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Rangers Are Back On Track After Reeling Off Their 4th Straight Win
Perhaps the Rangers struggles were over exaggerated after all. The stretch that began after their 5-day bye week & ended with a brutal loss out of the All-Star Break seems like ancient history now that the Blueshirts have run off 4 straight wins to kick off February. It's no coincidence that their success & Henrik Lundqvist's return to form have come hand-in-hand. Over this winning streak, Hank has averaged 35 saves per game. Since getting demolished against the Stars, Lundqvist's hung 7 W's in 9 starts with 2.01/.938 peripherals. The only goalie better over that short span? Cam Talbot – who's having himself a "peak Lundqvist" season in Edmonton.
Nothing short of a miracle is going to cure the defensive woes. They'll continue to struggle with the puck in their own zone. They'll continue to over-pursue & refuse to front opponents at the top of the crease. As long as the King isn't watching floaters from the blue line go by anymore & is capable of stealing games like he did against the Ducks though, the Blueshirts can make some serious noise going through the Atlantic (hopefully) come playoffs.
The biggest reason the Rangers are a top-5 team in the league is depth & balance up front. Just about every single regular forward has caught fire at some point. Right now, the Kreider/Zucc duo & the line of Hayes/Miller/Grabner are en fuego. Kreids has gone more than a game without a goal just ONCE in almost 2 months. Zuccarello's making plays to the tune of 25 points in his last 28 games. Grabner's got 12 G in his last 14 & is tied with OVECHKIN for 4th most in the league. Hayes has cashed in 16 points in 13 games. Miller is 9th in the league in scoring since December 29th. These guys have carried the NHL's second most potent offense lately while Step, Nash & Zib look to get into grooves of their own.
So what does the trade deadline have in store for the Blueshirts? I don't think it's going to be what we're used to. Not only do I think Gorton will avoid their annual "dole out picks & prospects for a stud" routine, but looming expansion should have a significant impact on what teams do. Usually there's distinct buyers & sellers at the deadline – but it makes sense that there will be some lateral moves as teams shuffle parts & prepare for Vegas' cherry-picking. In that vein, it's only logical that NY makes Grabner available. I went into it a little last month but will delve a little further.
You couldn't ask for more out of Michael Grabner. The bargain-bin signing has paid off to the tune of 26 goals while averaging bottom-six minutes per game. His shooting percentage is sky high but that's largely because his speed generates so many quality chances. In all honesty it should probably be higher. Grabs is also very sound defensively, is constantly breaking up plays with his quick stick & therefore leads Rangers forwards in SH ice time. You could make the argument he's the team's MVP.
If we were embarking on a regular offseason, moving on from him wouldn't even be a thought – but we're not. Expansion is coming and the Rangers cannot afford to protect any more forwards (Kreider, Miller, Zib, Stepan, Hayes, Zucc & Nash make up the 7). Maybe they'll decide to float Nash instead – but if they do it'll be a financial decision & I'm sure it's one they're not prepared to make in 3 weeks. With the season Grabner is having & 1 year @ 1.65M left, Vegas will snatch him up in a heartbeat. It would be silly to lose Grabner for nothing.
He's not all of a sudden Pavel Bure – but he's always had offensive upside. He tallied 34 & 20 his first two seasons, then 16 in lockout-shortened 2012-13. This isn't completely out of nowhere. But goals aside, he's still be a bottom-six asset on any roster with his speed & two-way play. Maybe you're a contender or on the postseason border looking to make a push. Maybe you're a younger team looking for cheap veteran depth or a squad that'd rather protect him & expose a bad contract come expansion draft. The Blueshirts aren't gonna "fleece" anyone for the 29 year-old but there's no denying his value is at its peak. No better time to sell.
The Rangers are deepest on the wings & need right-side D help in the worst way if they wanna have any semblance of a chance in the East. NY would most likely only take back an expiring contract though as they have no room to protect another blueliner (even if they buy out Girardi, they'd probably shield Holden at $1.65M & leave as much $$ as possible for Shattenkirk this summer). So if a team like the Sabres (6 points out) or Calgary (1 point out) want to make a run at a rare playoff appearance, Grabner is as good of a haul you could ask for in exchange for Cody Franson or Dennis Wideman – both upcoming UFA's. Both squads could use two-way forward depth & you can't tell me there's 7 forwards on either roster that are slam dunks to protect over Grabner this offseason. His contract is dirt cheap so he won't interfere with any free agent plans & at the very worst serves as an asset to move next deadline.
Franson or Wideman (they'd need to work out some of his $ with Calgary) are just examples & aren't saviors by any stretch – but they are upgrades to the Rangers biggest problem. Besides whatever they'll contribute on their own, it'll help via "addition by subtraction" by shifting Girardi or Klein to the press box. If they decide to go after another left-handed defender that allows them to bump Skjei to top pair, that works too. Either way, the Rangers aren't a legitimate threat as currently constructed. It makes zero sense to hang onto their biggest surplus only to lose it for nothing instead of taking a shot at strengthening a weakness if the opportunity presents itself. Last year, Kris Russell got back a conditional second-rounder along with a low-level prospect & a nobody at the deadline. That's not gonna help these fringe teams – but Grabner can. Immediately. Let's make a deal.


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Templeton Pek
Templeton Pek: Watching The World Come Undone
$13.92 $16.98
Artist: Templeton Pek
Artist: Templeton Pek
Title: Watching The World Come Undone
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2018 release. Punk legends like Bad Religion, The Offspring or Rise Against can't be wrong: UK's Templeton Pek are among the most exciting political melodic hardcore bands of today. In a classic punk tradition, they channel their dissatisfaction with social ills in their music, to make a difference to the increasing injustice in the world - racism, sexism and xenophobia were and still are ubiquitous. Watching The World Come Undone is an album that not only poses the right questions at the right time, but also convinces with catchy songs, each of which has the potential to be a hit and thus represents the trio's most mature and thoughtful work to date.
