What Makes a Dog a Legal Companion or Emotional Support Dog?
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If you were to go online and look for certification for your dog as a companion or emotional support animal you would find a number of websites that offer certificates, patches, ID tags, etc. for a fee, but is it worth spending $69.95 to get your dog certified? Many of these websites lead you to believe that with their certification, you will be able to take your dog anywhere, including airplanes and government buildings, but let’s look at the facts.
By federal regulation, a service animal is defined as a dog that has been individually trained to do work or perform tasks for an individual with a disability. These tasks need to be specific to the individual’s disability; such as a guide dog for a visually impaired individual or a medical alert dog for someone with seizures or diabetes. Service dogs do not have to be obtained through a service dog organization and registration of a service dog is not mandated by federal law. The law does not require a service dog to wear any identifying vest or ID. The law does specifically exclude dogs whose sole function is to provide emotional support. State laws may allow for a broader definition; both in the type of animals that qualify and the service they offer, so you may want to refer to your state’s statute for clarification.
When a service dog is in public, a business owner has the right to ask the disabled individual (or someone accompanying them) what tasks the service dog performs. It is very important that the individual is able to name tasks that relate to their disability or the business owner can deny access to the service animal. A business cannot deny access due to fear of dogs or allergies. This includes work and school.
When a service dog is in public they must be under the control of their handler at all times. It is preferred that a service animal have a harness, leash or tether but they can be loose if using these items limits the animals ability to safely and effectively perform the tasks it has been trained to do. In that case the handler must be able to maintain control of the animal through verbal commands and/or gestures. If a service animal is considered out of control, a business has the right to ask that the animal be removed from the premises; but the individual has to be allowed to finish their business (without the presence of the service animal).
So how can an emotional support or companion dog be a legal service animal with all the protections that come with the title? According to the Americans with Disabilities Act, one acceptable category of service dog is a psychiatric service dog. By definition a psychiatric service dog aids individuals with cognitive, psychiatric, or neurological disabilities. This opens the door for someone with PTSD or another severe emotional condition to qualify, if their physician can document an emotional condition that rises to the standard of a psychiatric diagnosis or the condition effects cognitive functioning.
Despite the exclusion of emotional support dogs in public, some airlines will allow an emotional support animal to fly with an individual if their primary care physician provides appropriate documentation.
Warning: Some folks just put a vest on a dog and fake it. That may work, or it may fail. There have been recent discussion with law makers for this to be a punishable offense.
Sources: www.thecenterforindependence.org; www.ada.gov; www.servicedogcentral.org; www.nsarco.com and Florida Statutes 413.08
Marijuana Could Be An Effective Treatment For Alzheimers
Image via Brett Levin
A trip to the dispensary for your Alzheimer’s clients might be on your to-do list in the near future.
A study published this month in Aging and Mechanisms of Disease suggests marijuana might eventually be an effective treatment for Alzheimer’s disease. The study, published in Popular Science, studied the effects of THC on lab-grown neurons.
Researchers found that the cannabis compound hampered the plaque buildup that is associated with Alzheimer’s. The buildup, caused by the amyloid beta protein, can cause inflammation of the cells in the brain, hampering communication between neurons.
The study reports that THC reduced the amount of amyloid beta proteins in the neurons and prevented inflammation. The THC worked similarly to the effects of physical activity. By affecting the same receptors in the brain, Alzheimer’s can be slowed.
In addition to showing marijuana could be used to treat Alzheimer’s, it may clarify the connection between amyloid beta proteins and inflammation.
Read the full study— Amyloid proteotoxicity initiates an inflammatory response blocked by cannabinoids— here.
The Risks and Difficulties of Selling Ward’s Cars, Boats, Trailers and More
Vintage Car, image via Riley
It looks like selling some titled property in Florida may be getting a bit more complicated– especially if it was not titled in Florida.
In the past I have written stories about the many pitfalls with selling cars, boats, trailers, and other property as a guardian.
These stories range from having a potential buyer attempt to steal a ward’s SUV during a test drive, to making sure (by going to the DMV with the buyer) that the title immediately transfers out of the ward’s name, to the risk of accepting a cashier’s checks from a buyer.
This twist is a requirement that I was not aware of, and you may not be either. This could cause a real struggle with one of these sales.
First let me say that the best way to resolve most all of these issues is to sell the car, boat, trailer, or other property in person (with you, the vehicle and the buyer) at the Florida Tax Collector/DMV office. This location provides extra security as there are usually law enforcement folks around to protect your personal safety as well as the property. Even better if it is a cash transaction to be fairly public.
This scenario may be very difficult if the buyer is from another state, if the vehicle is located in another state, if it does not run, if it is not insured or if it cannot be moved. Then what?
Form 82050
Florida DMV is becoming less willing to accept a Bill of Sale on any format other than their own form: form 82050. If this is true for other states as well, then that may make this really difficult to resolve.
Form 82050 requires a copy of the seller’s drivers license. First you have to first determine the answer to the question: who is that? You or the ward?
