Members in the News NAELA News...NAELA News • October/November 2005 3President’s Message By...

NAELAMembers inthe NewsNAELA wasmentioned as aresource and/orelder law wasprominently noted in:

“The Parent Trap,” which waspublished in the October 2005issue of O-The Oprah Magazine.

“Elder Law Planning,” which waspublished in the September 1,2005 issue of The CPA Journal.

“Elder-Law Attorneys: Do WeNeed One? How Can We FindOne,” which was published in theAugust 2005 issue of Fifty Plus.

In this issue...President’s Message ................ 3

ExecutiveDirector’s Column ..................... 5

Health Care SIG ...................... 10

Drafting Living WillsAfter Schiavo ........................... 14

FAQs about NAELA’sSenior Rights PoliticalAction Committee ................... 18

A Changing SupremeCourt: The Stakes forOlder Americans ..................... 22

Book Review ........................... 23

V O L U M E 1 7 � I S S U E 5

OCTOBER /NOVEMBER 2005

N A T I O N A L A C A D E M Y O F E L D E R L A W A T T O R N E Y S

NEWSNEWSNAELANAELA

(continued on page 8)

Guardianship/Capacity SIGLocked Units: Ins and OutsBy K.T. Whitehead, CELA

After the ad Litem’s initial visit, manylong discussions with the daughter’s at-torney, and an independent medical exam,Mrs. Smith was moved to an assisted liv-ing facility and later back to her ownhome.

How does someone become a resi-dent in a locked Alzheimer’s unit? Whendoes the individual decide if they are go-ing to move into a locked Alzheimer’sunit? When does a third party decide?What is the procedure for coming out ofa locked Alzheimer’s unit? Why do wehave almost no legal process for admit-ting or discharging people to or fromlocked Alzheimer’s units?

A locked unit is the same for mentalhealth and Alzheimer’s care. It is an areain a hospital, nursing home or assisted liv-ing facility that can only be entered orexited with a pass code or special keyingdevices. These codes and keys are con-trolled by those who run the units. Oncesomeone is placed into a locked unit, she

The doctor’s report said that Mrs.Smith, the proposed ward, was totallyincapacitated. Yet, when the ad Litemvisited her in a locked Alzheimer’sunit, for what she thought would be aperfunctory, routine few minutes, shefound Mrs. Smith sitting and work-ing the most recent New York TimesSunday crossword puzzle in ink. Mrs.Smith gave a very precise and accu-rate medical history, including datesof care, hospitalization, treatmentsand physicians over the past severalyears. While she was 92, she wasclearly not “totally incapacitated.”Mrs. Smith was angry. She wantedto return to her home and to know whyshe was “locked up in jail.”

Upon questioning the physician,it became apparent that the physicianrelied on the daughter’s statementsabout her mother’s mental healthwhen completing the guardianship af-fidavit. The doctor did not go backand check his own records. Mrs.Smith had no history of dementia.


2 NAELA News • October/November 2005

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NAELA News • October/November 2005 3

President’s MessageBy Lawrence E. Davidow, CELA


Dear NAELA Members:As you know, Con-

gress is currently consider-ing changing the Medicaidpenalty period start date tothe date of application andincreasing the lookback pe-riod from three to f iveyears. These changeswould severely hurt our cli-ents - the elderly and indi-viduals with disabilities across the na-tion. As a member of NAELA, I wouldwant my leadership to let me know whatsteps NAELA is taking in response tothis proposed legislation. Therefore, thepurpose of this letter today is to updateyou on NAELA’s public policy and pub-lic relations activities in response to thisthreat and to ask you to take action now.

If you haven’t yet done so, pleasetake the time to contact your Membersof Congress about these punitive Med-icaid changes that Congress may soonact upon.

There is urgency in this call to ac-tion. While it is true that House andSenate budget reconciliation action,which will include Medicaid cuts andprogram changes, has been delayed dueto Hurricanes Katrina and Rita, the factis that there is now more pressure fromsome in Congress to find budget cutsto offset the costs associated with thenatural disasters.

Please write to your representativeand senators TODAY using the sampleletter found at NAELA.org under Gov-ernment Affairs. Since Congress isback in session, fax or e-mail your let-ters to their Capitol Hill offices as soonas possible. Consider asking your cli-ents to call or write as well.

Following is a summary ofNAELA’s actions and activities relatedto the current Medicaid policy crisis.Please add your efforts to this list!

Thank you for helping NAELAwith this critical issue.

Sincerely,

Lawrence E. Davidow, CELANAELA President

Medicaid 2005:Public Policyand PublicRelations JointCampaignSummary

The NAELA Board ofDirectors approved andfunded an expanded public

policy advocacy campaign in May, andan expanded public relations campaignin July. The goal of the joint campaignis to defeat the proposals to change thepenalty period start date and thelookback period in order to protect se-niors and individuals with disabilities.NAELA is fulf illing this goal bystrongly opposing these changes and bypro-actively communicating better so-lutions for Medicaid reform. This strat-egy has helped secure a role for NAELAas an expert and valued resource forMembers of Congress and congres-sional staff.

Susan McMahon, NAELA’s Asso-ciate Director, coordinates the publicrelations efforts, led by Kellen Commu-nications, with NAELA’s public policywork in Washington, DC. StanSamples and Ann Krause direct ourpublic relations activities. CharlieSabatino chairs our Public Policy Com-mittee; Vincent J. Russo chairs theMedicaid Strategies Task Force; andBrian Lindberg, NAELA’s PublicPolicy Consultant, directs our advocacyand lobbying efforts in DC. At theboard’s direction, Brian hired two sea-soned lobbyists to assist in the Medic-aid fight: Howard Cohen and ChrisJennings. They have proven to be as-sets to our efforts.

This group of dedicated andhardworking NAELA members andstaff have developed strategies for coun-tering these punitive proposals by theBush Administration, the National Gov-ernors Association, and the newlyminted Medicaid Commission. Theyhave created workable solutions to ad-dress the budget mandate to find sav-ings in the Medicaid program while ad-

Board of Directors2005-2006

P R E S I D E N TLawrence E. Davidow, CELA

Islandia, NY

P R E S I D E N T - E L E C TDonna R. Bashaw, CELA

Laguna Hills, CA

V I C E P R E S I D E N TG. Mark Shalloway, CELA

West Palm Beach, FL

T R E A S U R E RCraig C. Reaves, CELA

Kansas City, MO

S E C R E T A R YRuth A. Phelps, CELA

Pasadena, CA

P A S T P R E S I D E N TStuart D. Zimring, Esq.

North Hollywood, CA

E X E C U T I V E D I R E C T O RLaury A. Gelardi

Tucson, AZ

A S S O C I A T E D I R E C T O RSusan B. McMahon, Esq.

Tucson, AZ

M A N A G I N G D I R E C T O RDeborah J. Barnett

Tucson, AZ

D I R E C T O R SEdwin M. Boyer, Esq.

Sarasota, FL

William J. Brisk, CELANewton Center, MA

Martha C. Brown, CELASaint Louis, MO

Gregory S. French, CELACincinnati, OH

Bradley J. Frigon, Esq.Englewood, CO

Doris E. Hawks, Esq.Los Altos, CA

Andrew H. Hook, CELAPortsmouth, VA

Barbara S. Hughes, Esq.Madison, WI

Michael F. Loring, Esq.Scituate, MA

Kerry R. Peck, Esq.Chicago, IL

Stephen J. Silverberg, CELAEast Meadow, NY

Timothy L. Takacs, CELAHendersonville, TN

Lauchlin T. Waldoch, CELATallahassee, FL

Wesley E. Wright, CELABellaire, TX

Edward E. Zetlin, Esq.Falls Church, VA

C O N S U L T A N T SBrian W. Lindberg, Public Policy

Washington, D.C.Hugh K. Webster, Legal Counsel

Washington, D.C.

Lawrence E. Davidow


of the Leadership Council of Aging Or-ganizations (LCAO), which includes 53aging groups in DC. In addition,NAELA is a member of the MedicaidCoalition, which has more than 200member organizations representing a di-verse group of consumer and providerinterests. These relationships are criti-cal in our fights to protect Medicaidbeneficiaries.

These coalitions are in constantcommunication with each other, con-gressional staff, and the media and areable to mobilize their many members towork on behalf of protecting Medicaid.

Recent coalition and individual or-ganization actions related to the assettransfer effort include:

� Briefings for the LCAO andMedicaid Coalition on assettransfer issues conducted byCharlie Sabatino, Trish Nemoreand Vincent Russo.

� AARP ran full-page ads on twooccasions in the Washington Post,Washington Times, Roll Call, andthe Congressional Quarterlyspecifically opposing the changeto the penalty period start dateand the lookback period.

� The LCAO wrote a letter to allMembers of Congress, includingmembers of the committees withjurisdiction over Medicaid,opposing the transfer of assetchanges. The LCAO includesAARP, National Committee toPreserve Social Security andMedicare, Alzheimer’s Associa-tion, National Council on Aging,

President’s Message(continued from page 3)

dressing the myths around Medicaidplanning. We have been able to promotegreater understanding and respect forelder law attorneys and NAELA itselfamong congressional leaders, Hill staff,and the public.

Public Policy ActivitiesMedicaid Section of NAELA.org:

The NAELA website is the central re-source for Medicaid advocacy materi-als, including the Grassroots AdvocacyKit. This kit was developed for use byNAELA members. It contains sampleletters, talking points, background in-formation, Capitol phone numbers,leave-behind materials, etc. The sitealso houses NAELA’s position papers,documents regarding the current trans-fer of asset proposals, the House andSenate budget reconciliation, NAELA’sproposed Medicaid solutions (presentedas replacements for current legislation),Myths and Realities About MedicaidPlanning, NAELA Members as Re-sources: Issue List; and a NAELA FactSheet. Go to http://www.naela.org/pri-vate/OurGov/medicaid.html.

