Elder Law Commons^™

Public Perceptions Of Family Caregiving Of Children Versus Older Adults, Elizabeth S. Scott, Tamar Kricheli-Katz

Faculty Scholarship

The population of older adults in the United States is growing at a rapid rate, both because people are living longer lives and because older adults are an increasingly large share of the population as baby boomers age. It is predicted that by 2030, one in ¿ve adults in the United States will be of retirement age, and one in six people worldwide will be age 60 or older. By 2034 there will be more adults age 65 and older in this country than minor children under age 18.

Among the important consequences of this demographic trend will be a …

Guardianship And Its Alternatives: A Handbook On Maryland Law, Joan O'Sullivan, Ellen A. Callegary, Rebecca Hall, James F. Silver

Faculty Scholarship

No abstract provided.

Family Law For The One-Hundred-Year Life, Naomi Cahn, Clare Huntington, Elizabeth S. Scott

Faculty Scholarship

Family law is for young people. To facilitate child rearing and help spouses pool resources over a lifetime, the law obligates parents to minor children and spouses to each other. Family law’s presumption of young, financially interdependent, conjugal couples raising children privileges one family form — marriage — and centers the dependency needs of children.

This age myopia fundamentally fails older adults. Families are essential to flourishing in the last third of life, but the legal system offers neither the family forms many older adults want nor the support of family care older adults need. Racial and economic inequities, accumulated …

Telehealth For An Aging Population: How Can Law Influence Adoption Among Providers, Payors, And Patients?, Tara Sklar, Christopher Robertson

Faculty Scholarship

Telehealth continues to experience substantial investment, innovation, and unprecedented growth. However, telehealth has been slow to transform healthcare. Recent developments in telehealth technologies suggest great potential for chronic care management, mental health services, and care delivery in the home—all of which should be particularly impactful for an aging population with physical and cognitive limitations. While this alignment of technological capacity and market demand is promising, legal barriers remain for telehealth operators to scale up across large geographic areas. To better understand how federal and state law can be reformed to enable greater telehealth utilization, we review and extract lessons from …

America Is Selling Its Seniors Short, Constantine N. Katsoris

Faculty Scholarship

No abstract provided.

It’S Still Me: Safeguarding Vulnerable Transgender Elders, Sarah Steadman

Faculty Scholarship

Transgender individuals have many reasons to be concerned about their welfare in the current political and legislative climate. Transgender elders are especially vulnerable. They are more likely to be disabled than the general elder population. Moreover, transgender elders profoundly fear a future when they must rely on others to maintain and protect their gender identity and dignity. This fear is alarmingly realistic because if a transgender elder becomes incapacitated or requires institutional care, they are likely to face discrimination and other harms by their caretakers. In addition, transgender elders who are incapacitated are particularly at-risk if a non-affirming guardian is …

Rip Currents: Rough Water For End Of Life Decision Making, Kathy Cerminara

Faculty Scholarship

No abstract provided.

End Of Life And Autonomy: The Case For Relational Nudges In End-Of-Life Decision-Making Law And Policy, Megan S. Wright

Faculty Scholarship

Autonomy is a central principle in many areas of health law. In the case of end-of-life decision-making law and policy, however, the principle of autonomy requires revision. On the whole, law conceptualizes autonomy at the end of life as an individual making private, personal decisions based solely on their interests and values, and independent of others. But ordinary people understand autonomous decisionmaking at the end of life differently, in a way that acknowledges the importance of their interpersonal relationships. Social science research has documented that strengthening relationships with others, sharing responsibility in the decision-making process with healthcare providers, and taking …

Removing Obstacles To A Peaceful Death, Kathy L. Cerminara, Barbara A. Noah

Faculty Scholarship

We all will die, but the American health care system often impedes a peaceful death. Instead of a quiet death at home surrounded by loved ones, many of us suffer through overutilization of sometimes-toxic therapeutic interventions long past the time when those interventions do more good than harm. This article proposes revisions to health professional training and payment policy to eliminate as much as possible physical and existential suffering while progressing through the terminal phase of illness. The solution lies in seamless progression from treatment with integrated palliative care to hospice before death, but provider attitudes and payor practices must …

