FOR BREAKING NEWS VISIT WWW.QNS.COM AUGUST 1, 2019 • HEALTH • THE QUEENS COURIER 41
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Elder Law Minute TM
Implications of Cognitive Impairment, Legal Capacity and the Right to Bear Arms
ELDER LAW
Assessing the Situation and Aging
John is an independent, proud-eightyyear
old man who had nursed his late
wife through her long bout with advanced
Alzheimer’s disease and kept her at home
until the very end. When friends and family
wondered how he did it, given his limited
mobility due to crippling arthritis, he would
say, “I would have it no other way.”
Not only did he insist on doing his own
shopping and cooking, he also shopped for
neighbors in his apartment building, whom
he characterized as the “old folks.” But when
John had a stroke which paralyzed his left
side, there was no way he could return
home from the hospital. John and his three
children were told by a hospital representative
that they had a week to fi nd a skilled
nursing facility for him.
Th e agonizing decisions which John was
facing are the same that numerous older
adults and their families will encounter.
Th is is an eventuality that most of us dread
and for which few of us plan.
John’s children love their father and want
the best for him, and they are deeply troubled
by the decisions they must now make.
Placing a loved one in a long-term care
facility is painful because it forces us to face
the irreversible deterioration of someone
we love, as well as our inability to care for
that person ourselves.
Religious tradition teaches us that we
are obligated to honor and revere our parents
to ensure that their basic needs are met
and that they are treated with dignity and
respect. However, we also recognize that
we have competing responsibilities, or that
there may be very real limits to our ability
to provide care directly for aging parents
who may have signifi cant physical or mental
impairments. Fulfi lling our obligations
to a loved one sometimes means fi nding the
right person and the right setting to care for
them, when we cannot.
Th e fi rst step before considering longterm
care, is to make sure your loved one
has been thoroughly assessed for needs,
resources and available alternatives. For
instance, you may want to have him medically
assessed to determine whether the
incapacity is likely to be temporary or permanent.
You will also want to consider what
level of care is needed and in what setting.
Th e theme is to investigate and then
choose a facility, whether it be home-based
care, personal care, assisted living or longterm
care.
Choosing a nursing home requires that
you choose carefully. To start, get referrals
from friends, neighbors, or a social worker
and once you have identifi ed a few places,
you will want to visit them. As you look
at a facility, carefully evaluate its physical
environment. Look not only for cleanliness,
but to what extent it seems “institutional.”
Be alert for what you can discover about
the atmosphere and its surroundings. For
example: how are residents addressed? Do
staff use the term “Pop” for an elderly man
instead of his name? Is their privacy with
dignity and freedom to move about unhindered?
As you make the decision as to where
your loved one will reside, involve everyone
who will have to live with the consequences.
By that I mean siblings who are
geographically distant from you. It is worthwhile
to give them information about any
and all options and to solicit their input.
Remember that the most important person
in all of this is the resident who will
live there.
It is vital to involve that individual in the
decision-making process to the maximum
extent possible. If he is not able to visit that
facility personally, try to show photos or
brochures to him.
As you help the resident move into a care
facility, be aware that leaving home involves
signifi cant loss, emotionally as well as physically.
Allow for a meaningful transition
from home to facility to make the moment
by letting him supervise those decisions
about what to take, what to give away, and
to whom things should be given. Make sure
your loved one brings treasured mementos
with him. Bring objects that refl ect something
about who he has been.
According to the researchers, Silverstone
and Hyman, they state the following in
their book You and Your Aging Parent,
“Institutionalization, although a tragic step,
is not tantamount to dying.”
Here are some fi nal thoughts. Although it
is diffi cult at best, you can help your loved
one adjust to care in a facility by visiting
regularly, which can boost his spirits, especially
if you can fi nd things to do together
that he particularly enjoys. You can also
help by forging a positive alliance with the
facility staff . You can help the staff to appreciate
what’s special about this resident by
telling them about his past and his accomplishments.
Remember, entering a nursing home does
Dr. Sheldon
Ornstein is a
registered
professional
nurse with
a doctoral
degree in
nursing organization. He
has specialized in the care
of older adults and has
published many articles on
the subject. He has done
post-graduate work in gerontology
and has taught
at several universities.
In 2013, he was inducted
into the Nursing Hall of
Fame at Teachers College,
Columbia University.
not have to be the “end of the line.”
Victor Frankel, a well-known psychoanalyst,
recounts his concentration camp experience
in his epic book entitled Man’s Search
for Meaning, with the following, “We can
fi nd meaning even amid suff ering through
our deeds, through encounters with others
and through growing and changing.”