New Personnel: One of our firstobjectives was to bring on to theNAELA advocacy team perspectivesfrom outside the organization that rep-resented both Republicans and Demo-crats. Howard Cohen and ChrisJennings were hired and bring years ofexperience and contacts to our publicpolicy efforts. Howard served as a coun-sel and senior staff member on theHouse Energy and Commerce Commit-tee, which is currently drafting the Med-icaid bill. Chris worked on health andaging issues on the Senate Special Com-mittee on Aging for almost 10 years andas President Clinton’s chief heath policyadvisor. Both Howard and Chris haveextensive knowledge of Medicaid andhave played integral roles in all aspectsof this campaign.

Coalitions: For more than 10years, NAELA has been working withcoalitions in Washington, DC. Repre-sented by Brian Lindberg and CharlieSabatino, NAELA has been a good teamplayer and has taken on leadership rolesfor these organizations. Brian currentlychairs the Long-Term Care Task Force

B’nai B’rith, AFL-CIO, and manyother prominent organizations.

� NAELA has worked with thenational trade organizations ofthe nursing home industry tooppose the change in the startdate for the penalty period. TheAmerican Health Care Associa-tion has testified before theFinance Committee in oppositionto the change and has lobbiedCongress on the issue. TheAmerican Association of Homesand Services for the Aging has alsolobbied against the date change.

Hearings/Brief ings/Debate:NAELA has taken a very public ap-proach to opposing the changes in theMedicaid transfer rules. By appearingbefore House and Senate committees,conducting briefings for staff, and pub-licly debating our harshest critic, wehave positioned NAELA as a voice ofauthority, professionalism, and reason.We owe a debt of gratitude to our mem-bers who have helped make this effortpossible – those on the Medicaid Strat-egies Task Force and those who haverepresented us. They have served uswith distinction and class.

� NAELA Past President BernieKrooks testified on April 27,2005, before the House Energyand Commerce Committee.

� Vincent Russo, also a NAELAPast President, testified beforethe Senate Special Committee onAging on July 20, 2005.

� Brian Lindberg, Trish Nemore,

E-BulletinMissed the latestissue? Not aproblem. They’reall available atwww.naela.org.



Laury Adsit Gelardi

NAELA Executive Director’s ColumnBy Laury Adsit Gelardi

I am sure this will be one ofthe last Executive Director’scolumns I will write forNAELA. After 17 years, Iwill miss this…and interact-ing with NAELA memberson a daily basis. It has beena long, but very wonderfuljourney.

Each of you deal withretirement issues with yourclients all day long. But,

have you ever really sat down to think of your ownretirement: what it means, whenit will happen or what you willdo? Most of you tell me youhaven’t. In fact, many of you haveconfessed to me over the yearsthat you haven’t even done yourown wills. I always thought youwere too busy. Now I am fairlycertain that it is a case of the“cobbler’s children having noshoes.” Or could it be “the avoid-ance theory” — if I don’t do it,nothing will happen and I will putoff the inevitable. As Dr. Philwould say….how has that workedfor your clients?

At the Joint Meeting beingheld in Tucson December 9 – 11,I will be a small part of a panel ofNAELA members who will betalking about “the real issues ofretirement.” Each one of the pan-elists is coming at it from a dif-ferent tract – being forced to re-tire due to health reasons, want-ing to cut back on work time toavoid going stark-raving mad,wanting to devote more time tofamily issues or just deciding thatthe “time has come” to do some-thing else in life. The one com-mon theme is that it takes a lot ofsoul (and sole) searching. Quit-ting work, losing an identity thathas taken years to achieve, chang-

ing roles, and no longer “being the one in charge” arenot easy changes to make…and most of us won’t do iton the spur of the moment, although some of us willwait until we are forced into it by our own health is-sues. Retirement is a decision that takes planning –way beyond the wills and the trusts and the powers ofattorney – way beyond the distribution of wealth andyour own end of life issues – way beyond the papertrail that we leave when we are ultimately gone.

I hope that sharing my journey will encourage someof you to think about it. None of us is getting anyyounger and the years aren’t getting any easier to en-dure. While most of us view the age of 65 as the “time

to begin” thinking about retirement,the reality is different. There isenough research out there, that eachof us needs to look realistically atthe good ole’ family tree and seewhat our “genetic future” has to bebring? It was a wake-up call whenI realized that my Mom, being 67when she died, represented a mile-stone in our family. She actuallylived longer than any other femaleon the maternal side of the family.While my father’s mother was 88when she died, my Father was only62. I remember being angry whenthey died….not because of my loss,but because I felt they were cheatedout of their time to enjoy their hardearned, yet never achieved, retire-ment years. Now, approaching 50and being the youngest of five girls– now all in their 50’s – 62 and 67don’t seem so far way.

If you believe that you work tolive…. not live to work, then “whatthe future might bring” is very im-portant. If you admit that life is fi-nite and uncertain, how do you as-sure that you will accomplish whatis really important to you? Plannersencourage people to go through the“what if I had one year to live sce-nario.” Most of us shrug-off thoseefforts as hokey. I never liked role-

I hope that sharingmy journey will

encourage some ofyou to think about it.None of us is gettingany younger and theyears aren’t getting

any easier to endure.While most of us viewthe age of 65 as the

“time to begin”thinking about

retirement, the realityis different. There isenough research outthere, that each of us

needs to lookrealistically at the

good ole’ family treeand see what our

“genetic future” hasto be bring?




The NAELA News is published by theNational Academy of Elder Law Attorneys, Inc.

1604 N. Country Club Road � Tucson, AZ 85716-3102520/881-4005 � 520/325-7925 Fax � www.naela.org

Articles appearing in the NAELA News may not be regarded as legal advice. Thenature of elder law practice makes it imperative that local law and practice be con-sulted before advising clients. Statements of fact and opinion are the responsibilityof the author and do not imply an opinion or endorsement on the part of the officersor directors of NAELA unless otherwise specifically stated as such.

Publications Chair ............................................... Edwin M. Boyer, Esq., Sarasota, FLEditor ............................................................ Judith D. Grimaldi, CELA, Brooklyn, NYAssociate Editor ....................................... Bridget O’Brien Swartz, Esq., Phoenix, AZPublications Coordinator ........................................... Jonathan D. Boyle, Tucson, AZGraphic Designer .......................................................... Kristin L. Hager, Tokyo, Japan

© Copyright NAELA 2005


and Vincent Russo briefed theDemocratic staff of the HouseEnergy and Commerce Commit-tee and the Senate FinanceCommittee staff on Medicaideligibility rules, including spousalimpoverishment, transfer rules,and how the currentproposals would hurtolder and disabledindividuals.

� NAELA organizedsimilar briefings onthe issues of reversemortgages, long-term care insur-ance, and the Long-Term Care Partner-ship Program forthe Energy andCommerce Com-mittee staff.

� Republican staffturned down offersfor similar brief-ings, but wecontinue to provideinformation to themon an individual basis.

� On September 7, 2005, VincentRusso debated Stephen Moses atthe Cato Institute, in Washington,DC. More than 125 individualsattended – many of them keyplayers in the health care policyworld. Stephen Moses runs theCenter for Long-Term CareFinancing. For years, Mr. Moseshas accused elder law attorneys ofbeing one of the primary reasonsthat our long-term care systemdoes not serve Americans well.Vincent Russo demonstrated hisknowledge, expertise, andcompassion for our clients withhis reasoned and thoughtfuldelivery at the debate.

Congressional Budget Office/Government Accountability Office/Congressional Research Service:NAELA and its members have success-fully initiated a dialogue with CBO,GAO, and CRS to provide data, insights,and observations about whom we serveand how the Medicaid program works.These influential entities have responded

positively and have requested our assis-tance as they develop their work prod-ucts for Congress.

SR-PAC: Brian Lindberg and ourlobbyists have attended more than 20fundraisers since July 15th and have dis-cussed the Medicaid transfer of assetchanges with key congressional mem-bers. Examples include: Finance Com-

mittee ChairmanGrassley and RankingDemocrat, SenatorBaucus; numerous HouseEnergy and CommerceCommittee members in-cluding RepresentativesDingell, Wilson, andWaxman, and key Med-icaid supporters such asSenators Gordon Smithand Jeff Bingaman of theSmith-Bingaman amend-ment, which reducedMedicaid cuts in the Sen-ate. The opportunitiesthat the Senior RightsPAC affords NAELAhave been invaluable dur-ing this critical fight tosave Medicaid.

Proactive ReformProposals: NAELA’s Medicaid Strat-egies Task Force, the Public PolicyCommittee, and the Board of Directorsapproved a list of six changes to theMedicaid program eligibility rules thatour advocacy team could use (as neces-sary) in working with Congress to stopthe change in the penalty period start

date and lookback period. These pro-posals have shown NAELA to be forth-coming about certain areas of Medic-aid law, shown our willingness to help findsavings in the program, and have helpedprovide opportunities for us to discusswhy other proposals would severely hurtour clients. The proposals can be foundin Vincent’s testimony on the NAELAwebsite under Government Affairs.

Public RelationsActivities

NAELA’s public relations staff hasplayed a key role in successfully posi-tioning NAELA in the public spotlight.The PR team has worked side-by-sidewith the public policy team to ensure thatNAELA’s message has been deliveredproperly and promptly to Congress, themedia, and the NAELA membership.