Let’s assume the DMV determines it is you, as the guardian. Then you have the concern of giving your personal and private info (printed on your driver’s license) to a buyer, before they give it to their home state’s DMV. Bad idea.
The 82050 form is relevant for all used motor vehicles and trailers not currently titled in Florida and with a net weight of 2,000 pounds or above.
Form 82042
Then there is the HSMV 82042 form. This is a bit easier to deal with, as long as you deal with it while the vehicle is in your possession.
The 82042 form is an owner’s affidavit. Again, you have to deal with the “who is the owner” with your local DMV office. You have to get the current odometer reading (sometimes hard to do with a dead electronic dash). You’ll need a law enforcement officer, notary or dealer to do this in person with you. If the car runs, has a tag and has current insurance, you can do this at the DMV.
Hope this gives you just a bit of food for thought if you are faced with selling a ward’s property. There are certainly a lot of “if this, then that” situations to consider…
SNF + ALF: Law vs. Reality
Laws, image via Woody Hibbard
In the world of guardianship, elder care and advocacy, there are laws. Tons of them! While I am not an attorney, I have learned that there are laws, and then there’s how things work in the real world.
Here are two commonly-broken laws that you can be aware of:
Discharge From a Skilled Nursing Facility (SNF)
While SNF’s don’t have to accept all applicants, the law does say that they can not 911 a difficult or non-paying client to the hospital just to get them out the door. Unfortunately, it still happens. To be prepared, know your client’s rights in a SNF: http://buff.ly/1WH1Gxn
Honoring Contracts at an Assisted Living Facility (ALF)
While most residents checking into an ALF might expect to spend the rest of their days there, sometimes plans change and they need to leave the facility. The Agency For Health Care Administration rules limit the amount of days an ALF can require residents to give notice when they want to move out. Currently, that is 30 days. We now are seeing contracts from some ALF providers with closer to 45 and 60 day terms. Buyer beware.
How to Approach a Doctor’s Appoint as a Guardian
Image via Ilmicrofono Oggiono
We recently attended a neurologist appointment with one of our young guardianship clients. In the past she had a history of seizures, but they had been successfully under control for an extended period of time. During her annual appointment, the doctor started to talk to the client about her interest in driving, considering that her seizures were well-controlled.
This was a very difficult situation, as the client had been determined to be totally incapacitated and had her right to drive removed by the probate courts many years ago. She was so confused – here a neurologist, a high level doctor, started to ask her if she wants to drive. Then here we are, trying to explain to her that the guardianship courts had removed her right to drive. We spent a good bit of time trying to calm her, and to help her to understand this complicated circumstance about her right to drive.
We were also frustrated with the physician. He did not think about the ramifications of what he was saying to her, maybe because he did not recall that the client was in a guardianship, maybe because he was trying to give her some hope and help in being able to drive. Whatever the cause, it was very hard for this client to grasp this. After this, she was distrustful of many of our conversations – regardless of the subject– and she continued to refer back to the doctors’ discussion for a long time afterwards.
So how do we prevent this from happening in the future?
To be fair, doctors and their offices, and frankly ALL of the health care providers in the U.S., are dealing with mountains of shifting sands in our new “Affordable Care Act” health care system each and every day. Each day they are trying to figure out (just like we are) how to work within this new system of moving deductibles, elusive co-pays, codes that don’t match the diagnostic procedures – all this while trying to focus on their real job – which is providing quality health care to their patients.
To prevent such a mistake happening in the future, remind the office and the doctor (privately, with dignity) before the appointment, or just as the doctor is about to come in. (We often wait for the doctor just outside of the exam room.) Remind the doctor of the legal status of the patient that they are about to see. This may help the doctor to recall this small detail as he/she is seeing the patient and save you loads of work later.
Quick Test: What Kind of Advocate-Entrepreneur Are You?
Image via simpleinsomnia
What kind of advocate-entrepreneur are you? Or are you maybe a combination of these?
A – Analytical-Entrepreneur: You perform deep analysis of any new client to determine profitability of that case before accepting the client. You are a pessimist in thinking that there will not be enough funds to care for the client.
B – Risk Taker-Entrepreneur: You accept cases where there are no immediately available funds to care for the client. Or where the major assets are a mess, there are title problems or are in unsellable condition. You are optimistic that there are benefits or assets that will be found to pay for the client’s care and needs.
C – Administrator-Entrepreneur: You have created and keep a current, detailed written Policy & Procedures for the whole system you have created.
D – Social Worker-Entrepreneur: You have brought a client to your home for a night during an emergency or for a holiday meal.
How far back and deep should you delve ?
Image via hobvias sudoneighm
As the years have gone by, we have learned the many twists that can come up when becoming the guardian for a person who has had dementia for years or decades. It is often surprising how deep and far back we need to go to resolve issues.
Case in point — we became the guardian for a windowed gal, Cynthia, in 2013. She was a retired civil servant who had worked for decades as a government contracts-comptroller and in an H.R. pension support position.
She was very astute to the business world, to how pensions worked and how life and health insurance worked. She was a very detailed bookkeeper who had appeared to be organized, disciplined and methodical in her personal business affairs by the old records we found.