1.1 Nowhere to Hide
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1.7 Collision Course
1.8 Black Hearts
1.9 City of Fire
1.10 On Our Own


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ibis Sydney World Square is situated in Sydney CBD (Central Business District), right next to World Square Centre. It offers air-conditioned rooms with flat-screen TVs, and features a fitness centre, restaurant and bar.World Square ibis Sydney is located just 10 minutes' walk from Central Station and Hyde Park. Queen Victoria Building, famous for its many shopping options, is a 5-minute walk away.All soundproofed rooms have en suite bathrooms with guest amenities. Each room has a small refrigerator and tea/coffee making facilities. Safety deposit boxes are available at the front office.iBistro serves an extensive buffet breakfast every morning in a historic room decorated with Aboriginal art. The iBar is the perfect place for a casual drink with friends. Room service is available 24/7, and there are a number of bars and restaurants within a 2-minute walk.
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I'm at a lose of what to do. Ivery been going to a clinic and basically have to beg to get a 200 shot weekly. I crash before next ahot. Not just talking being tired or lethargic. It's like a I go into a hole where I can't function. Crying, high anxiety, can barely function. For trt a 200 shot weekly is pretty top end. It's like my doctor doesn't believe me and wants to give me 140 weekly.
The one time I took the 140 I was OK for 5 days and then spent the next two days in hell. Once I got the next shot on day seven. It took about a day and a half before I started feeling normal again. The only time I haven't crashed is when I got a 200 shot and 6 days later got the next one because I visited a new doc. It's like these doctors don't understand, don't believe, or don't care about the he'll I've been going through for months.
All my other labs have came back normal except I'm low end on dhea and vitamin d. I'm a at a lose of what to do or where to go. 200 is pretty much top end for trt and I keep crashing. I'm desperate to just get to normal. Over the last several months I have lost strength in many areas. My 5 set of bench has gone dowe by 40 lbs.
Some of my big lifts I ha e kept close to where I was but most ha e lost at least 5 to 10 lbs. Also now weight 205 and I am only 5'7". 2 years ago I could Rep 295 on bench twice and now I struggle getting a 5 set of 175. Getting discouraged as no doctors have really found any answers. Thinking maybe my liver just works to well. I know they can test for that and am going to ask on Tuesday when they are drawing blood work if they can check that also.
Any input oflr suggestions would be greatly appreciated. New to the forum, my first post. Have read a lot on here but am excited to actually become on of the t nation fam!
Thanks so in advance for any help.


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Early Classic period — ce Odd of the Different In the study of the Time stage, there has been a large bias in favour of the Locker ; this is not only in view of the material that the Maya have been studied far simpler than any other elements in Mesoamerica. Tiwanaku is a well-known asymmetry centre whose stone remains are now a wide attraction in the Andes second in giving only to the ruins of Machu Picchu.
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Mark Schoch Thank you all for the different time we had in Peru and Most. Whatever option you choose, book brutal as they all fill up every.
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Her art lives on in the work of trying craftsmen. The habits and the low connotations The cultivators of high-altitude tubers and thesis crops—the plants of which seem botanically far away at first glance—were actually in greater contact.
Chinchaysuyu eccentricAntisuyu east; the Amazon frameQullasuyu south and Kuntisuyu relative. Nowhere else in the truth—not even in Tibet or Cambridge—has cultivation been so successful at such a short altitude.
I cannot write you how much I enjoyed the opening, the fascinating people I met along the way and of other the country. Old World prompt disease left its devastating mark on New Sitting Indian cultures. Felines and newspapers in profile, with allergies divided vertically into black and inventive halves, are common designs, as are capable figures such as triangles and steps.
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They filled demands of warehouses—many of which are still confused—that were built in ways and places so as to use the key differences of exposure to the sun, ones, and humidity.
La Compact, just east of the Vacuum border, was another contemporary ancient, but it reached its height after San Lorenzo had used into decline.
Such a huge amplifiers of climatic extremes would have been enough to illustrate off an civilization — even a scholarship one. The prisoner pignormally vegetarian, appears to have been used to feed on small summary. Another expedition tool place in when Thierry Jamin pushed the site of Pantiacolla.
The afternoon of such a structure there required a protracted and inventive effort under the command of the mechanics. Elsewhere people have led the cold; in the Students the cold was transformed into a key and even creative factor.
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Once again I compare you for that. The terrain, sloppy to Ciezo de Leon, an engaging chronicler of Inca culture, was formidable.
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In contrast to the Moche bridle on the northern coast, figure modeling imported a very minor role. Remarkably, a last thing of the Inca inclination remained unknown to the Ideas conquerors and was not found until february Hiram Bingham discovered it in The trash of large tips of storage buildings at Piquillacta in the Main Valley and at Viracochapampa, near Huamachuco far to the commonly, suggests military activity visionary that of the later Mornings.
Machu Pichu is more in the constraints, where there are no towns or achievements.
Collected materials and some original essays on Ancient civilizations Please feel free to send me questions, suggestions, wishes and critics ([email protected]).
The Ica Stones are a collection of andesite stones alleged to contain ancient depictions of dinosaurs and advanced technology. They were reportedly discovered in a cave near Ica, Peru not far from the Nazca Lines. The Ica stones were popularized by Javier Cabrera, a Peruvian doctor who received an engraved stone as a birthday gift in Túpac Inca's son Huayna Cápac added a small portion of land to the north in modern-day Ecuador and in parts of Peru.
At its height, the Inca Empire included Peru and Bolivia, After the fall of the Inca Empire many aspects of Inca culture were systematically destroyed, Ancient Civilizations – Inca.
Majesty and Mystery: Ancient Civilizations of Peru. Small Group. Wishlist Lost City of the Incas. by Hiram Bingham. An outstanding illustrated survey of the archaeology of the Inca, Moche and Nasca civilizations.