Lawyers And The Secret Welfare State, Milan Markovic

Faculty Scholarship

This Article suggests that the United States maintains a secret welfare state. The secret welfare state exists because of lawyers’ ubiquitous use of questionable practices in representing clients before benefit-granting government agencies, which enable thousands of individual to collect public benefits who may not qualify for them. This Article focuses in particular on lawyers’ handling of evidence of nondisability in Social Security Disability Insurance (SSDI) proceedings and participation in Medicaid planning. It may be possible that the legal profession’s central role in the distribution of public benefits is an obstacle to a fairer and more transparent social safety net.

The (Ir)Rationality Of (Un)Informed Consent, Barbara A. Noah

Faculty Scholarship

This essay considers the problem of over-utilization of medical care at the end of life and the lack of truly informed consent and briefly considers the multiple causes of these phenomena. It then explores the inherent challenges to making informed medical decisions using concepts of Knightian uncertainty, bounded rationality, optimism bias, and other heuristics. The essay concludes that uncertainty inherent in these decisions means that challenges to making truly informed decisions about medical care are even more substantial than physicians acknowledge or patients ever realize. Acknowledging these challenges is the first step to better medical decision making. informed consent has …

Avoiding Overtreatment At The End Of Life: Physician-Patient Communication And Truly Informed Consent, Barbara A. Noah, Neal R. Feigenson

Faculty Scholarship

This Article considers how best to ensure that patients have the tools to make informed choices about their care as they near death. Informed decision making can help reduce excessive end-of-life care and unnecessary suffering, and result in care that aligns with patients’ well-considered values and preferences. The many factors that contribute to dying patients receiving too much therapy and life-prolonging care include: the culture of denial of death, physicians’ professional culture and attitudes toward treatment, physicians’ fear of liability, physicians’ avoidance of discussions about prognosis, and the impact of payment incentives that encourage overutilization of medical technologies.

Under the …

A Better Death In Britain?, Barbara A. Noah

Faculty Scholarship

In the United States, patients and physicians often avoid discussing the inevitability of death and planning for it. As a result, opportunities are missed to make choices that comport with patients’ values and preferences. In the absence of such decisions, the default model is to “err on the side of life,” which often results in overtreatment or inappropriate prolongation of life and avoidable suffering. This Article discusses the United States' end-of-life training and care and Britain’s Liverpool Care Pathway as related to end-of-life care availability, quality, and cost. It further sets forth the argument that while the United States' medical …

The Growing Power Of Healthcare Ethics Committees Heightens Due Process Concerns, Thaddeus Mason Pope

Faculty Scholarship

Complex ethical situations, such as end-of-life medical treatment disputes, occur on a regular basis in healthcare settings. Healthcare ethics committees (HECs) have been a leading dispute resolution forum for many of these conflicts. But while the function of HECs has evolved from mediation to adjudication, the form of HECs has not evolved to adapt to this expanded and more consequential function.

HECs are typically multidisciplinary groups comprised of representatives from different departments of the healthcare facility: medicine, nursing, law, pastoral care, and social work, for example. HECs were established to support and advise patients, families, and caregivers as they work …

It's Complicated: Age, Gender, And Lifetime Discrimination Against Working Women - The United States And The U.K. As Examples, Susan Bisom-Rapp, Malcolm Sargeant

Faculty Scholarship

This article considers the effect on women of a lifetime of discrimination using material from both the U.S. and the U.K. Government reports in both countries make clear that women workers suffer from multiple disadvantages during their working lives, which result in significantly poorer outcomes in old age when compared to men. Indeed, the numbers are stark. In the U.S., for example, the poverty rate of women 65 years old and up is nearly double that of their male counterparts. Older women of color are especially disadvantaged. The situation in the U.K. is comparable.

