off dementia. Speed training includes computer exercises that get users to visually process information more quickly. This method was proven even more effective than memory and reasoning exercises, two other popular brain-training techniques. In fact, researchers found that a total of 11 to 14 hours of speed training has the potential to cut by as much as 48% the risk of developing dementia 10 years later.

In conclusion, you CAN reduce your risk of dementia through a combination of healthy habits, including eating right, exercising, staying mentally and socially active, and keeping stress to a minimum. By leading a brain-healthy lifestyle, you may be able to prevent the symptoms of Alzheimer’s disease and slow down, or even reverse, the process of deterioration. Read our blog post on this topic for more details.

Medicaid Asset Protection

Despite this encouraging news, if someone in your family is among the 9 million Americans living with dementia, you need to take action. If you haven’t already, please call us to make an appointment for a no-cost initial consultation. Here at the Farr Law Firm, we focus on easing the financial and emotional burden on those suffering from dementia and their loved ones. Every day we protect assets and obtain benefits for clients with dementia in order to maintain client comfort, dignity, and quality of life.

Fairfax Dementia Planning: 703-691-1888
Fredericksburg Dementia Planning: 540-479-1435
Rockville Dementia Planning: 301-519-8041
DC Dementia Planning: 202-587-2797

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Critter Corner: Can Dogs Get Dementia?

Dear Baxter,

My Shih Tzu, Morty, is getting up there in age. I recently saw him exhibiting some rather odd behaviors. For instance, he spins in circles, performs repetitive behaviors, and often appears completely lost or disoriented in our own house. Sometimes I wonder if he has dementia. So, I thought I’d ask you: can dogs get dementia? If so, what are the symptoms, and what should I do?

Thanks for your help,
Doug E. Stisoriented

Dear Doug,

Thanks for your question. Yes, dog dementia is a real thing. It is commonly referred to as “Canine Cognitive Dysfunction.” According to dogdementia.com, these are some of the symptoms:

◾Getting lost in familiar places
◾Staring into space or walls
◾Walking into corners or other tight spaces and staying there
◾Appearing lost or confused
◾Failing to get out of the way when someone opens a door
◾Failing to remember routines, or starting them and gets only partway through
◾Barking for no apparent reason and/or for long periods
And more.

Unfortunately, similar to dementia in humans, there is no cure for age-related dog dementia, but a number of treatments appear to help slow the process somewhat, and to varying degrees. These can include prescription drugs, over-the-counter supplements, and specially-formulated foods.

If you suspect your dog has canine cognitive dysfunction, be sure to check with your veterinarian for his or her recommendations. Supplements can have side effects and interact with other prescription or over-the-counter drugs your dog takes, and some antioxidants have toxic levels.

Best wishes to Morty and your family!

Baxter

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