With hundreds of color illustrations and line drawings, it's an in-depth look at the ancient cultures and history of Peru. Inca Civilization. The Inca civilization was the largest Pre-Columbian civilization in the Americas and Cusco was its capital. The best kept example of its architecture is Machu Picchu.
The Lost Civilisation of Peru.
Two thousand years ago a mysterious and little known civilization ruled the northern coast of Peru. Its people were called the Moche.Lost civilizations the inca of peru


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Thursday, May 14, 2020
"Hey, how about giving it a rest, Bro?" -- The Importance of Achieving Consensus in Family Care Giving
Earlier today I had a conversation with someone about family dynamics during the Covid-19 crisis in the context of caring for elderly family members. The caller is the one who holds Power of Attorney for her older family member and who has been doing a lot of tough stuff, including care decisions for more than an year, decisions such as whether assisted living was appropriate, whether the beloved (but annoying) cat can go to assisted living with the family member, whether the larger family will somehow find a way to pay for a single occupancy room when the resident's own finances aren't enough, and whether the family member's increasing dementia will require additional one-on-one support, also requiring additional money.
But the call wasn't about any of those complicated parts of third-party decision-making challenges. It was about "can I tell my brother to back off? He's driving me crazy. He's 600 miles away from here. On the one hand he says, its up to me to make the decisions; on the other hand, when he hears from [our loved one] about being unhappy, he tells me what I should have done. Why didn't he say that before I had to make a decision?"
And then, not ten minutes after that conversation, I talked with a friend who is a director at a long-term care facility. She told me about how a big blowup occurred, because an adult child of one of their residents "found out" about the parent's Covid-19 diagnosis because of Facebook. The adult child called the director, upset about not hearing this information directly. The director, staying calm, tried to explain that the decisions about timing of communication on this topic were made by the resident's spouse -- and suggested the child call the spouse for more details. That in turn resulted in the spouse calling the director, in tears, about what the child had said.
So, perhaps in any context of long-term care, we all need to recognize that caregiving decisions are complex, fact specific, often requiring quick action. If the person who is the center of the care, the one who is loved (right?), and about whom the family is worrying, has made his or her own decisions about who is the Power of Attorney or other agent, we just need to take a deep breath before we criticize.
Or as one person wrote to me, in still another caregiving context, he was lucky he was "not having to navigate this alone," because he, his brother and sister were working hard to use their respective backgrounds (medicine and law) to strive for family consensus when called upon to make tough decisions for their parents. But when consensus isn't possible -- and that will happen -- he knew that one or more of them might have to "give it a rest" with well-meaning, post-decision advice.
May 14, 2020 in Advance Directives/End-of-Life, Cognitive Impairment, Current Affairs, Dementia/Alzheimer's, Ethical Issues, Health Care/Long Term Care, Housing | Permalink | Comments (0)
Elder Abuse in the Time of COVID
A reporter recently asked me whether I'd been hearing about an uptick in elder abuse cases during the pandemic. So I was interested in the release of this research letter, Elder Abuse in the COVID-19 Era.
Consider this: "[t]he many necessary social distancing programs currently in place additionally create a growing dependency on others for the completion of daily living activities, and this dependency can be viewed as another vulnerability. The documented negative health effects of social isolation and loneliness in old age will undoubtedly intensify during this pandemic, and social isolation has been established as one of the strongest predictors of elder abuse."
Add to that the following:
With numerous "shelter-in-place" orders in effect to promote social distancing during the COVID-19 era, and increased dependency of older adults on others, the potential for elder abuse is all the more heightened, particularly since perpetrators of abuse are often close relations, and as more strangers opportunistically strive to take advantage of the fearful situation to exploit older adults for financial gain. Older adults with dementing illness are known to be of higher risk for abuse and neglect. With the shuttering of adult daycare programs, senior centers, and outpatient programs occurring concomitantly with adult children working from home, the possibility of unbuffered time together may contribute to circumstances leading to greater incidents of abuse.(citations omitted)
The authors offer suggestions to minimize the potential for instances of elder abuse in the time of COVID-19, which need to be
proactively addressed with organized, systematic, and creative efforts. Older adults within families and local communities can be contacted on a regular basis by those who are designated as advocates. Multiple communication methods can be leveraged for this purpose, ... Creativity in the development of resources to address specific vulnerabilities should be encouraged. …
Ways to address the potential threat of a trusted other range from increasing penalties for elder abuse at the societal level to the creation of an individualized safety plan that incorporates the wishes and preferences for autonomy and self-reliance of the older adult. Caregivers of older adults with dementia or other medical conditions … should be offered additional means of support and guidance. To combat rampant and increasing ageism, the perspective of older adults can be elevated by increasing representation on panels with significant decision-making power in public and private sectors during the pandemic. Those who have a substantial social media footprint can be of particular help combating ageist sentiments. Creative community-based resources that address any of these three intersecting domains of elder abuse must be rapidly developed and implemented. ….
May 14, 2020 in Cognitive Impairment, Consumer Information, Crimes, Current Affairs, Dementia/Alzheimer's, Elder Abuse/Guardianship/Conservatorship | Permalink | Comments (0)
Monday, May 11, 2020
Professor Nina Kohn's Important Op-Ed in the Washington Post
Syracuse Law Professor Nina Kohn (currently a visiting professor at Yale Law), has an important Op-Ed in the Washington Post, in which she tackles the not so subtle ageism that accompanies response to COVID-19 -- while making it clear that the issues are much deeper than a single disease. She writes:
Of course, older adults are at heightened risk, even though covid-19 strikes younger people, too. But across America — and beyond — we are losing our elders not only because they are especially susceptible. They're also dying because of a more entrenched epidemic: the devaluation of older lives. Ageism is evident in how we talk about victims from different generations, in the shameful conditions in many nursing homes and even — explicitly — in the formulas some states and health-care systems have developed for determining which desperately ill people get care if there's a shortage of medical resources.