To capture the phenomenon, the article …

A Role For Law In Preparing For Death, Barbara A. Noah

Faculty Scholarship

This Article discusses the limits of how end of life law can address threats to patient autonomy. The reluctance of physicians, patients and family to discuss end of life matters and to confront the certainty of death, together with a culture that actively denies the aging process itself, interferes with a patient’s ability to exercise choice as death approaches. Thus, patients often suffer needlessly from the continuation of treatments and life-supportive measures that they would choose to decline if better informed about their choices and the importance of choosing. Advance directives, as a legal mechanism, often fail fully to protect …

You Can't Get There From Here: Elderly Prisoners, Prison Downsizing, And The Insufficiency Of Cost Cutting Advocacy, Elizabeth Rapaport

Faculty Scholarship

The prison population in the United States has peaked and begun to recede, reversing more than 30 years of growth. Mass incarceration is yielding to the imperative to reduce state budgets in recessionary times. As states turn away from the extravagant use of prison for nonviolent offenders, the percentage of the prison population serving long and life sentences for violent felonies will increase. By 2009 one in eleven prisoners were lifers. These are the prisoners growing old and dying in prison. High cost elderly prisoners who have aged out of crime should be good candidates for cost saving measures such …

Clinicians May Not Administer Life-Sustaining Treatment Without Consent: Civil, Criminal, And Disciplinary Sanctions, Thaddeus Mason Pope

Faculty Scholarship

Both medical and legal commentators contend that there is little legal risk for administering life-sustaining treatment without consent. In this Article, I argue that this perception is inaccurate. First, it is based on an outdated data set, primarily damages cases from the 1990s. More recent plaintiffs have been comparatively more successful in establishing civil liability. Second, the published assessments focus on too-limited data set. Even if the reviewed cases were not outdated, a focus limited to civil liability would still be too narrow. Legal sanctions have also included licensure discipline and other administrative sanctions. In short, the legal risks of …

Filial Support Laws In The Modern Era: Domestic And International Comparison Of Enforcement Practices For Laws Requiring Adult Children To Support Indigent Parents, Katherine C. Pearson

Faculty Scholarship

Family responsibility and support laws have a long but mixed history. When first enacted, policy makers used such laws to declare an official policy that family members should support each other, rather than draw upon public resources. This article tracks modern developments with filial support laws that purport to obligate adult children to financially assist their parents, if indigent or needy. The author diagrams filial support laws that have survived in the 21st Century and compares core components in the United States (including Puerto Rico) and post-Soviet Union Ukraine. While the laws are often similar in wording and declared intent, …

In Denial: The Role Of Law In Preparing For Death, Barbara A. Noah

Faculty Scholarship

Only approximately 20% of Americans have engaged in any form of advance care planning and, even among older Americans, the process frequently is delayed until an acute illness provides sufficient pressure to act. End of life law, though flawed, offers some opportunity to express individual values and preferences via advance directives of various kinds in order to prepare for death before it is imminent. Yet many people avoid making these preparations because the thought of death is uncomfortable to confront. This Article considers the utility of existing law in preventing and resolving end of life disputes and avoiding over-utilization of …

Two Conflicts In Context: Lessons From The Schiavo And Bland Cases And The Role Of Best Interests Analysis In The United Kingdom, Barbara A. Noah

Faculty Scholarship

This Essay considers the different approaches to end of life decision making for incapacitated patients in the United States and in the United Kingdom. In the United States, individual patient autonomy is the primary guidepost for making end of life decisions for incapacitated patients. In the United Kingdom, patient preference is openly and deliberately supplemented with a careful consideration of the patient’s best interest. To contrast the two approaches, the Essay focuses on two cases involving patients in permanent vegetative states (PVS) for whom little was known about their respective individual preferences, and it analyzes the differences in conceptualization and …

How Do The Elderly Fare In Medical Malpractice Litigation, Before And After Tort Reform? Evidence From Texas, Myungho Paik, Bernard S. Black, David A. Hyman, William M. Sage, Charles M. Silver

Faculty Scholarship

The elderly account for a disproportionate share of medical spending, but little is known about how they are treated by the medical malpractice system, or how tort reform affects elderly claimants. We compare paid medical malpractice claims brought by elderly plaintiffs in Texas during 1988–2009 to those brought by adult non-elderly plaintiffs. Controlling for healthcare utilization (based on inpatient days), elderly paid claims rose from about 20% to about 40% of the adult non-elderly rate by the early 2000s. Mean and median payouts per claim also converged, although the elderly were far less likely to receive large payouts. Tort reform …