However, we also found that in the more recent years, she wrote reminders to herself, hundreds and hundreds of reminders, for the same actions: pay a bill, call the tax office, file a claim form. But it appeared that she did not take those actions, she just kept reminding herself to-do’s, still leaving them undone.
So after many months of fighting with the pension provider to accept the letters of guardianship, we finally got a copy of her pension check stub with the gross amounts and the details of the amounts being withheld from her retirement check and for what.
We were shocked to find that there was an ongoing deduction, each month, for a spouse’s life insurance policy.
Why were we shocked? Her spouse had been deceased since 2005, and she had never remarried.
In speaking with her friends, they could not understand why she was still paying life insurance premiums for her husband, who had been dead for 8 years. Since she worked in H.R and in pension support in her career, she would have understood how this all worked.
This made us wonder: had she ever filed the claim on his life insurance(s) when he passed? We dug in and, as it turned out, NOPE.
So we filed the claim for $ 25,000, and then we started the fight to get the years of premiums (paid on a dead fella) back from the federal government.
So, back to the question: how far back and deep should you delve? You decide. 🙂
A Guide to the Two Do Not Resuscitate Forms
Did you know that there are more than one Do Not Resuscitate Order forms (also becoming known as A.N.D. (Allow Natural Death)), and when to use which? We clear up the differences and physical settings for each document:
#1. The Yellow DNR Form
Often called the Community DNR, the yellow DNR form is best when used in the community: in your car, on an ALF’s medical chart, as a Nursing Home’s doctor’s order, at an in-patient hospice unit, in your purse, on your fridge (in a red envelope) or in other residential settings. This document generally will NOT work in a hospital setting as the hospital prefers their own specific document (and for good reason).
If a patient comes to the hospital with a community DNR, one question is: “What will the hospital do if that patient starts to code (when a patient stops breathing or their heart stops beating)?”
If you consider general anesthesia is used during most major surgeries, your breathing is being managed by the anesthesiologist and surgical staff. Since you are not breathing on your own, having a DNR during any kind of major surgery doesn’t really work.
Another question might be, “Why would someone with a DNR be going to the hospital anyway?” An end-of-life patient might be on hospice or be cared for at home. If she were to fall and break a bone, or get a deep gash on her forehead that needed care, she very well may need hospital surgical care. This could happen even while on hospice care and with a community DNR. In this situation, the community DNR is generally put on hold and hospice is often temporality discharged. The patient receives urgent medical care at the hospital and then is possibly returned back home, back on hospice care, with her community DNR back in effect.
#2. The Hospital DNR Form
This form is an example of a hospital DNR (each hospital system has their own version of this form). It is very specific, with many more options than the community DNR form. Generally, the hospital wants this on the chart of any patient who has a community DNR or who has stated their wishes and does not want any or all life prolonging procedures performed while in the hospital. This gets a bit complicated if they will be having surgery, again due to the managed breathing which is often part of surgery.
Now if you hear someone talking about a Community DNR or a Hospital DNR, hopefully you will have a better idea of what they look like and why they are different.
Pill Crush Wednesday
So what happens to all those discontinued medications at a residential facility?
How much does an ALF have to dispose of in a month? Hint — The photo in this post is a month’s worth for an 80-bed facility.
Here are your options for disposing of discontinued medications safely:
- Ask pharmacies to take them and dispose
- Dispose yourself properly so be careful, as we don’t want them getting in our aquafer
- Check with your local fire station, as many will take them and dispose of properly.
- See if your local homeless shelters or other charities may be able to use the discontinued medications. For patient privacy, be sure that the patient’s info is removed (name and address) but do leave the medication’s name, dose of the med, date and other necessary info.
Guardians Out of the Box
Image via Pink Sherbert Photography
As guardians, we have to work/think out of the box… I’m talking so far out of the box that it looks more like a tube.
Recently we had a client who had, years before, installed a BIG wall-mounted bed system into his independent unit in a care community.
This client needed to move to a memory unit. As we were in the process of our move-out inspection, turning the independent unit back over to the community, we were told that we must remove this BIG installed unit.
Ugghh – this was of course something that we did not know would need to be done (we thought it had come with the unit), so we were up against a very tight timeline to get it removed.
We had court approval to sell or dispose of it, but it was a very expensive unit (back in the day), so we really wanted to be able to sell it. As we called many places to try to sell this Behemoth, we found that there were no interested buyers – not the estate sale folks, not the auction people, not the thrift stores and not the store who had originally sold and installed it. The family did not want it, so that idea did not work.
We had to get it out ASAP or the rent would continue to rack up. We then tried for the donation option. Salvation Army, Habitat for Humanity and few others charities – no bites there either. So not only did we NOT have a buyer, but we did not have anyone to take it down, much less to perform the job quickly and at a reasonable price.
So when there are no other options, what do you do?
Home-cooked meals. One of our staff members, who is also a great cook, got some single guy friends over to the unit. In trade for the removal of this Big Heavy Unit, she cooked them a great homemade meal.
And that is how we work, out of the box – and sometimes maybe, on top of the stove.