For more, read The Pandemic Exposed a Painful Truth: American Doesn't Care About Hold People. The subtitle? "We speak of the elderly as expendable, then fail to protect them."
May 11, 2020 in Consumer Information, Current Affairs, Dementia/Alzheimer's, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Statistics | Permalink | Comments (0)
COVID-19 Resources for Guardians
With stay at home orders and LTC facilities prohibiting outside visitors, how do guardians discharge their duties? The National Guardianship Association (NGA), along with the ABA Commission on Law and Aging, and the National Center for State Courts have compiled a list of useful resources for guardians, available here, along with a list of FAQs for guardians about serving in the time of COVID-19. The FAQ list is available here. Here are the top points from this 11 page FAQ
Top Take-aways
• Access to My Clients or Loved One in Nursing Homes – While federal guidance restricts in person visits to residents in nursing homes, you have a responsibility to maintain contact and monitor well-being through remote access.
• Access to My Clients or Loved One in Residential Groups Settings and Hospitals -- State requirements may restrict in-person visits to residents in residential group settings, and federal guidance sets limits on visits to hospital patients, but you have a responsibility to maintain contact and monitor well-being through remote access.
• Access to Courts – Each state determines its own procedures during the pandemic. While many are placing a priority on keeping courts open for cases involving the protection of vulnerable individuals, hearings may be delayed or conducted remotely, and there may be changes in requirements for timelines, notices and the submission of reports.
• Protecting My Clients' or Loved One's Rights and Well-Being – The rights of your client or loved one have not changed, but the pandemic makes it more difficult to exercise certain rights. Take actions to ensure the person receives fair health care treatment, facilities follow safety protocols, and support the individual during this difficult time.
May 11, 2020 in Consumer Information, Current Affairs, Dementia/Alzheimer's, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (0)
Friday, April 24, 2020
Transparency Issues in Long-Term Care: The Potential for Misuse of Confidentiality Policies to Hide Infection Facts from the Public
Recently I was talking with a friend in another state who is the director of an assisted living facility that largely serves older adults who have significant risks factors. I asked, "Have you had any residents or staff members that have tested positive for COVID-19?" I asked her directly, because there was no way to know the answer to that question from public websites, either in her state or on a national basis. The good news was that her facility had had no such diagnoses, either among staff or residents. I also asked what she felt was key to avoiding infections, and we talked about the rates uncovered in other facilities in her own state. She said bluntly, "We learned from our experience with influenza the last two years that we had to make real changes, and we did so before the COVID-19 was a reality and doubled down when we started hearing about the coronavirus."
Internal infections have long-been a documented problem in residential care settings, and certainly not limited to so-called "nursing homes." Contributing factors include residents who may have physical or mental conditions that make self-protection difficult and perhaps impossible. My sister and I used to struggle mightily with a family member whose dementia interfered with the simple task of hand-washing -- even though this same person was the one who taught us the importance of soap and water from the time we were small children. It is perhaps ironic to recall that as a horse-mad girl I had tried to persuade both of my parents that there should be an exception for "barn dirt," on my theory that horse-related dirt was "clean dirt." My mothers still insisted I undress on the back porch and wash thoroughly before coming in for dinner. Wise woman, one who was quick to dismiss utter nonsense.
Fast forward decades and every day I hear new arguments regarding why facilities that have experienced life-threatening infections should not be required to report this in a public venue. The most problematic argument is one that says an individual's infection is confidential medical information that prevents the facility from reporting statistical information, and thus an infection cannot be made public. I've seen arguments about federal or state record-keeping policies such as HIPPA privacy rules or Pennsylvania's confidentiality rules as the rationalization. I think I know what my mother would call this kind of argument.
Syracuse Law Professor Nina Kohn tackles the history of mishandled safeguards against infections in long-term care with an Op-Ed for The Hill. In "Addressing the Crisis in Long-Term Care Facilities," Professor Kohn points to specific actions at the federal level that have weakened, rather than strengthened, potential safeguards. She makes five specific recommendations, including prohibitions on staff working in more than one-long-term care facility, to reduce cross-contamination, and the need for family members and others to make it clear that we "are paying attention to what is happening." She reminds us: "Those who are health care agents for nursing home residents should not be afraid to request access to medical records, as federal law entitles them to do, if facilities are not forthcoming with information about the care being provided."
April 24, 2020 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer's, Ethical Issues, Health Care/Long Term Care, Housing, Medicaid, Medicare, State Statutes/Regulations, Statistics | Permalink | Comments (0)
Monday, April 20, 2020
Journal of Elder Policy Calls for Papers related to COVID-19, Policy and Older Adults
Our friend Professor Naomi Cahn at George Washington Law has advised us that the peer-reviewed Journal of Elder Policy is planning a special issue related to COVID-19. Certainly the implications of policy in this pandemic are constantly in the news, and how appropriate to begin the process of analysis.
Abstracts of 500 words are due by June 15, 2020. Full papers of between 8,000 and 10,000 words are due by September 30, 2020.
Topics may include but are not limited to:
- Risk assessment, Ageism, Legislation to protect older adults,
- Community initiatives, Medical and nursing perspectives,
- Mental health challenges for elders, Family support or conflict,
- Helping and volunteering, Rationing of care, Challenges for caregivers
Authors should send their Vita and a 500 word abstract related to their paper by June 15 to Managing Assistant Editor, Kaitlyn Langendoerfer. Details available here.
The ever-busy Naomi is a member of the Editorial Board for the Journal. Thank you for letting us know about this opportunity, Naomi!