Municipal Elder Law: A Minnesota Perspective, A. Kimberley Dayton, Israel (Issi) Doron

Faculty Scholarship

The field of elder law has developed dramatically over the past several decades and is primarily regarded as a creature of state and federal law. This area of law will be of paramount importance in the coming years as the elderly population continues to increase dramatically. Indeed, nearly every community in the United States will undoubtedly be impacted in some way by the influx of older residents. Notably, however, the effect of an aging society will impact each local community differently. For these reasons, Professors Kimberly Dayton and Israel (Issi) Doron sought to examine the role that municipal elder law …

Standards For Health Care Decision-Making: Legal And Practical Considerations, A. Kimberley Dayton

Faculty Scholarship

This Article explores the guardian’s role in making, or assisting the ward to make, health care decisions, and provides an overview of existing standards and tools that offer guidance in this area. Part II outlines briefly the legal decisions and statutory developments assuring patient autonomy in medical treatment, and shows how these legal texts apply to and structure the guardian’s role as health care decision-maker. Part III examines the range of legal and practical approaches to such matters as decision-making standards, determining the ward’s likely treatment preferences, and resolving conflicts between guardians and health care agents appointed by the ward. …

Thinking Locally: Law, Aging And Municipal Government: Findings From A National Survey, A. Kimberley Dayton, Israel (Issi) Doron

Faculty Scholarship

Municipal law, which has been largely ignored in the body of elder-rights scholarship, often plays a far more important role in the everyday lives of older persons than the principally aspirational concepts of international law. Accordingly, this article examines how well modern cities have fulfilled their potential role in assuring the civil and human rights of older persons. The author concludes, based on the results of a national study, that local law is not currently fulfilling its potential as a means to expand the rights of older citizens. Few cities across the country appear to have taken more than minor …

A Modest Proposal: The Aged Of Death Row Should Be Deemed Too Old To Execute, Elizabeth Rapaport

Faculty Scholarship

My exploration of the case for an Eighth Amendment bar against executing the long-serving elderly will begin with a review of the representation of the elderly on Americas death rows and a survey of the very limited avenues of relief currently available to them on the basis of age. I will then discuss the attribution problem by asking at whose door should 'fault' for long delays between condemnation and consummation of a capital sentence be laid--the prisoner, the state, or the working through of due process? For many jurists, attribution of fault is critical to resolving the question of whether …

Voluntarily Stopping Eating And Drinking: A Legal Treatment Option At The End Of Life, Thaddeus Mason Pope

Faculty Scholarship

Despite the growing sophistication of palliative medicine, many individuals continue to suffer at the end of life. It is well settled that patients, suffering or not, have the right to refuse life-sustaining medical treatment (such as dialysis or a ventilator) through contemporaneous instructions, through an advance directive, or through a substitute decision maker. But many ill patients, including a large and growing population with advanced dementia who are not dependent upon life-sustaining medical treatment, do not have this option. They have the same rights, but there is simply no life-sustaining medical treatment to refuse.

Nevertheless, these patients have another right, …

Guardianship And Its Alternatives: A Handbook On Maryland Law, Virginia Rowthorn, Ellen A. Callegary

Faculty Scholarship

No abstract provided.

La Caja De Pandora: Improving Access To Hospice Care Among Hispanic And African-American Patients, Kathy L. Cerminara, Alina M. Perez

Faculty Scholarship

Many patients clinging to hope in the form of potentially curative treatment could benefit from hospice services, but, for the most part, it is not until the patient accepts the finality of his or her condition that the physical, psychological and social benefits of hospice care become accessible to the patient and his or her family. Under current Medicare regulations and other health care payers’ policies, patients must abandon the hope of curative treatment before opting for hospice services. As a result, many terminally ill patients access the services late, sometimes a few hours before death. Scholars have proposed that …

Show Me The Money The Applicability Of Contract Laws Ratification And Tenderback Doctrines To Title Vii Releases, Daniel P. O'Gorman

Faculty Scholarship

No abstract provided.