Communicating on Key Events:Ann Krause and Stan Samples havemade it their business to ensure that themedia is informed of each of the keydevelopments that help to make our caseagainst the punitive transfer of assetschanges and in favor of more reasonedapproaches.

Letters: One example of this hasbeen their work to ensure that letters toCongress from organizations and coa-litions supporting NAELA’s position ontransfer of assets are provided to andunderstood by the media. Ann and Stanhave worked hard to make sure every-one is aware of the significance of the

NAELA’s

public relations

staff has

played a key

role in

successfully

positioning

NAELA in the

public

spotlight.


NAELA ExecutiveDirector’s Column(continued from page 5)

playing, but when I sat down and askedmyself “what I wanted to do if I onlyhad 10-15 years left?”….I realized thatwhile I love my work, it captivates meto the point that I exclude a lot of im-portant things from my life. In thehustle and bustle of getting things done,it has become a hassle to schedule timeoff or to enjoy it when I do have it. Ithas become impossible to find the timeto decorate for the holidays or to sendcards to those who mean the most tome. It has become a real life-barrier tospend 180 days per year in hotels andaway from home. It has become com-mon place to feel exhausted all the time,but to always feel under the gun.

As a baby boomer, business owner,association executive, and youngest inthe family, I tend to be an over-achieverand a workaholic. I don’t say that tomake anyone feel sorry for me….I saythat to make some of you recognize that

you may be too! I love what I do, buthave often said: “if I could only do lessof it, I could get a life!” After years ofsaying that, I have come to the realiza-tion that I can’t do anything “part way.”I’m an “all or nothing kind-of-gal.” So,I have given my all to this first chapterof my life. NAELA has been a tremen-dous source of pride, a great source ofgrowth and strength and a precioussource of love and support to me for17 years.

Now is the time for me to give backin other ways and to have time to takecare of myself. I am blessed to have awonderful husband who came to melate in life (yes, he’s my second hus-band, after NAELA) and with whom Iwant to spend more time. I want thetime to tend to sick friends, to go onspur-of-the-moment lunches, to deco-rate the house, to communicate withfriends and to travel to places withoutschedules, timelines and committeemeetings! And I do expect to see manyof you along the way…


letters from the LCAO and AARP. Inaddition, the PR team faxed NAELA’sown letter on the same topic to all ofthe congressional offices

Hearings: The PR staff preparedpress releases, pitches for radio, TV, andprint media, and communicated with lo-cal DC media when Vincent Russo tes-tified before the Senate Special Com-mittee on Aging.

Debate: When Vincent debatedStephen Moses of the Center for Long-Term Care Reform, the PR staff wrotepre- and post-debate press releases,“packaged” debate transcripts, andpitched the debate to the media. At thedebate and afterwards, Stan Samples metwith several DC-based media contacts.The PR staff helped prepare Vincent forthe debate with specific message plat-forms, edited for sound bite use with themedia, and on-location media training, in-cluding videotape auditing.

Letters to the Editor: The PRteam distributed “letters to the editor”to daily newspapers in areas home tomembers of the Senate Finance Com-mittee and the House Energy and Com-merce Committee. The letters statedNAELA’s position opposing thechanges to Medicaid and went out un-der local NAELA member signatures.We also sent similar letters to the edi-tor, but using a national perspective, tonational media. These letters weresigned by Lawrence Davidow, NAELAPresident.

News Bureau: One of the most im-portant functions of the NAELA PRteam is to staff the news bureau. Annand Stan answer questions from themedia, develop news releases and othercontent, pitch and place stories with themedia, facilitate interviews, and providepre-interview media coaching. In ad-dition, they spend many hours workingto connect the appropriate NAELAmember with an interested media con-tact in order to get the right story aboutNAELA, our members, and our clientsin the public eye. They also provide acritical function by monitoring Medic-aid hits in the media and by monitoringMedicaid activity by various groups, in-cluding the Medicaid Commission andthe National Governors Association.

Schedule of EventsD E C E M B E R 8 - 1 1 , 2 0 0 5NAELA InstituteA Joint Conference with the National Association of ProfessionalGeriatric Care Managers. Rescheduled from the Sheraton, New Orleansto the JW Marriott Starr Pass in Tucson, Arizona.

J A N U A R Y 2 0 - 2 2 , 2 0 0 62006 NAELA UnProgram, Embassy Suites Outdoor World,Grapevine, TX

A P R I L 1 9 , 2 0 0 6Fundamentals of Elder Law, Hyatt Regency at Capitol Hill,Washington DC

A P R I L 2 0 - 2 3 , 2 0 0 62006 NAELA Symposium, Hyatt Regency at Capitol Hill,Washington DC

N O V E M B E R 2 0 0 62006 NAELA Institute - location to be determined.

M A Y 2 - 6 , 2 0 0 72006 NAELA Symposium, Renaissance Cleveland Hotel,Cleveland, OH

F A L L , 2 0 0 72007 NAELA Institute, Atlanta, GA

S P R I N G , 2 0 0 82008 NAELA Symposium, NAELA’s 20 Year Anniversary, Hawaii


Chapter PresidentsArizona Chapter

Bridget O’Brien Swartz, Esq.Phoenix, AZ

(602) 955-7886Colorado Chapter

Catherine Anne Seal, CELAColorado Springs, CO

(719) 448-0734Florida Chapter

Alice Reiter Feld, CELATamarac, FL

Phone: (954) 726-6602Illinois Chapter

Amy Parise Delaney, CELAPalos Heights, IL(708) 361-8819

Kansas ChapterTimothy P. O’Sullivan, Esq.

Wichita, KS(316) 267-6371

Maryland/DC ChapterMorris Klein, CELA

Bethesda, MD(301) 652-4462

Massachusetts ChapterMichael F. Loring, Esq.

Scituate, MA(781) 545-2600

Missouri ChapterReginald H. Turnbull, CELA

Jefferson City, MO(573) 634-2910

New Jersey ChapterEugene Rosner, CELA

Clark, NJ(732) 382-6070

New York ChapterVincent J. Russo, CELA

Westbury, NY(516) 683-1717

California Chapter - NorthernTrudi S. Riley-Quinn, CELA

Roseville, CA 95661(916) 782-8212

North Carolina ChapterJ. Gregory Wallace, Esq.

Raleigh, NC(919) 876-1400

Wendy A. Craig, Esq.Black Mountain, NC

(828) 669-0799California Chapter - Southern

Brian Sheppard, CELAEncino, CA

(818) 342-5799South Carolina Chapter

Leigh Flynn, Esq.Columbia, SC

(803) 791-1991Texas Chapter

Patricia F. Sitchler, CELASan Antonio, TX(210) 224-4491

Virginia ChapterR. Shawn Majette, Esq.

Richmond, VA(804) 698-6233

Washington ChapterBeth A. McDaniel, Esq.

Renton, WA(425) 227-8700

Please note thatthis list does not

include theNAELA chapters

currently information.

cannot leave without permission.The legal system has developed a

very specific and elaborate process toensure that when services are imposedfor mental illness, one’s 14th Amend-ment rights are not violated. “No stateshall make or enforce any law whichshall abridge the privileges or immuni-ties of citizens of the United States; norshall any state deprive any person oflife, liberty or property, without dueprocess of law...” U.S. Const. Amend.XIV. Exact procedures and substantiveevidentiary standards must be followedbefore placing a person with mental ill-ness into a locked unit. The constitu-tional mandate is the underpinning ofall legal precedent for confining peoplein locked mental health units. An explo-ration of the constitutional case law sur-rounding commitment can give us insightinto the protections that should be in place,but are not for people who may be placedin a locked Alzheimer’s unit.

One Supreme Court case outliningthe minimum due process needed forcommitment was O’Connor v. Donaldson,422 U.S. 563, 95 S.Ct. 2486 (1975). Inthis case, Donaldson sued his physician,the hospital superintendent and otherstaff members for wrongfully confin-ing him to the Florida State Hospital.Donaldson was found by his physicianto be suffering from “paranoid schizo-phrenia” and was committed to “careand maintenance.” Donaldson was con-fined for fifteen years. His treatmentplan was to have “milieu therapy.” “Mi-lieu therapy” was a euphemism for con-finement in a mental hospital and min-gling with other patients.

The law in Florida at the time gavethe hospital staff and the physician thepower to release or not release the pa-tient. The sole and simple reason forDonaldson’s conf inement was thephysician’s opinion. There was no thirdparty process to review a commitment.The Supreme Court found that “a Statecannot constitutionally confine withoutmore [sic] a non-dangerous individualwho is capable of surviving safely infreedom by himself or with the help ofwilling and responsible family membersor friends.” Id., at 491.

Mrs. Smith’s case parallels Donald-

son’s facts. The simple findings by aphysician that someone has Alzheimer’sor dementia or “needs” a locked unitfalls short of the due process to causesomeone to be restrained in a lockedunit. There must be findings and thirdparty review to ensure that appropriateplacements are made into lockedAlzheimer’s and dementia units.

In the mental health process thereis a presumption that the person on trialand being placed into a locked unit hascapacity and is not in need of the men-tal health services. The moving partymust overcome the presumption by clearand convincing evidence. Addington vs.Texas, 441 U.S. 418, 99 S.Ct. 1804(1979). The basis for the high stan-dard is that “society has a minimal con-cern with the outcome of such privatesuits, plaintiff ’s burden of proof ismerely a preponderance of the evi-dence.” Procedurally, one is entitled toa hearing where evidence is presentedand not just doctor’s orders before some-one is committed. Substantively, theevidence presented must be clear andconvincing.