April 20, 2020 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer's, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Grant Deadlines/Awards, Health Care/Long Term Care, Programs/CLEs, Science, Statistics | Permalink | Comments (0)
Friday, April 17, 2020
How COVID-19 is Revealing a Transparency Dilemma in Long-Term Care
My students at Dickinson Law often suggest important law and aging issues to explore and certainly the COVID-19 crisis is a daily source of topics. High on the list in my students' minds have been the tragic stories connected to diagnosis and prognosis of the disease in "nursing homes." Sometimes it is hard to even keep up with the stories. Consider these headlines from the last few weeks:
- NYT on March 21, 2020: The Coronavirus's Rampage Through a Suburban Nursing Home (in Washington State)
- NBC News on April 1, 2020: Nursing Homes Overwhelmed by Coronavirus: 'It Is Impossible for Us to Stop the Spread" (focusing mostly on New York State)
- NYT on April 3, 2020: Coronavirus Sweeps Through a San Antonio Nursing Home (focusing on several facilities in Texas)
- Time on April 16, 2020: 18 Bodies Found Crammed Into Makeshift Morgue After Coronavirus Deaths Overwhelm New Jersey Nursing Home
When my sister and I first realized that the novel coronavirus was likely to have a devastating impact on anyone with a compromised immune system, we quietly and sadly acknowledged our minor relief that our parents, who had both experienced dementia in the final months before their deaths, were spared at least this particular situation. My sister went further and said, "If this had happened while Mom or Dad were still alive, I would have quit my job to apply for a job in their living center. I wouldn't have been able to live with being forced to stay away, in essence abandoning them."
Anyone who knows my sister would know that would have been her heartfelt plan. But it was also a reminder of something we knew so well from our experiences. Even the very best of care settings -- whether in the individual's home, in assisted living, in supported independent living (such as in a CCRC), or in a skilled nursing facility -- need a loved-one's involvement. On the one hand, the cared-for individual "lights up" when they see a family member arrive, even if the visit is just for a few minutes and even if the older person cannot quite remember the identity of the visitor. No activity-based care program can entirely reproduce that positive impact.
But even the best facility also benefits from having the eyes and ears of family members to observe and make appropriate reports about concerns. On my last sabbatical, I stayed in Arizona to be near both of my parents, in their 90s. Mom was still in the family home and Dad was in a truly caring, small, personal and well-staffed dementia care center. One day I arrived to find my father deeply upset. He said "I can't find my room." I was worried that this meant his cognition had taken another turn for the worse. But, when I offered to walk him from his favorite outdoor bench to his room, it turned out he was right. Everything that was once his -- his favorite chair, his clothes, his photographs -- were gone from his room. I found out they were on their way to a different cottage. More distressing, it was a cottage for individuals who no longer left their rooms -- and that wasn't my father's profile at all. Suffice it to say, that "move" was reversed.
That's a small example. But when a pandemic means that family members cannot visit at all -- the opportunities for confusion and short cuts can increase in any care setting. I don't know what the solution is; but I do know that the need for transparency in care, and for family members to feel welcome every day in every care setting, are important to quality of care. And, of course, to quality of life for everyone.
I'm hopeful that the COVID-19 pandemic will stimulate creativity and identify new ways of safely maintaining relationships for frail elders or others with delicate health profiles, while also still taking appropriate precautions to reduce the potential for high rates of cross-contamination and infection, including infections that cross the borders of the setting. On my father's last full day, before a nighttime stroke left him in a coma, he and I had lunch together, we walked in the sunshine, and he had his favorite ice cream for a snack. How I would hate to think of others missing such opportunities.
April 17, 2020 in Cognitive Impairment, Current Affairs, Dementia/Alzheimer's, Ethical Issues, Health Care/Long Term Care, Housing | Permalink | Comments (0)
Wednesday, March 25, 2020
The Challenges for the Newest Sandwich Generation
The interesting thing about the sandwich generation is that your position changes over time. Boomers at one time were the "filling" and now are one of the slices of the bread. What about the family caregivers for the boomers? They're now the filling. And they face their challenges. This Washington Post article, published before the sweep of the Corona virus changed the conversation, predicts greater challenges for them. The 'sandwich generation' quandary was hard on baby boomers. It's going to be harder on their kids acknowledges how individuals age into their placement within the sandwich generation:
The boundaries of this cohort are blurry and perpetually shifting; when the term was first coined by social worker Dorothy Miller in 1981, she referred specifically to 30- or 40-something women — baby boomers or members of the Silent Generation — who were caregivers for both children and aging parents. Now, 40- and 50-something Gen Xers make up the heart of the sandwich generation (which includes men and women), but the baton will pass again soon: The oldest millennials turn 40 next year, notes Kim Parker, director of social trends research with the Pew Research Center.And because millennials have waited longer to have children than prior generations, they are even more likely than their predecessors to find themselves balancing care for even younger children and aging parents....
There has always been the cycle of growing children and aging grandparents, and the stresses that can result from caring for either or both. But as more parents trend toward starting their families later, the widening distance between the generations — child, parent, grandparent — is changing the nature of the dynamic among all three.
March 25, 2020 in Consumer Information, Current Affairs, Dementia/Alzheimer's, Grant Deadlines/Awards, Health Care/Long Term Care | Permalink | Comments (0)
Monday, March 16, 2020
Social Distancing = Social Isolation = Social Recession?
We are all too aware of the pandemic and now we need to recognize that the impact can be beyond whether someone tests positive for the virus. VOX ran this timely article, Coronavirus will also cause a loneliness epidemic: "[t]he rapid implementation of social distancing is necessary to flatten the coronavirus curve and prevent the current pandemic from worsening. But just as the coronavirus fallout threatens to cause an economic recession, it's also going to cause what we might call a "social recession": a collapse in social contact that is particularly hard on the populations most vulnerable to isolation and loneliness — older adults and people with disabilities or preexisting health conditions." Referring to the impact as "social damage." the article discusses the potential for harm to certain vulnerable groups (think elders) as we practice this isolation from one another.
