Author Archives: Adam Peck

There are numerous other health issues that people with various types of disabilities have to cope with on an almost daily basis. Depending on the “main” disability, other issues such as high blood pressure, urinary tract infections, lack of coordination and the like can compound living with that disability to a more uncomfortable life.

Preventing pressure sores is a daily concern for individuals who have a spinal cord injury. If you are a person dealing with an SCI, you should always work to stay healthy and avoid this serious skin problem in order to be free to do what you would like to do or anything else that life has to offer.

Pressure sores are known by many names, such as pressure ulcers, decubitus ulcers, ischemic ulcers, bed sores or skin sores. No matter what they are called, they are a serious problem that can take days, weeks, months or even longer to heal.

A pressure sore is an area of the skin or underlying tissue that is dead or dying as a result of the loss of blood flow to the area. It can begin in a number of ways. The most common way is when you or rest on a bony area for a prolonged period of time.

Anyone can get a pressure sore, but individuals with spinal cord injuries are at a much higher risk. It is estimated that up to 80 percent of individuals with an SCI will have a pressure sore during their lifetime, and 30 percent will have more than one pressure sore.

There are a number of factors that can put you at risk, especially if you are disabled by an SCI. They can include disability-induced limited mobility, which can place extended pressure on an area of the body; moisture from bladder and bowel accidents that can further weaken the skin and cause the skin to break down more quickly; a lack of feeling in specific parts of the body that can keep you from sensing that your skin has been damaged; and/or a cut or a scratch that can quickly develop into a larger problem if not properly treated. Spasticity or transfers can also sheer (or rub) the skin and cause damage as well.

The most common sign that a pressure sore is beginning is the appearance of a red area on the skin. Ordinarily, redness should clear within 30 minutes after the pressure is released. If the redness does not clear, a pressure sore has begun. A person with dark skin may also see a change in their skin color. The area may become light, dry, flaky or ashy. Other signs that may indicate the beginning of a pressure sore is an area of skin that is warmer than normal or a change in the skin’s texture.

There are four different stages of a pressure sore. They are:

# Stage 1 — Damage is limited to the top two layers of skin, the epidermal and dermal layers. The skin is not broken and the redness does not turn white when touched.

# Stage 2 — Damage extends beyond the top two layers of the skin to the adipose tissue. The skin is slightly broken. The sore appears to be an abrasion, blister or small crater.

# Stage 3 — Damage extends through all the superficial layers of the skin, adipose tissue, down to and including the muscle. The ulcer appears as a deep crater, and damage to adjacent tissue may be present.

# Stage 4 — Damage includes destruction of all soft tissue structures and involves bone or joint structures. Undermining of adjacent tissue and sinus tracts may be associated with these ulcers.

A recent Congressional hearing and the poignant testimony of an unexpected victim — Mickey Rooney — have helped focus new attention on the abuse and exploitation of old people. Congress should seize the moment to help repair their threadbare web of protection.

The hearing of the Senate Special Committee on Aging, as well as several recent studies, make clear that elder abuse is a growing problem that far outmatches the resources available to fight it.

One national study estimated that in the last year 14 percent of older adults had been neglected, abused or exploited. The numbers could be far higher since the sample did not include people living in institutions or those with significant mental impairments. A 2009 study on financial exploitation estimated that elderly victims lost at least $2.6 billion a year to fraud and abuse.

The loss of power and the isolation that come with age and infirmity make elders particularly vulnerable to abuse from unscrupulous caregivers but also, chillingly, from unscrupulous family members. “I felt trapped, scared, used and frustrated,” Mr. Rooney told the committee, saying he had been defrauded by “someone close.” “But, above all, I felt helpless.”

The cost, on top of the human suffering, is immense: in stolen and squandered savings; the strain on the court system from abusive guardianships; the cost to Medicare and Medicaid from fraud; and from the care of fleeced victims who end up destitute in nursing homes.

The solutions begin with filling the gaps in data collection and services. The Government Accountability Office found that in 25 of 39 states surveyed, financing for adult protective services had fallen or flat-lined in the last five years. Case workers are poorly trained and overwhelmed. The study also found that federal programs to fight abuse are scattered ineffectively across the Department of Health and Human Services. The report urged the department to create a resource center to collect and share abuse data among the states.

Only with coordinated efforts — like those urged by the offices and agencies created years ago to advocate for children and victims of domestic violence — will real progress be made. The committee’s chairman, Senator Herb Kohl of Wisconsin, is sponsoring a bill to create an office of elder justice, in the Justice Department, to tighten reporting standards and definitions of elder abuse and to help states investigate cases and impose stricter protections for victims. Congress should pass it.

For most people, the durable power of attorney is the most important estate planning instrument available–even more useful than a will. A power of attorney allows a person you appoint — your “attorney-in-fact” — to act in your place for financial purposes when and if you ever become incapacitated says California Elder Law Attorney Steven Peck.

In that case, the person you choose will be able to step in and take care of your financial affairs. Without a durable power of attorney, no one can represent you unless a court appoints a conservator or guardian. That court process takes time, costs money, and the judge may not choose the person you would prefer. In addition, under a guardianship or conservatorship, your representative may have to seek court permission to take planning steps that she could implement immediately under a simple durable power of attorney.

A power of attorney may be limited or general. A limited power of attorney may give someone the right to sign a deed to property on a day when you are out of town. Or it may allow someone to sign checks for you. A general power is comprehensive and gives your attorney-in-fact all the powers and rights that you have yourself.

A power of attorney may also be either current or “springing.” Most powers of attorney take effect immediately upon their execution, even if the understanding is that they will not be used until and unless the grantor becomes incapacitated. However, the document can also be written so that it does not become effective until such incapacity occurs. In such cases, it is very important that the standard for determining incapacity and triggering the power of attorney be clearly laid out in the document itself.

However, attorneys report that their clients are experiencing increasing difficulty in getting banks or other financial institutions to recognize the authority of an agent under a durable power of attorney. A certain amount of caution on the part of financial institutions is understandable: When someone steps forward claiming to represent the account holder, the financial institution wants to verify that the attorney-in-fact indeed has the authority to act for the principal. Still, some institutions go overboard, for example requiring that the attorney-in-fact indemnify them against any loss. Many banks or other financial institutions have their own standard power of attorney forms. To avoid problems, you may want to execute such forms offered by the institutions with which you have accounts. In addition, many attorneys counsel their clients to create living trusts in part to avoid this sort of problem with powers of attorney.

While you should seriously consider executing a durable power of attorney, if you do not have someone you trust to appoint it may be more appropriate to have the probate court looking over the shoulder of the person who is handling your affairs through a guardianship or conservatorship. In that case, you may execute a limited durable power of attorney simply nominating the person you want to serve as your conservator or guardian. Most states require the court to respect your nomination “except for good cause or disqualification.”