In locked Alzheimer’s units, the fa-cility has a vested interest in retainingthe resident. The facility’s financial vi-ability is based on a full census. Underthe constitutional standard, a personentering a locked unit is entitled to thereview of an unbiased third party andthe presentation of evidence before be-ing retained against their will.

Under 42 U.S.C. § 1983, anyonewho is deprived of their 14th Amend-ment rights under color of State law isentitled to damages. Attorney’s fees andexpert fees are available under 42 U.S.C.§ 1988. Potentially, people like Mrs.Smith have a private cause of action fordamages, having been deprived of theircivil rights without due process. Thisopens a whole new element of liabilityfor: (1) facilities who are housing peoplewithout due process; (2) physicians whoare writing orders directing people beplaced into Alzheimer’s units; and, (3)family members and friends who are plac-ing people into locked Alzheimer’s units.

What happens when someone iswilling to go to the Alzheimer’s unit atfirst but objects later? Alzheimer’s ordementia is usually a chronic degenera-tive disease. As the disease processcontinues, it further impairs the person’smind and capacity to make good deci-

Guardianship/Capacity SIG(continued from page 1)



sions or participate in the decision pro-cess. It is difficult for physicians togauge the needs of an older adult dur-ing this devastating process, let alonefor family members to figure out whensomeone with dementia or Alzheimer’sis capable of making decisions and con-senting to treatment.

While being placed into anAlzheimer’s unit which is locked maybe in a patient’s best interest, problemsarise for those few patients for whomthe placement is inappropriate. Addi-tionally, there are many persons whosimply do not need a locked unit evenif they have a dementia or Alzheimer’sdiagnosis. When someone has a diag-nosis of Alzheimer’s or dementia,should they automatically be placed intoa locked unit? What duty do we haveto safeguard these people from them-selves, while also allowing them theirown freedoms and personal rights?There is a clash between the practicalside of the day-to-day care for a personwith Alzheimer’s or dementia, and withthe patient’s constitutional rights.

A delicate balance between therights of the individual versus the needto protect the individual exists whenplacing someone in a locked unit. Thereis a need for an inexpensive and efficientprocess to protect the older person, whileenabling family members to obtain appro-priate care for the older person.

When an older person is sufferingfrom dementia or Alzheimer’s, the fam-ily is often suffering and having a diffi-cult time coping with the loss of theolder person’s mental acuity. Good in-tentions abound, but the first questionshould be: what does the older personwant? Then, when do the wishes of theolder person need to be overruled, be-cause she has lost capacity and her de-cisions are not sound? If her wishes areto be overruled, what is the processneeded to guarantee the rights of theolder person?

There are huge consequences whendecisions to place into a lockedAlzheimer’s unit are made in haste with-out process or substance. We mustmake sure our client’s constitutionalrights are protected; that they are in theleast restrictive environment; and thatthey are appropriately placed.

GuardianshipCapacity SIG(continued from page 8) Stetson College of Law

Builds First ModelCourtroom for Seniors andPeople with Disabilities

National advocates for the rights of seniors and people with disabilitiesgathered at Stetson University College of Law on Sept. 16 for the dedicationof the nation’s first “elder-friendly” courtroom.

“We can only hope that this courtroom inspires the creation of others,”said AARP CEO Bill Novelli. “You have created a place of law and justicethat is accessible to anyone and everyone.”

The courtroom has touch screens, electronic gates that open automati-cally, hearing amplification devices, flat-panel monitors, refreshable Brailledisplays, a multi-lingual software speech synthesizer and translator and otherfeatures specially designed for people with reduced vision, limited hearingor other physical disabilities.

As U.S. Attorney General, Dick Thornburgh shepherded the Americanwith Disabilities Act. He reminded the courtroom audience of landmark Su-preme Court case Lane V. Tennessee, in which a gentleman with disabilitieswas forced to climb out of his wheelchair and crawl up the steps of a court-house to attend a judicial proceeding. “The Eleazer courtroom doesn’t sim-ply accommodate wheelchair access, though that is monumental in its ownright. It goes so much further. Its technology will enable people with varioussensory impairments to participate fully in our judicial process,” Thornburghsaid.

Lawrence Davidow, President of the National Academy for Elder LawAttorneys said construction of the new courtroom is the beginning of a move-ment to increase access, dignity, respect and involvement of all people withdisabilities, regardless of age, in every courtroom in the United States. “Thiscourtroom is all about enhancing the lives of people with disabilities andpeople as they age. We intimately know what this courtroom means to them;access to justice with dignity, enhancing their ability to be a part of a pro-cess that directly impacts their lives, without barriers, seamlessly allowingtheir disabilities to be a non-issue,” Davidow said.

Stetson professors Rebecca Morgan and Roberta Flowers spearheadedcourtroom construction. “This innovative courtroom combines cutting-edgetechnology while recognizing that our system of justice will always be aboutpeople,” said Flowers.

The courtroom will be used initially for Consumer Protection Programactivities that educate the elder community about various types of consumerfraud. In the spring, elder law and advocacy students will use the new facil-ity, and Morgan and Flowers are working to make the courtroom availablefor actual court proceedings in the near future. Stetson dedicated the court-room in honor of Distinguished Professor of Law Emeritus William R.Eleazer.

To view images of the courtroom and the dedication event, please visithttp://www.law.stetson.edu/Communications/news.asp?id=206

Stetson University College of Law is Florida’s first law school. It haseducated lawyers for more than a century and offers continuing legal educa-tion programs for regional, national and international audiences. Stetson istied for first in advocacy and third for legal research and writing by the 2006U.S. News & World Report national rankings and is the headquarters for theNational Conference of Law Reviews.



Health Care SIGTalking With Your Clients AboutThe New Medicare PrescriptionDrug BenefitBy Vicki Gottlich, Esq.

In recent weeks President Bush,Secretary of Health and Human Ser-vices (HSS) Leavitt, Centers for Medi-care & Medicaid Services (CMS) Ad-ministrator McClellan, former senatorand presidential candidate Bob Dole,and others have begun a publicity cam-paign around the country to discuss thenew Medicare Part D, which adds anoptional prescription drug benefit to theMedicare program effective January 1,2006. If these people are talking aboutPart D six months before the benefitwill pay for covered drugs costs, is ittime for elder law attorneys to start dis-cussing Part D as well? The answer isyes.

That answer may be surprising,given that we really do not know muchdetail about the practical operation ofthe Part D program. We do know thatthe prescription drug benefit will be of-fered through private insurance plansknown as Prescription Drug Plans orPDPs. We will not know how many ofthese plans will be available in each ofthe prescription drug regions estab-lished by CMS until CMS enters intofinal contracts with the plans sometimein September. Based on public an-nouncements, we know that 10 compa-nies, including AARP in conjunctionwith United Health Group, have appliedto CMS to offer national plans that serveall of the regions. CMS has said thatbeneficiaries in some regions will havemany more than 10 plans from whichto choose while beneficiaries in otherregions, such as the Maine- New Hamp-shire region, may be limited to the 10national plans. In addition, MedicareHMOs, PPOs, and some private fee-for-service plans (known collectively asMedicare Advantage plans with pre-scription drug coverage, or MA-PDs)will also be offering prescription drugbenefits, increasing the choices for ben-eficiaries who live in areas where theseoptions are available.

We also do not know how much the

prescription drugplans will cost.Press accountsmention an av-erage pre-mium of $37per month, butthat f igure isonly an esti-mate. The PDPssubmitted theirpremium bidsto CMS on June6; these bids are cur-rently being analyzed. It islikely that some plans will have a pre-mium that is much greater than the es-timate. The amount of the premium willbe significant to all beneficiaries, es-pecially given the large increase that isanticipated in the Medicare Part B pre-mium for 2006. The premium amountswill be particularly relevant to benefi-ciaries with low-incomes who seek ad-ditional assistance in paying their PartD costs since the assistance with pre-miums will be capped. In addition, pre-mium amounts are expected to rise eachyear.

Each plan’s benefit structure alsois unknown. The statute defines thefollowing standard benefit: There is a$250 deductible for drugs on a plan’sformulary. After the deductible is met,the beneficiary pays 25% of the cost offormulary drugs and the drug plan pays75%, up to $2250 in total formularydrug costs. Then the beneficiary en-ters the proverbial “doughnut hole”where s/he is responsible for the fullcost of prescriptions while continuingto pay the monthly premium. Once thebeneficiary’s total out-of-pocket costsfor formulary drugs, including the de-ductible but not the premium, equal$3600, the beneficiary is responsible for5% of drug costs and the drug plan paysthe remaining 95% of costs. Generally,the beneficiary and the drug plan willhave expended $5100 on formulary

drugs before the catastrophic coveragelevel is reached. The $3600, which willbe indexed yearly, represents annualout-of-pocket expenditures; a benefi-ciary begins again at $0 each January1.

Drug plans arenot required tooffer the stan-dard benef it,however, as

long as the valueof the drug benefitthey offer is actu-arially equivalentto the value of thestandard benefit.In fact, it is antici-

pated that manydrug plans will not

offer the standarddrug benefit. Instead,

plans may follow the modelused by private insurance and

vary beneficiary cost-sharing to pro-mote use of less costly drugs. For ex-ample, a plan may have different tiersof cost-sharing: the lowest tier for ge-neric drugs, a higher tier for preferredbrand name drugs, and the highest cost-sharing tier for non-preferred brandname drugs. Plans may also require avery high amount of cost-sharing forvery expensive and rare drugs. Theregulations even allow plans to have atier under which the beneficiary paysthe full cost of the drug. A beneficiary’scosts may also depend on the pharmacys/he uses. Plans may charge more ifbeneficiaries use pharmacies that arenot in the drug plan’s pharmacy networkor charge more for non-preferred net-work pharmacies.