Sheldon Ornstein Ed.D, RN, LNHA
BY RONALD FATOULLAH, ESQ.
Close to 6 million Americans are currently
living with Alzheimer’s disease. As the
baby-boomer generation continues to age,
this number is bound to increase. According
to the World Health Organization, the
number of people over the age of sixty is
projected to double by 2020. Cognitive
impairments, mood disorders, depression,
anxiety, dementia and Alzheimer’s disease
are all important considerations when dealing
with an elderly individual who may
be behaving erratically. Understanding the
causes, signs, and symptoms of these brain
disorders and/or mental illness is necessary
in order to act in the individual’s best interest.
Neurodegenerative disease and other
mental disorders in elderly people aff ect
their fi nancial security as well as their physical
safety and that of their loved ones.
An individual who is exhibiting signs of
mental illness or cognitive impairment may
lack the capacity to sign legal documents or
make informed decisions. As such, to protect
the individual, his/her family, friends
and loved ones, as well as any business
interests, it is important to recognize signs
of mental degeneration.
Signs include but are not limited to:
• Intellectual impairment
• Memory problems
• Confusion, disorientation
• Lack of situational/spacial awareness
• Mood/behavior changes
• Irrational behavior, reality distortion or
delusions
• Lack of awareness of risks to self and others
• Diffi culty speaking, walking, or swallowing
If any of these signs are observed, it is
indicative that the individual may lack the
appropriate level of capacity to enter into
a contractual agreement, understand and
discern appropriate responses to situations
or comprehend the consequences of their
actions. At this point, it is critical that professional
advice be sought prior to entry
into potentially harmful legal contracts or
agreements. If an agent has not already
been appointed as Power of Attorney, an
experienced and knowledgeable elder care
attorney should most certainly be consulted
right away. In some instances, a petition
for guardianship may be necessary to protect
this individual personally, legally and
fi nancially.
As individuals age and mental illnesses
present themselves or worsen, the risk to
that individual’s own health, as well as the
safety of those around him or her can also
become increasingly compromised. Th ere is
a positive correlation between age and suicide
rate in the United States. Men eightyfi
ve years or older commit suicide at the
alarming rate of 45.23 per 100,000 people,
compared to the overall average of
11 per 100,000 people (Kunz, Depression
and Anxiety in Older Adults). When compounded
with the presence of a fi rearm,
these statistics suggest a recipe for disaster.
Firearm suicide accounts for more than
half of all suicides in the United States,
claiming the lives of 22,000 Americans
annually. In response to this statistic, and
to the wave of mass gun violence plaguing
the nation, New York joined several other
states in signing a “red fl ag” gun protection
bill in February 2019. CNN sums up the
bill eff ectively: “Under the new law, police
offi cers, family or household members, or
school personnel such as a teacher, principal
or guidance counselor, are all able to petition
a judge to issue a temporary order to
stop someone from purchasing or possessing
a gun upon a fi nding that there is probable
cause to believe that person is likely
to engage in conduct that would result in
serious harm to himself, herself or others...”
Th e symptoms of mental impairment,
including memory loss, lack of spatial
awareness, impaired cognition, confusion
and mood swings, increase the possibility
of an accidental tragedy when a fi rearm is
involved. It is not a far-fetched scenario to
consider that an elderly person with dementia
could mistake a loved one for a stranger
or intruder and react out of fear. Th e
red fl ag bill empowers people to have their
loved ones legally separated from their fi rearms
to ensure everyone’s safety. Although
this may strike some people as a breach in
autonomy, it will undoubtedly save lives.
If you suspect that a loved one or friend
has dementia and/or other signs of cognitive
impairment and you are aware that he/
she has fi rearms in the home, it is advisable
to contact the authorities for assistance and
guidance.
Ronald A. Fatoullah, Esq. is the founder
and principal of Ronald Fatoullah &
Associates, a law fi rm that concentrates in
elder law, estate planning, Medicaid planning,
guardianships, estate administration
& litigation, trusts, wills, and real
estate. Th e law fi rm can be reached at
718-261-1700, 516-466-4422, or toll free
at 1-877-ELDER-LAW or 1-877-ESTATES.
Mr. Fatoullah is also a partner of Advice
Period, a wealth management fi rm where he
can be reached at 424-256-7273.
RONALD FATOULLAH
ESQ, CELA*
/WWW.QNS.COM