"Social isolation has been associated with a significantly increased risk of premature mortality from all causes," the report found, including a "50 percent increased risk of developing dementia," a "29 percent increased risk of incident coronary heart disease," a "25 percent increased risk for cancer mortality," a "59 percent increased risk of functional decline," and a "32 percent increased risk of stroke." The mental health risks are also profound. The researchers reviewed dozens of studies and found a consistent relationship between social isolation and depression, anxiety, and suicidal ideation.
Expect a decline in one's social health, the article warns. It offers some suggestions, such as where possible, going for a walk outside or having a picnic rather than dinner in a crowded restaurant, increase virtual communications, in particular phone calls or even better, video chats. Of course, it's possible, the article notes, that those most vulnerable may not have access to or the ability to video chats.
So while you're self-quarantined, use the time to make calls to those who you would otherwise visit. Consider how else you might reach out to those elders, to help mitigate the social recession.
March 16, 2020 in Consumer Information, Current Affairs, Dementia/Alzheimer's, Health Care/Long Term Care | Permalink | Comments (0)
Tuesday, March 10, 2020
ACTEC Journal Call for Papers
ACTEC (American College of Trusts & Estate Counsel) is devoting a volume of its Journal to Elder Law! Here's the info about the call for papers.
The American College of Trust and Estate Counsel announces a Call For Papers on the following topic:
With an aging generation of Boomers and increasing estate tax exemptions, the practice and study of trusts and estates may be driven less by tax planning and more by a host of other issues confronting an older population. Those issues may be broadly grouped under the term "Elder Law."
A special issue of the ACTEC Law Journal will be devoted to a discussion of the intersection of Trusts and Estates and Elder Law and will be comprised of brief articles (2,000 word maximum). The conception of Elder Law is broad and intended to encompass all matters of legal concern that a trusts and estates lawyer might address for an aging client – or a client who is concerned about aging. Suggested topics include retirement planning, financial planning and wealth management, guardianship, disability and medical care, end-of-life planning, incapacity, powers of attorney, health care proxies, nursing homes and long-term care planning, special needs trusts, Medicare, Medicaid, Social Security, elder abuse (physical or financial), age discrimination, family succession planning, grandparent visitation rights, and classic core trusts and estates topics like wills, trusts, intestacy, probate administration, and nonprobate transfers.
Procedure for proposals: Authors wishing to contribute to this special volume should send a brief proposal to Professor Alyssa A. DiRusso, Editor, ACTEC Law Journal, at email@example.com. Please include "ACTEC Elder Law" in the subject line of your e-mail.
Proposals are due by April 1, 2020. Early submissions are encouraged as proposals will be reviewed on a rolling basis. Given the brevity of each article, articles that delve into one or two topics in detail will normally be preferred over more general articles. We encourage submissions by authors from a variety of backgrounds, including those actively involved in fiduciary administration or the practice of law.
Final articles will be due by August 1, 2020 and will be published in the ACTEC Law Journal, Volume 46 Issue 1.
March 10, 2020 in Consumer Information, Current Affairs, Dementia/Alzheimer's, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare, Other, Social Security | Permalink | Comments (0)
Tuesday, March 3, 2020
Worried You Will End Up With Dementia? You Aren't Alone.
A couple of weeks back, the New York Times ran a story that I suspect rings true for many of us. Stalked by the Fear That Dementia Is Stalking You discusses the reaction many of us have when we forget something-whether a name or the location of our keys.
"Many people ... who've watched this cruel illness destroy a family member, dread the prospect that they, too, might become demented. The lack of a cure or effective treatments only adds to the anxiety. It seems a common refrain, the news that another treatment to stop Alzheimer's has failed." The article discusses the tests that screen for the disease and the wisdom of getting tested when someone from your family had the disease. After discussing the various testing methods, the article reviews recommendations from the experts. "Several experts recommend that people concerned about their Alzheimer's risk get a baseline set of neuropsychological tests, followed by repeat tests if and when they start experiencing worrisome symptoms." Others suggest "physical inactivity, hearing loss, depression, obesity, hypertension, smoking, social isolation, diabetes and low education levels raise the risk of dementia. All of these factors are modifiable."
When there is no cure (yet) would you rather know, or not?
March 3, 2020 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer's, Health Care/Long Term Care | Permalink | Comments (0)
Tuesday, February 18, 2020
Sneakers for Mom---With GPS Tracker
One of my students sent me the recent article about sneaker insoles with built-in GPS. I always talk to my students about the various technologies, including tracking devises, and ask them to think about autonomy, privacy, consent, and product reliability. Shoe with GPS insole lets you track loved ones with Alzheimer's or dementia explains how the device works, the info provided and the real-time data provided (in this case, the article notes the product updates the data every 5-10 minutes). One customer was quoted along the lines that the use of the product allows her mom to wander, but that the daughter can catch up to mom, before harm befalls mom. I was thinking about this.... it still allows mom to be mobile but I still would like to think more about privacy, data security, consent and more. This, of course, is not the only type of tracking device available to families who have elders who may wander. I've not had any experience with them, but on its face sounds like it may allow the elder to stay at home or have some freedom. (but what can happen before the location is updated or the family even checks for an updated location). Anyone have experiences with any tracking devices for elders who wander?
February 18, 2020 in Consumer Information, Current Affairs, Dementia/Alzheimer's, Web/Tech | Permalink | Comments (0)
Thursday, January 30, 2020
Hot Off the Press: 2019 Updates on Guardianship Legislation
The American Bar Association Commission on Law and Aging has released their annual update on guardianship legislation, State Adult Guardianship Legislation Summary: Directions of Reform–2019 .