We also do not know precisely whatdrugs will be paid for under Part D. Thestatute establishing the Medicare drugbenefit specifically excludes from pay-ment certain classes of drugs, includ-ing barbiturates, benzodiazepines (suchas Xanax and Valium), weight loss/weight gain drugs, and over-the-counterdrugs that are frequently used by olderpeople, particularly those in nursinghomes. Some PDPs and MA-PDs mayoffer to cover these drugs as an optionalbenefit for an extra premium. All PDPsand MA-PDs can determine whichdrugs covered by Part D to include in


P A I D A D V E R T I S E M E N T

Manually Placed Negative From Last Issue

their formulary, or list of covered drugs,as long as they include at least two drugsin each category or class of drugs. CMShas recently announced that drug plansmust cover all or substantially all drugsin six categories: anti-cancer,anticonvulsants, antidepressives,antipsychotics, immunsuppressants,and HIV/AIDS drugs. If a drug is noton a drug plan’s formulary, then the ben-eficiary will get no assistance in pay-ing for the drug, and out-of-pocket costsfor the drug do not count towards thedeductible or towards reaching the out-of-pocket spending limit and cata-strophic coverage.

In addition to determining whetherto include a drug on its formulary, eachdrug plan can determine the cost-shar-ing tier on which to place the drug.Drug plans may also require that a ben-eficiary get prior approval or prior au-thorization from the plan before payingfor the drug, and may deny coverage if

such approval is not obtained. They mayalso require the beneficiary to try a lesscostly drug first before they will pay forthe more costly drug in order to deter-mine whether the less costly drug willbe effective. Thus, it will not be enoughfor beneficiaries to determine whetherthe medications they take are includedon a particular plan’s formulary. Theywill have to know the cost-sharing tierand whether a plan employs utilizationmanagement tools to discourage the useof certain drugs.

Again, information about drug planformularies will not be made availableuntil October when the drug plans be-gin marketing and CMS sends informa-tion about Medicare Part D to all ben-eficiaries. Formulary information willnot be mailed directly to all beneficia-ries, however. Beneficiaries, their fami-lies and their advocates who use theInternet will be able to obtain formu-lary information through the CMS website, www.medicare.gov. Others willhave to call all of the drug plans avail-able in their region. The drug plans may

give them information specific to themor an abridged formulary; the plans willnot be required to give beneficiaries thecomplete drug formulary unless theyrequest a copy.

Medicare Part D is voluntary; somebeneficiaries may choose not to enrollduring the initial enrollment period,which will run from November 15,2005-May 15, 2006. However, indi-viduals who delay enrolling in a Part Dplan until after their initial enrollmentperiod will have to pay a late penaltyon their premium, similar to the way apenalty is imposed for delayed enroll-ment in Medicare Part B. Under PartD, the late penalty will be 1% of thepremium for each month of delayedenrollment for as long as a beneficiaryremains in a Part D plan. A beneficiarywho delays enrolling in Part D for 5years will therefore pay an additional60% on her premium; the actual dollaramount will fluctuate as the premiumchanges each year. Individuals who havedrug coverage through a retiree health

Health Care SIG(continued from page 10)



plan or through a Medigap policy withprescription drug coverage and whodelay enrolling in Part D will not beassessed a late penalty if their othercoverage is deemed to be “creditable,”i.e., to be as good as or better than theMedicare Part D benefit. Employersand unions that offer employment-re-lated drug coverage, as well as insur-ance companies that offer Medigap poli-cies with drug coverage, must notifypeople enrolled in their plans this fallwhether the coverage they provide iscreditable.

If more detailed information aboutPart D drug plan choices will not beavailable until the fall, and if beneficia-ries cannot even begin to choose a PartD plan until November, then why shouldelder law attorneys begin talking aboutthe Medicare prescription drug benefitnow? Three reasons: the new drug lawchanges how individuals who are du-ally eligible for Medicare and Medic-aid (dual eligibles) get their prescrip-tions; individuals with limited incomeand resources need to apply now for alow-income subsidy; and Medicare PartD should be incorporated into health-care planning.

Effective January 1, 2006, Medic-aid will no longer cover prescriptiondrug costs for dual eligibles. These in-dividuals will get their prescriptiondrugs paid for through a Medicare drugplan. To ensure that no one is left with-out drug coverage on January 1, CMSwill begin this fall to automatically en-roll dual eligibles into a prescriptiondrug plan whose premium is at or be-low the benchmark or average premium.Because they will be randomly assignedto a plan, no analysis will be made ofwhether the drug plan’s formulary in-cludes the drugs they take or whetherthe pharmacy network includes thepharmacy they use. Dual eligible indi-viduals will receive a low-income sub-sidy, referred to euphemistically as “ex-tra help,” which will cover the premiumup to the benchmark amount, the de-ductible, most of the co-payments forformulary drugs, and the doughnut hole.Those with incomes at or below 100%of the federal poverty level (FPL) willpay $1 for generic drugs and $3 forbrand name drugs. Those with incomes

below 135% of FPL will pay $2 and $5,respectively. Dual eligibles living innursing homes, but not those living inassisted living facilities under a Med-icaid waiver program, will have no co-payments. In some states, dual eligibleswill be paying a co-payment for theirprescriptions for the firsttime.

People who are cur-rently enrolled in one ofthe Medicare SavingsPrograms (MSP),namely, Qualified Medi-care Benef iciaries(QMB), Specified Low-Income Medicare Ben-ef iciaries (SLMB),Qualif ied Individual(QI), that pay the Part Bdeductible and some-times Medicare co-pay-ments, as well as people who get SSIbut who do not automatically get Med-icaid, are deemed eligible for the PartD low-income subsidy and do not haveto apply. The deeming of MSP recipi-ents may prove significant for some cli-ents.

Others with incomes up to 150%of FPL and with resources of up to$10,000 for an individual or $20,000 fora couple also may be eligible. Theamount of assistance varies with incomeand resource levels. CMS estimates that8.2 million Medicare beneficiaries mayqualify for the subsidy by filing an ap-plication with the Social Security Ad-ministration (SSA) or with the localMedicaid office. SSA has begun send-ing applications to beneficiaries whopotentially may be eligible, and willcontinue mailing applications throughmid-August. SSA and Medicaid officeswill begin processing applications onJuly 1. Also on July 1 people can ap-ply by filling out an application on theSSA web site, www.ssa.gov. Anyonewho is found eligible for the subsidy,either by applying or by being deemedeligible, will automatically be enrolledin a Part D plan in May 2006 if theyhave not chosen a plan on their own.

Here’s where elder law attorneyscome in. First, attorneys can discusswith their clients the need to apply forthe low-income subsidy, if not now, thenpossibly when their income and assetsare diminished during a spend-downperiod before Medicaid eligibility. For

many people the subsidy will mean thedifference between being able to affordprescription drug coverage and not be-ing able to purchase the coverage. In-dividuals whose income and/or re-sources appear slightly too high shouldbe encouraged to apply because of vari-

ous exclusions and disre-gards. Beneficiaries wholive in states whose in-come and asset eligibilitycriteria for the MedicareSavings Programs aremore liberal than the cri-teria for the Part D low-income subsidy shouldbe encouraged to applyfor MSP. Again, once anindividual is found eli-gible for an MSP pro-gram s/he is automati-cally eligible for the low-income subsidy, even if s/

he does not meet the subsidy incomeand/or assets eligibility criteria. Attor-neys should familiarize themselveswith MSP eligibility criteria in theirstates in order to determine whether anyof their clients are more likely to re-ceive assistance with Part D costs byapplying for MSP assistance.

Second, attorneys need to evalu-ate the role they can play in assistingclients choose and enroll in a Part Dplan. Although dual eligibles will au-tomatically be enrolled in a plan, they,unlike other Medicare beneficiaries,can change plans at any time. Thus, anelder law attorney can assist a dual eli-gible client or the client’s family in de-termining the plan that is best for theclient. Other clients may also need as-sistance, especially those who currentlyhave other drug coverage through anemployer or Medigap plan and whoneed to determine whether they shouldretain their current coverage or enrollin a Part D plan.

Third, attorneys need to incorpo-rate Medicare Part D into their healthcare planning. Remember, the low-in-come subsidy for dual eligibles and oth-ers with limited income and resourcespays the Medicare Part D premium onlyup to the benchmark or average pre-mium amount. A beneficiary whowants to enroll in a more costly Part Dplan with perhaps a more generous for-mulary will have to pay the difference



In some states,dual eligibles

will be paying aco-payment for

theirprescriptionsfor the first

time.


between the benchmark and higher pre-miums. Can these payments be madefrom a trust already established on be-half of the beneficiary? Can an exist-ing trust be used to pay the beneficiary’sother cost-sharing expenses, includingthe deductible and costs in the dough-nut hole, if the beneficiary does not re-ceive a subsidy, or the co-payments andcosts for non-formulary drugs? Doesyour state Medicaid program recognizethe incurred medical expense deduc-tion? Will dual eligible clients in nurs-ing homes be able to deduct the extrapremium amount and the cost of non-formulary drugs from their share of costpaid to the nursing home?

