Lecture 5- Legal Aspects of Aging

Question 1

by 2040, people 65 and older will make up ______ of the population

Answer 1

20%

Question 2

Legal concerns with geriatric care

Answer 2

• lack of family support
• concerns of asset preservation- maintaining adequate lifestyle while keeping some to pass to their family
• mental capacity
• end of life decision-making

Question 3

Medicare qualifications

Answer 3

• 65 and older

- everyone qualifies

Question 4

Medicaid qualifications

Answer 4

• 65 and older
• income limit of $2200
• have to have VERY low income in order to qualifty

Question 5

Guardianship

Answer 5

• can be limited, temporary, standby, or general
• an individual appointed by the court to make personal and health care decisions for a person who is incapacitated.
• does NOT constitute a decision that the ward is of unsound mind.
• to file a petition, person’s decision-making capacity must be so impaired that the person is unable to care for their personal safety or to attend to or provide for necessities such as food, shelter, clothing, or medical care

Question 6

Conservatorship

Answer 6

• Person assumes responsibility for custody and control of the property or finances of the ward.
• No one has the right to manage the property of an adult without their consent, unless they are a conservator.
• Powers of the conservator
• • payment/receipt of property/income
• • sale or transfer of personal property

Question 7

Power of Attorney

Answer 7

When a person gives someone else the authority to act on their behalf in one or more matters

• must be written when person is in sound mind
• Several types-
• • general powers- financial
• • limited powers or termporary
• • durable
• • health care

Question 8

Health care decision making core principles

Answer 8

• Competent patients must give INFORMED consent

- competent patients can refuse or terminate life-sustaining medical treatment.

Question 9

Decision making hierarchy

Answer 9

• if no advance care directive, the order goes as follows…
• Person designated in a power of attorney, if any
• Court appointed guardian, if any
• ——- guardian must obtain court approval before making this decision.
• A spouse
• An adult child - if more than one then majority of them makes the decision
• The parent or parents
• An adult brother or sister

Question 10

Health Care power of attorney

Answer 10

designates a person to make healthcare decisions on behalf of the patient when the patient is unable to do so.

• can be revoked through written or oral means.
• They MUST act consistently with patient’s desires as stated in living will or otherwise made known
• gives them the power to end life-sustaining support

Question 11

Advanced Directives/Living Will

Answer 11

• written declaration that informs medical personnel of the person’s desire
• not to have life-sustaining procedures induced
• if they are diagnosed as terminally ill and
• Cannot participate int he decision-making process regarding treatment, and
• use of life-sustaining procedures would merely prolong the dying process
• have to be 18 or older
• Signed in presence of 2 witnesses
• witnesses have to be 18 and older and CANNOT be family members
• Must be signed voluntarily

Question 12

medicare per capita spending ______ with age

Answer 12

DECREASES!

Question 13

Majority of the public believes _________ should discuss end-of-life care issues with their patients and that medicare should cover these conversations

Answer 13

Doctors!

Question 14

Physical payment for end-of-life care planning

Answer 14

• Medicare allowing for advance care planning including discussion of advance directives BY THE PHYSICIAN or other qualified health professional-
• 2 codes in place- the first is for the first 30 minutes
• the second is for any time past 30 minutes
• allows the physician to be paid for these discussions, which can be time consuming and complex

Question 15

Even AFTER these laws were passed to help pay physicians for end of life planning, ______ of family physicians do it

Answer 15

15%- needs work

Question 16

Hospice and Palliative Care

Answer 16

• Benefit is elected upon eligibility
• To be eligible under medicare, beneficiary must be entitled to part A of medicare benefit and be certified by a physician as terminally ill (less than 6 months to live)
• In electing, the patient acknowledges that the care is palliative and NOT curative and that certain medicare services are waived by the election
• —- Medicare won’t be paying for curative treatments, just comfort care

Question 17

Iowa Physician Order for Scope of Treatment

Answer 17

• Consolidates and summarizes patient preferences for key life-sustaining treatments, including CPR, general scope of treatments, antibiotics, artificial nutrition and hydration
• Persons may refuse treatment, request full treatment, or specify limitations.
• meant to complement advance directives by translating patient wishes into actionable medical orders
• physician signature translates patient preferences into physician’s orders actionable across the healthcare continuum
• Primarily intended for chronically ill person in frequent contact with healthcare providers

Question 18

IPOST process

Answer 18

Must be completed by a health care professional based on patient treatment preferences and medical indications

• must be signed by physician, NP, or PA
• Photocopies ARE valid

Question 19

IPOST directions

Answer 19

• IPOST belongs to person
• IPOST MUST accompany the person upon all transfers between care settings
• Keep it in easily accessible location that the ambulance service could easily find

Question 20

Does completion of an IPOST replace or invalidate prior directives?

Answer 20

NO- you need to update them in order for IPOST to be valid

Question 21

“right to try”

Answer 21

legislation that would give terminally ill patients the right to try treatments that have not been fully approved….
- didn’t move very far through the legislature this year… but could in the future

Question 22

Physician Assisted Suicide- Right to die

Answer 22

Huge amount of conversations about this- keep it in mind for the future.