Here's the introduction of the Summary:
This 2019legislative summary reviews approximately 58enactmentsfrom 33states,as compared with 29 enactments from 18 states in 2018. An earlier version of this 2018 legislative summary [January –August] was published as part of the National Guardianship Association's 2019 NGA Legal and Legislative Review, presented at the 2019 NGA National Conference. States were active on a variety of fronts, enacting a variety of significant changes to guardianship laws.Washington became the second state, after Maine in 2018, to adopt the Uniform Guardianship, Conservatorship, and other Protective Arrangements Act (UGCOPAA). Without adopting UGCOPAA in its entirety, Nevada and New Mexico enacted certain provisions of the model law.Iowa and Mississippi also included sections from UGCOPAA in sweeping statutory reforms.To rebuild its probate code, the Virgin Islands adopted five uniform laws –Nonprobate Transfer on Death, Real Property Transfer on Death, Disclaimer of Property Interest, Custodial Trust, and Partition of Heirs.Texas and New Mexico established new programs to address guardianship abuse. Texas founded a guardianship abuse, fraud, and exploitation detection program to review guardianships and identify issues, work with courts to develop best practices, and report concerns of potential abuse, fraud, or exploitation. New Mexico created a grievance procedure, which includes mandatory court review, for complaints against guardians and conservators. Indiana, North Dakota, Nevada, and Rhode Island recognized supported decision-making agreements, bringing the total to nine states that have made these agreements legally enforceable since 2015. The acts are not uniform;provisions such as governing who may serve as a supporter, the scope of the supporter's duties, and indemnification of third parties vary among the state statutes. Since 2011, states have enacted a total of approximately 328 adult guardianship bills–ranging from a complete revamp of code provisions to minor changes in procedure. Most of these statutory changes have advanced guardianship reform by safeguarding rights, addressing abuse, and promoting less restrictive options. The real challenge lies in turning good law into good practice.
The prior summaries, dating back to 2013, can be accessed here.
January 30, 2020 in Consumer Information, Current Affairs, Dementia/Alzheimer's, Elder Abuse/Guardianship/Conservatorship, State Statutes/Regulations | Permalink | Comments (0)
Wednesday, January 29, 2020
Hot Off the Press: 2019 Updates on Guardianship Legislation
The American Bar Association Commission on Law and Aging has released their annual update on guardianship legislation, State Adult Guardianship Legislation Summary: Directions of Reform–2019 .
Here's the introduction of the Summary:
This 2019legislative summary reviews approximately 58enactmentsfrom 33states,as compared with 29 enactments from 18 states in 2018. An earlier version of this 2018 legislative summary [January –August] was published as part of the National Guardianship Association's 2019 NGA Legal and Legislative Review, presented at the 2019 NGA National Conference. States were active on a variety of fronts, enacting a variety of significant changes to guardianship laws.Washington became the second state, after Maine in 2018, to adopt the Uniform Guardianship, Conservatorship, and other Protective Arrangements Act (UGCOPAA). Without adopting UGCOPAA in its entirety, Nevada and New Mexico enacted certain provisions of the model law.Iowa and Mississippi also included sections from UGCOPAA in sweeping statutory reforms.To rebuild its probate code, the Virgin Islands adopted five uniform laws –Nonprobate Transfer on Death, Real Property Transfer on Death, Disclaimer of Property Interest, Custodial Trust, and Partition of Heirs.Texas and New Mexico established new programs to address guardianship abuse. Texas founded a guardianship abuse, fraud, and exploitation detection program to review guardianships and identify issues, work with courts to develop best practices, and report concerns of potential abuse, fraud, or exploitation. New Mexico created a grievance procedure, which includes mandatory court review, for complaints against guardians and conservators. Indiana, North Dakota, Nevada, and Rhode Island recognized supported decision-making agreements, bringing the total to nine states that have made these agreements legally enforceable since 2015. The acts are not uniform;provisions such as governing who may serve as a supporter, the scope of the supporter's duties, and indemnification of third parties vary among the state statutes. Since 2011, states have enacted a total of approximately 328 adult guardianship bills–ranging from a complete revamp of code provisions to minor changes in procedure. Most of these statutory changes have advanced guardianship reform by safeguarding rights, addressing abuse, and promoting less restrictive options. The real challenge lies in turning good law into good practice.
The prior summaries, dating back to 2013, can be accessed here.
January 29, 2020 in Consumer Information, Current Affairs, Dementia/Alzheimer's, Elder Abuse/Guardianship/Conservatorship, State Statutes/Regulations | Permalink | Comments (0)
Thursday, January 16, 2020
Forgetfulness is Not Just for the Old
I always talk with my students about memory loss and what it might signal--but always when we talk about memory loss, or for them, forgetfulness, every one of them has experienced an episode of forgetfulness, whether misplacing their phones or losing their keys. I was pleased to read a recent editorial in the New York Times by neuroscientist, Everyone Is Wrong.
Short-term memory contains the contents of your thoughts right now, including what you intend to do in the next few seconds. It's doing some mental arithmetic, thinking about what you'll say next in a conversation or walking to the hall closet with the intention of getting a pair of gloves.
Short-term memory is easily disturbed or disrupted. It depends on your actively paying attention to the items that are in the "next thing to do" file in your mind. You do this by thinking about them, perhaps repeating them over and over again ("I'm going to the closet to get gloves"). But any distraction — a new thought, someone asking you a question, the telephone ringing — can disrupt short-term memory. Our ability to automatically restore the contents of the short-term memory declines slightly with every decade after 30.
Given that everyone has forgetfulness, the author's next point is important:
The relevant difference is not age but rather how we describe these events, the stories we tell ourselves about them. Twenty-year-olds don't think, "Oh dear, this must be early-onset Alzheimer's." They think, "I've got a lot on my plate right now" or "I really need to get more than four hours of sleep." The 70-year-old observes these same events and worries about her brain health. This is not to say that Alzheimer's- and dementia-related memory impairments are fiction — they are very real — but every lapse of short-term memory doesn't necessarily indicate a biological disorder.
So, why might we focus on this with elders? The author suggests elders have more memories to get through-it's going to take more time to remember a specific and generally it may take older folks a bit longer to remember things.
This is a very interesting article that I plan to reference when I'm discussing issues regarding memory loss and dementia with my students.