Attorneys who draft financial andhealth care powers of attorney docu-ments on behalf of clients need to con-sider which agent will have authority tochoose a Part D plan or to change PartD plans if the client becomes incapaci-tated. Which agent will have authorityto pursue an exception on behalf of theclient to get a non-formulary drug cov-ered by the plan or to get a formularydrug moved to a lower cost-sharing tier?There is some concern among nationaladvocates that nursing homes will filefor guardianships on behalf of residentswho lack family or others to assist themin choosing a plan or in seeking a for-mulary exception. What role can an el-der law attorney play in that regard, es-pecially to ensure that guardianships arelimited?

Finally, what opportunities will thenext few months bring to promote in-formation about elder law generally andas it relates to Part D? Representativesfrom CMS and SSA will be visiting se-nior centers and lunch sites throughoutthe country to encourage enrollment inthe low-income subsidy and Part D.How can an elder law attorney partici-pate in such events? Can an attorneyfollow-up on such events through OpEd pieces or other media exposure?

As advocates for older people andpeople with disabilities, we need to en-sure that our clients get all of the ben-efits to which they are entitled. We needto ensure that the information providedto them is clear and accurate. Talk withyour clients about Medicare Part D, andin doing so promote the role that elderlaw attorneys can play with all of theirhealth care and planning needs.


NAELA AnnouncesAvailability of TwoSymposium TuitionScholarships

The National Academy of Elder Law Attorneys proudly announces twoVivian Cohn Smith Scholarships for Patient Advocacy to be awarded forattendance at the 2006 Symposium in Washington, DC, April 19-23, 2006.

The scholarship was established through the NAELA Memorial Fundin memory of Vivian Cohn Smith. It is a needs-based scholarship, cover-ing tuition and room at the 2006 Symposium. The annual scholarship isavailable to elder law attorneys who are unable to afford the costs associ-ated with attending the NAELA Symposium, and who would use the train-ing to assist and advocate on behalf of the disabled and incapacitated.

The Vivian Cohn Smith Scholarship for Patient Advocacy was madepossible through the generous donations made in Vivian’s name to theNAELA Memorial Fund by Vivian’s family and friends; Needham, Mitnick& Pollack, plc; and other individuals and law firms. Vivian, the sister ofNAELA Fellow Helen Cohn Needham, CELA, passed away in November1997 after a 10-year fight against breast cancer. She learned the value ofpatient advocacy from her own experience–Vivian was a disability workerfor the state of North Carolina and saw her role as using what she hadlearned as a patient to advocate on behalf of others.

Application ProcessThe applicant must send a statement to NAELA (no more than one

page long) that explains the following:

� Applicant’s current job/position and involvement in elder law.

� Why the applicant needs the scholarship.

� How the applicant would apply the training received at the Sympo-sium to her/his advocacy on behalf of patients.

Selection ProcessThe family of Vivian

Cohn Smith will review allapplications and determineto whom to grant thescholarships.

Deadline forApplication

All applications mustbe submitted no later thanFebruary 15, 2006.Applications must besent to Bridget Jurich,NAELA, 1604 NCountry Club Rd.,Tucson, AZ 85716-3102.


“Smart RetirementPlanning for EveryAge,” which waspublished in theOctober 1, 2005 issueof Black EnterpriseMagazine.

“Ill Winds Blowing Busi-ness Our Way,” which waspublished in the September 23, 2005issue of the Arizona Daily Star.

“Storm Damage Driving Conventionsto the West,” which was published inthe September 23, 2005 issue of theArizona Republic.

NAELA Members in the News:

Marc Crawford Leavitt, Esq., wrotethe article titled “Who Cares AboutOral Health for Seniors,” which waspublished in the Summer 2005 issueof the Elder Law Attorney: a publica-tion of the Elder Law Section of theNew York State Bar Association.

Lawrence E. Davidow,CELA, was quoted in “Do-It-Yourself Estate Planning,”which was published in theSeptember 2005 issue ofBlack Enterprise Maga-zine.

Lawrence E. Davidow,CELA, was quoted in“Prominent Long Island

Attorney AssumesLeadership of 5,000

Member Organization,”which was published in the August

4, 2005 issue of Smithtown Messen-ger (Smithtown, NY).

Lawrence A. Friedman, CELA, wrotethe article titled “Settlement, Divorceand Estate Planning To SafeguardDisability Aid,” which was publishedin the September 5, 2005 issue of theNew Jersey Law Journal.

Joseph S. Karp, CELA, has beenawarded the Accredited InvestmentFiduciaryTM from the Center forFiduciary Studies. The AIF designa-tion reflects understanding of thespecial ethical obligations andprudent investment practices requiredof a fiduciary.

Drafting Living WillsAfter SchiavoBy Thomas J. Murphy, Esq.

Paul Mitchell, CELA, co-authoredthe article titled “Protecting Clientsfrom Abuse and Identity Theft,” withD. Wayne Stewart, which waspublished in the October 5, 2005special Elder Law issue of TheColorado Lawyer.

Vincent J. Russo, CELA, was quotedin “Proposed Medicaid TransferChanges Will Hurt Elderly,” which waspublished in the August 3, 2005 issueof the Belvidere Daily Republican.

Vincent J. Russo, CELA, was quotedin “Experts Debate Medicaid’s Role inLong Term Care,” which was pub-lished in the September 7, 2005 issueof CQ Healthbeat.

Vincent J. Russo, CELA, was quotedin “Lido Attorney Testifies BeforeSenate,” which was published in theJuly 28, 2005 issue of the Long BeachHerald (Long Beach, NY).

G. Mark Shalloway, CELA, wasquoted in “Moving Up: G. MarkShalloway Partner in Shalloway &Shalloway P.A.,” which was publishedin the September 26, 2005 issue ofthe Palm Beach Post.

For estate planning practitioners, theTeri Schiavo controversy has created a“good new, bad news” situation. The goodnews is that the Schiavo case heightenedinterest in the general public regarding theneed to have a living will, also known asan advance medical directive. The badnews is that Schiavo poses a tougher chal-lenge for practitioners by highlighting theneed to draft living wills addressing theproblematic issues that arise when fam-ily members cannot agree on treatmentfor a seriously ill person. The purpose ofthis article is to suggest new provisionsfor practitioners to include in the livingwills they are drafting for their clients.

The Schiavo case first came into thepublic limelight in the spring of 2004when the Florida legislature passed a stat-ute that precluded Ms. Schiavo’s husbandand guardian from withdrawing life sup-

port procedures.Since that time, I havereviewed hundreds ofliving will forms andhave discussed thematter with manyhealth-care providersand administrators, aswell as other attor-neys.

There are threedeficiencies that Icommonly see in theliving wills (includ-ing my own) that Ihave reviewed. First,they only apply to a patient who has beendiagnosed as terminally ill. However,many patients, to include Teri Schiavo,may be gravely ill and in an irreversiblecondition but are not considered to be ter-

minal.Second, virtu-

ally all living wills arepremised on the factthat all family mem-bers know what thepatient would want tohave done and are allin agreement on this.But when a disputeerupts, living willsare silent on how toaddress and resolvethis.

Third, livingwills typically offervery little practical orprecise guidance tothe decisionmakersbeyond some generalplatitudes about un-dertaking no heroicmeasures. With

many state legislatures proposing tighterstandards for ascertaining the patient’s in-tentions, providing some guidance willtake on added importance.

...they only apply to

a patient who has

been diagnosed as

terminally ill.

However, many

patients, to include

Teri Schiavo, may be

gravely ill and in an

irreversible condition

but are not

considered to be

terminal.


NAELA Members inthe News(continued from page 1)


Given these concerns, I have somesuggestions in drafting more effective liv-ing wills.

Terminal and Non-Terminal Conditions asthe Triggering Event

Most living wills specifically applyto a terminally ill patient. But often theterm “terminally ill” is not defined, whichcan create problems for healthcare provid-ers. The most workable option is to usethe Medicare definition of “terminally ill,”defined as “death occurring within sixmonths of the diagnosis if the conditionruns its normal course.” 1

But this does not solve all the prob-lems. Several gerontologists have empha-sized to me that patients with advancedAlzheimer’s or who have suffered a seri-ous stroke are never considered to be ter-minal. It would also not include thosepatients in an irreversible coma or persis-tent vegetative state, nor those patients whomay be conscious but enduring an unac-ceptable quality of life due to the injury orillness.

As a result, I have revised my livingwill to address three categories of condi-tions that will allow the agent or agents tomake the decision regarding end-of-lifecare:

a) an incapacitated person who isterminally ill,

b) irreversible coma, brain death orpersistent vegetative state, and

c) a greatly diminished and, hence,unacceptable quality of life.

The first category is for the incapaci-tated and terminally ill patient. I use thecommon probate code definition of “in-capacity,” i.e., the inability to make or com-municate responsible decisions about theperson.

The second category of a patient’scondition is for an irreversible coma, braindeath or persistent vegetative state(“PVS”). Teri Schiavo would have comewithin this category. Because of the me-dia coverage of Ms Schiavo, I have alreadyhad several clients question the appropri-ateness of using PVS as a standard becausemuch of the media raised questions about

what a PVS diagnosis meant and even ifsuch a condition actually exists.

Unfortunately, much of this discussionwas very inaccurate and misinformed.Since the early 1990s, PVS has come tobe a well-defined and recognized condi-tion. The leading authority is the Multi-Society Task Force on PVS that issued atwo-part article in 1994, in the New En-gland Journal of Medicine that set forththe definition and clinical aspects of PVS.2

A diagnosis of PVS requires no awarenessof self or the environment and an inabilityto respond to any visual, auditory, tactileor noxious stimuli. The distinguishing fea-ture is intermittent sleep-wake cycles,where the patient opens his or her eyes withsome reflexive response to external stimuli.But the response is only reflexive. Thereis no sustained visual tracking of an objector any fixation on a visual target. Like-wise, other reflective actions such as gag-ging, coughing, chewing, blinking, smil-ing, grimacing or sighing may occur. MostPVS patients have fairly normal breathingand gastrointestinal functions and maintaina normal body temperature but are unableto experience pain, thirst or hunger

There seem to be two main points toemphasize to a client who may have somereservations about appointing an agent ifthe client should ever lapse into PVS. Onepoint is that the diagnosis can only be madeif the patient lacks all awareness. The sec-ond point is that at least one month mustelapse since the onset of the condition be-fore a diagnosis of PVS can be made. Inother words, a doctor cannot make this di-agnosis within hours or days of admissionto a hospital. This has been a frequent con-cern of my clients since Schiavo.

The third category of a patient’s con-dition that will authorize an agent to act isif the non-terminal patient is incapacitatedand suffering an unacceptable quality oflife. The patient may be conscious andsomewhat alert, but the illness or injuryhas caused the patient’s condition to dete-riorate to the point where life may no longerbe worth living. This category would in-clude the advanced Alzheimer’s patient orthe patient who has suffered serious andirreparable injury from a stroke.

Guidance to the Agent/Decisionmaker

It is difficult for many of my clientsto define or describe exactly when it be-comes fruitless to continue treatment andaccept a death occurring sooner than it

otherwise might. It is also impossibleto plan for every medical treatment orpossibility3.

This is where estate planning prac-titioners will need to get creative andeven seek assistance from the medicalcommunity in drafting living wills.Most living wills are couched in termsof treatments, or what the medical com-munity calls “interventions.” The typi-cal living will has the client check offyes/no boxes dealing with specific in-terventions like CPR, dialysis, transfu-sions or chemotherapy. But this is justa tiny portion of all possible interven-tions. What of the other thousands ofinterventions or future interventions notyet invented or widely used?

The doctors that I have spoken withstrongly discourage this approach. In-stead, they recommend a broad, goal-oriented approach4. It focuses on theresult the patient wants to achieve andnot on how to reach that result. My new,revised living will lists the followingcriteria for the agent to consider whenmaking a decision:

� Inability to walk without theassistance of others or a wheelchair

� Experiencing pain most of thetime

� Experiencing discomfort (such asnausea, diarrhea or weakness)most of the time

� Inability to control my bladderand bowels

� Having a feeding tube insertedinto my stomach and/or beingunable to be fed by a spoon

� Use of a ventilator that is re-quired to keep me alive

� Inability to recognize family orclose friends

� Incurring costs for the provisionof medical care that will create afinancial hardship for me, myfamily or other loved ones

The idea is to provide some objec-tive guidance to the decisionmaker.The living will should indicate that anyone or more of these criteria tend tosupport the decision to withhold or ter-

Drafting Living Wills AfterSchiavo(continued from page 14)



minate life support. In other words,the decisionmaker is not compelled towithhold life support if one or more ofthe criteria exist. Rather, they are sim-ply factors for the agent to weigh whenexercising his or her discretion.

When I began to use this approach,I was surprised with my clients’ reac-tion. Some wanted to include some ofthese criteria but not all. Different cli-ents removed different criteria. As aresult, I have the client initial whichones they agree with. I am also con-sidering having a blank space next toeach criteria and having the client usea scale of 1 to 5 to rank them in order ofimportance.

This is far preferable to the ap-proach often taken by practitioners thatsimply authorize the withdrawal of lifesupport treatment if the burdens of treat-ment outweigh the benefits. Such animprecise test is an invitation to litigateif a dispute within the family erupts. Itwill also create problems in those stateswhere legislation may be enacted to im-pose higher standards in proving thepatient’s intentions.

Schiavo emphasizes the need toprovide the decisionmaker with somedelineated and objective criteria to con-sider when making the decision. Thisis not an easy task for the estate plan-ning practitioner who is discussing thiswith a young and healthy client who hasnever given much thought to any of this.A goal-oriented approach has workedwell for me.

Disputes Regarding theWithdrawal of LifeSupport

Another diff icult issue in theSchiavo case was the dispute thaterupted regarding decisions made byMs Schiavo’s husband/guardian. Vir-tually every doctor or hospital admin-istrator that I have spoken with havecandidly admitted that it is the familymember who complains the loudest whowill, at least initially, control the deci-sion regarding termination of life sup-port treatment. In other words, a hos-pital ethics committee will not autho-rize the withdrawal of life support if

there is a family member who is threat-ening to hire a lawyer or complain to alocal television reporter. While estateplanning practitioners can argue overwhether a hospital can lawfully exercisesuch authority, it is a foreseeable situa-tion that must be addressed when draft-ing a living will5.

I have made three revisions to myliving wills to address disputes. First, Ihave included a new paragraph, cap-tioned “Resolution of Disputes,” thatnames a particular person to make thefinal and binding decision in the eventof a disagreement.

Second, in that same paragraph, thereis a provision that states who is excludedfrom the decisionmaking process, such asa troublesome child or in-law. This is toavoid what one colleague of mine hascharacterized as“the black hat on thewhite horse,” suchas the child who hasnot been in contactwith the family formany years but whosuddenly appearsand wants to controlthe decision. Thisprovision shouldprevent this messysituation from im-pacting the decision.

Third, I haveadded a paragraphthat specifically al-lows the agent to ini-tiate litigationagainst the hospital,healthcare provideror family memberwho fails topromptly imple-ment the agent/decisionmaker’s directives.This is already authorized under the Pa-tient Self Determination Act,6 but it is al-ways a good practice to include this lan-guage since this could be the tipping pointin having the hospital honor the agent’sdecision.

Likewise, a provision should beadded that the patient or the patient’sestate will not be responsible for thepayment of medical bills for servicesprovided that are inconsistent with thepatient’s desires. While this provisionmay or may not be enforceable, it maycause doctors and family members to

think twice when the decision is made.Or a provision may state that any fam-ily member will forfeit their inherit-ance if they contest, interfere with ordelay the patient’s expressed desires.

Other suggestionsSeveral other points should be kept

in mind when drafting living wills.First, all practitioners should reacquaintthemselves with the seminal UnitedStates Supreme Court decision inCruzan v. Director, Missouri Dept ofHealth, 497 US 261 (1990) that held thatthere is a constitutionally protected rightto refuse any and all health care treat-ment, to include the provision of nutri-tion and hydration. A state is permittedto require a surrogate decisionmaker to

produce clear andconvincing evi-dence of what thepatient’s desireswould have been,but it cannot other-wise infringe onthat right. The fed-eral Patient Self De-termination Act(PSDA), whichlargely codified theCruzan case, re-quires that allhealthcare facilitiesmust follow a livingwill or other ad-vance medical di-rective. Cruzan andthe PSDA shouldremind practitionersthat they should notbe constrained byrestrictive state

laws. Examples are where a state re-quires the use of a statutorily-createdform, limits the decisionmaking author-ity to only certain irreversible or termi-nal conditions or to a certain period oftime, or requires a doctor’s certificationwhere the cessation of nutrition and hy-dration is prohibited.

Another point to consider concernsthe termination of the provision of hy-dration and nutrition. The media inSchiavo repeatedly referred to “starv-ing her to death” and of the pain thatwould result to Ms. Schiavo. This isnot so. Patients do not starve to death



Virtually every doctoror hospital

administrator that Ihave spoken with

have candidlyadmitted that it is thefamily member who

complains the loudestwho will, at least

initially, control thedecision regardingtermination of life

support treatment.


in these situations. It is the lack of hy-dration that results in death. Withhold-ing hydration causes death much fasterthan withholding nutrition. The lack ofhydration creates renal (kidney) failurethat causes a fairly painless death, usu-ally within days and always within amonth of the withholding. It also over-looks that food or fluids can be very dis-tressing to a dying patient by making itharder for the patient to breath and in-creasing the need for suctioning. It canalso increase pressure on tumors,thereby increasing pain. Food and flu-ids can also induce nausea, diarrhea orswelling.

It should also be kept in mind thatmost of the justices in Cruzan stated thatartificially-administered hydration andnutrition is a medical treatment. It re-quires consent by the patient or agentand a skilled clinician to implant and re-move the feeding tube. There is noth-ing natural or non-invasive about it.

Encouraging clients tohave “the talk”

No written document can take theplace of a thorough discussion amongfamily members about end-of-life is-sues. The silver lining of Schiavo is that,hopefully, more of these discussionshave and will take place. Practitionersdrafting living wills are simply tryingto memorialize that discussion. The ob-jective is to allow the agent/decisionmaker to make the best decisionthey can with the least amount of guilt.The agent should be able to say “That’swhat Dad would have wanted us to do”.If so, the drafting attorney has done anexemplary job.

Thomas J. Murphy, Esq., is an estateplanning, probate and elder lawattorney in Phoenix. He can bereached at 480-838-4838 or byvisiting his website atwww.murphylawaz.com.

Endnotesi. 42 CFR 418.3

ii. Medical Aspects of the PersistentVegetative State. New England Journalof Medicine, 1994; 330:1499-1506 &1572-1578

iii. Brett, A. Limitations of Listing SpecificMedical Interventions in AdvanceDirectives. Journal of the AmericanMedical Association, 1991; 266(6):825

iv. Tulsky, J. Beyond Advance Directives:Importance of Communication Skills atthe End of Life. Journal of theAmerican Medical Association, 2005;294(3): 359-365

v. Meisel, A, Snyder, L & Quill, T. SevenLegal Barriers to End-of-Life Care:Myths, Realities and Grains of Truth.Journal of the American MedicalAssociation, 2000; 284(19): 2495-2501

vi. 42 USC 1395cc(a)

Additional SourcesIt helps to have clients elaborate on

their thoughts and goals for end-of-lifeissues by reviewing and completing avalues questionnaire. There are a num-ber of good questionnaires on the Web.Two of the best are the Values HistoryForm published by the Institute for Eth-ics of the University of New Mexico


Health Sciences Center, available athttp://hsc.unm.edu/ethics/advdir/vhform_eng.shtml and the Caring Con-versations questionnaire published bythe Center for Practical Bioethics inKansas City, available at www.practicalbioethics.org/mbc-cc.htm.

Two useful sources for drafting liv-ing wills are the popular Five Wishesbooklet that can be purchased for $5from www.agingwithdignity.org and theLawyer’s Tool Kit for Health Care Ad-vance Planning published by the ABA’sCommission on Legal Problems of theElderly, available at www.abanet.org/elderly.

For a very compelling insider’sview of a family’s end-of-life ordeal,read Long Goodbye: The Deaths ofNancy Cruzan, an excellent book writ-ten by William H. Colby, attorney forthe Cruzan family, available fromwww.longgoodbye.org.

Call forNominationsAnnual Theresa Award

The Theresa Award is an annual communityservice award presented by the Theresa Alessandra Russo Foundation to aNAELA member in recognition of his or her advocacy and support ofindividuals with disabilities. Through the efforts of this NAELA member,individuals with disabilities are able to achieve a better quality of life,protect their rights and preserve their dignity.

There are many NAELA members who are worthy of this communityservice award. It is a wonderful opportunity for a NAELA member tonominate a colleague who is “making a difference” in the lives of those inneed. Please let us know who you would like us to consider. We need tohear from you!

The recipient of the award will be announced at the NAELA Sympo-sium and honored at the Theresa Foundation’s Annual Awards Dinner, heldin the Spring.

The Theresa Foundation will also contribute a cash grant of $2,500 toan organization named by the recipient of the award, that assists andsupports children with special needs.

Nominations can be made by contacting NAELA Executive Director,Laury Adsit Gelardi at 1604 N. Country Club Road, Tucson, AZ 85716-3102; they can be faxed to her at (520) 325-7925. Nominations areaccepted throughout the year.

For more information, call Laury Adsit Gelardi at (770) 850-0015, ext.113 or Vincent Russo at (516) 683-171, ext. 2131. Nominations will beconsidered by an awards committee comprised of past recipients of theTheresa Award as well as Vincent J. Russo and Laury Adsit Gelardi, whoare board members of the Theresa Foundation


FAQsabout NAELA’s Senior RightsPolitical Action Committee

Why do we havea Senior Rights PAC?

� To assist congressional candidates who supportour goals and objectives

� To increase NAELA’s access to Members of Congress

� To educate Congress about the needs of theelderly and individuals with disabilities

� To promote understanding of the work of elder lawattorneys

To whom does theSR-PAC give money?

� Republicans, Democrats, Independents, Senators,and Representatives who are running for office orare up for re-election

� Candidates who are committed to our goals and theinterests of our clients, such as those who supportedthe Elder Justice Act and improvements to Medicare

� Candidates who have been sympathetic to ourconcerns about Medicaid cuts and punitivechanges to asset transfer rules

� Candidates who have shown an interest in workingwith NAELA on issues of mutual concern and interestto our clients, such as the Older Americans Act

� Candidates who need to hear more about ourclients’ needs

How do we raise moneyfor the SR-PACcontributions?

� Regularly scheduled Happy Hours at NAELAInstitutes and Symposia, held in conjunction withthe Public Policy Committee

� Fundraisers like Comedy Night at the 2005 Symposiumand the UnFundraiser at the 2005 UnProgram

� Deputization: NAELA members are beingdeputized to raise money on behalf of the SR-PAC

� Contribution forms are available in membershippackets and online contributions will soon bepossible via the Government Affairs section ofwww.naela.org

Who are our strongestsupporters?

Our strongest supporters are NAELA members whohave a steadfast commitment to protecting the rightsof elders and the rights of elder law attorneys toadvise them. Contributors include the NAELA Boardof Directors, Past Presidents, Fellows, ChapterPresidents, and YOU! Thanks for making a difference!

How much have weraised so far?

More than $128,000!

How much money havewe given away?

In 2004, the first year of the SR-PAC’s existence,$28,000 was given to candidates.

To date, in 2005, $49,000 has been contributed tocandidates, with another $35,000 pledged tocandidates for 2005.

How do SR-PACcontributions translate intoaccess to Members ofCongress?

Political Action Committees are a major presence inthe political process. NAELA’s SR-PAC enables PACDirector, Brian Lindberg, and NAELA members toattend fundraisers for congressional members andcandidates. Fundraisers offer us an opportunity tomeet with the Member of Congress and to discuss thecritical issues of the day as they relate to elder law andour clients. On occasion, NAELA members haveattended fundraisers in the home states of their ownsenators and representatives and in DC.

Q

Q

Q

Q

Whogives to theSR-PAC?

Pacesetters ($5000)

Benefactors ($2,500 – $4,999)

Friends ($1,000 – $2,499)

Supporters ($500-$999)

Patrons ($1-$499)

Q

Q

Q

Q


Which Members of Congress has theSR-PAC contributed to this year?

Democrat Republican

Sen. Max Baucus (MT) Finance Sen. Norm Coleman (MN)

Sen. Jeff Bingaman (NM) Finance; HELP Sen. Susan Collins (ME) Aging

Sen. Hillary Clinton (NY) Aging, HELP Sen. Mike DeWine (OH) HELP; Judiciary; Approp.

Sen. Kent Conrad (ND) Budget; Finance Sen. Mike Enzi (WY) Budget; Aging; HELP

Sen. Blanche Lincoln (AR) Aging, Finance Sen. Bill Frist (TN) Leadership

Sen. Jack Reed (RI) HELP Sen. Chuck Grassley (IA) Finance

Sen. Harry Reid (NV) Leadership Sen. Jon Kyl (AZ) Finance; Judiciary

Sen. Charles Schumer (NY) Finance; Judiciary Sen. Gordon Smith (OR) Finance; Aging

Sen. Ron Wyden (OR) Finance; Aging Sen. Olympia Snowe (ME) Finance

Rep. Sherrod Brown (OH-13th) Energy & Commerce Sen. Arlen Specter (PA) Judiciary

Rep. John Dingell (MI-15th) Energy & Commerce Rep. Joe Barton (TX-6th) Energy & Commerce

Rep. Eliot Engel (NY-17th) Energy & Commerce Rep. Dennis Hastert (IL-14th) Leadership

Rep. Anna Eshoo (CA-14th) Energy & Commerce Rep. Nancy Johnson (CT-5th) Ways & Means

Rep. Steny Hoyer (MD-5th) Ways & Means, Leadership Rep. Bill Thomas (CA-22nd) Ways & Means

Rep. Frank Pallone (NJ-6th) Energy & Commerce Rep. Heather Wilson (NM-1st) Energy & Commerce

Rep. Nancy Pelosi (CA-8th) Leadership

Rep. Charles Rangel (NY-15th) Ways & Means

Rep. Henry Waxman (CA-30th) Energy & Commerce

Senate/House Committee KeyAging = Senate Special Committee on Aging HELP = Senate Health, Education, Labor and Pensions CommitteeApprop. = Senate Appropriations Committee Judiciary = Senate Judiciary CommitteeBudget = Senate Budget Committee Leadership = Senate or House Leadership OfficerEnergy & Commerce = House Energy & Commerce Committee Ways & Means = House Ways & Means CommitteeFinance = Senate Finance Committee

The purpose of the SR-PAC is to help elect candidates who will support the goals and objectives of NAELA. SR-PAC funds are used to make contributions to candidates for public office. The contribution amounts listed are onlysuggestions; more or less may be contributed (subject to a limit of $5,000 per donor per calendar year). The amountgiven, or the refusal to give, will not benefit or disadvantage a NAELA member. You may refuse to contribute withoutreprisal. Only members of NAELA may be solicited to contribute. We may not accept contributions fromcorporations, foreign nationals, federal government contractors, or by one person in the name of another person, normay we accept contributions of more than $5,000 per calendar year from any one contributor. Contributions are nottax deductible. Federal law requires us to obtain and report the name, address, occupation, and employer of eachcontributor who gives more than $200 in any calendar year.

Q


Who’sWho on

theNAELAStaff?

There are often questions as towho is who on the NAELA staff.As you know, we have a largestaff working for us, and every-one is responsible for very spe-cific things. The NAELA officeis located at 1604 North Coun-try Club Road, Tucson, Arizona85716, and is open from 8:00a.m. to 4:30 p.m., MountainStandard Time, Monday throughFriday, except holidays. Thetelephone number is (520)881-4005. The fax number is(520) 325-7925.

Name/Telephone ExtensionName/Telephone ExtensionName/Telephone ExtensionName/Telephone ExtensionName/Telephone Extension E Mail AddressE Mail AddressE Mail AddressE Mail AddressE Mail AddressAddress Changes Yika Riley-Smith ext. 123 [email protected] Jonathan Boyle ext. 115 [email protected] Director Susan McMahon ext. 113 [email protected] Questions Vicki Kanarr ext. 111 [email protected] Action/Policy Laury Gelardi ext. 113 [email protected] Terri Anth

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