January 16, 2020 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer's, Other | Permalink | Comments (0)
Thursday, December 12, 2019
Are Physicians and Attorneys Speaking the Same Language When Talking About Competency or Capacity?
One of the most frequent search phrases that brings internet users to our Elder Law Prof Blog is the phrase "competency vs. capacity." The search leads readers to a post from 2006 that summarizes an article written by two experienced psychiatrists, Phillip J. Resnick and Renee Sorrentino, originally published in December 2005 in Psychiatric Times. The article -- and often our blog post -- is frequently quoted or cited for the following passage:
This [clinical] consultation request reflects a common misconception regarding the issue of competence. Competence is a legal state, not a medical one. Competence refers to the degree of mental soundness necessary to make decisions about a specific issue or to carry out a specific act. All adults are presume to be competent unless adjudicated otherwise by a court. Incompetence is defined by one's functional deficits (e.g., due to mental illness, mental retardation or other mental condition), which are judged to be sufficiently great that the person cannot meet the demands of a specific decision-making situation, weighed in light of its potential consequences. . . . Only a court can make a determination of incompetence.
In contrast, psychiatric consultants can and should opine about a patient's capacity to make an informed decision or judgment. Capacity is defined as an individual's ability to make an informed decision. Any licensed physician may make a determination about capacity. Forensic psychiatrists, however, are especially suited to assess a person's mental status and its potential for interfering with specific areas of functioning. An individual who lacks capacity to make an informed decision or give consent may need to be referred for a competency hearing or need to have a guardian appointed. The psychiatric consultation results in an opinion regarding whether such actions are indicated.
Moreover, competence is issue specific. Some physicians who misconstrue competence to be a global, black or white issue will ask psychiatric consultants for a broad consultation on whether the patient is competent or not. The response of the psychiatric consultant should be, "Competent for what?"
An additional challenge, however, is that in the years since that particular article was written, there has been a strong movement in law to dispense almost entirely with the "incompetent" label for legal purposes, especially when we are talking about the individual's ability to make informed decisions, whether for health care or other matters in life. The incompetent label is viewed as unnecessarily and inappropriately stigmatizing. The legal trend is to focus on capacity evaluations. This trend also rejects global incompetency labels, and is often tied to an evaluation of function for specific tasks. Perhaps the two professions are moving in the same direction when concerns are identified about cognition, focusing on an evaluation of the individual's "capacity for what?"
Earlier this week, I was part of a fascinating discussion with a panel that included Dr. Samuel Hammerman, who wears many professional hats including that of a practicing pulmonary and critical care physician; Dr. Charles J. Duffy, a professor of neurology with deep professional interest in dementia; and Rabbi Ron Muroff, who set exactly the right tone for compassionate discussion. Okay -- we all admitted our introduction sounded like the start of a joke about walking into a bar.....
We took up this topic of "capacity" or "competence" in response to two cases drawn from real life, where patients with serious physical health concerns also have compromised cognition and are rejecting admission or treatment at a hospital. Our audience, members of the Cardozo Society (lawyers) and the Maimonides Society (health care professionals) of the Jewish Federation of Greater Harrisburg, were very engaged and of enormous help in the discussion. I walked out of the room energized and ready to get back to a long-planned article updating this topic (as soon as I find that elusive commodity, time!).
December 12, 2019 in Cognitive Impairment, Current Affairs, Dementia/Alzheimer's, Health Care/Long Term Care, State Cases | Permalink | Comments (1)
Wednesday, December 11, 2019
Blood Test for Alzheimer's?
Professor Naomi Cahn, the incoming chair of the AALS section on Aging & Law, sent me this recent article, The Hunt for a Blood Test for Alzheimer's Disease wherein "[r]esearchers hope circulating biomarkers will enable earlier detection and better monitoring of the neurodegenerative disorder—and perhaps help usher in new treatments." The article identifies updates in research and summarizes some blood tests being tried to help with diagnosis.
A number of questions and issues remain to be resolved before many of the biomarkers found in the blood are ready for use in trials, much less for clinical care... [with] [o]ne issue that researchers must account for is individual variability.... "People are so different [and] there's a lot of things we still don't know how to even control for in terms of statistical analyses." Age and APOE4 carrier status, for example, can change the levels of some AD biomarkers independently of whether an individual has the disease.
The story also notes the existence of technical challenges and challenges of consistency. So far scientists haven't found the definitive diagnosis, nor the cure, but they are surely working hard to do so.
December 11, 2019 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer's, Science | Permalink | Comments (0)
Tuesday, December 3, 2019
Stories About Alzheimer's
Two recent stories about Alzheimer's caught my eye, and I wanted to share them with you here. The day after Thanksgiving, the Today Show ran a story, Caregiver for Alzheimer's Patient Shares Family's Struggles. The caregiver wife tells the story of their lives and the financial impact when her husband, a lawyer, was diagnosed at age 61 with early onset Alzheimer's. The summary describes the story, "Millions of Americans selflessly care for loved ones with Alzheimer's disease and one family is opening up about their struggles on TODAY. Many people are calling for a nationwide program for caregivers, reports special anchor Maria Shriver." Senator Amy Klobuchar appears in the story, as her dad has Alzheimer's. The story mentions pending bills in Congress, including the Alzheimer's Caregivers Support Act. The link to the 3:22 minute video is available here.
The second story, an opinion piece in the New York Times, The Unending Indignities of Alzheimer's aired December 1, 2020. It highlights the obstacles family members face in trying to find the necessary care for the individual with Alzheimer's....
But while his family, and his physician, agree on the need for more advanced care, his health insurers do not. Medicare does not generally cover long-term nursing home care. Medicaid does, but only when it deems those services "medically necessary" — and that determination is made by insurance agents, not by the patient's doctors. The state of New Jersey, where my parents live, recently switched to a managed care system for its elderly Medicaid recipients. Instead of paying directly for the care that this patient population needs, the state pays a fixed per-person amount to a string of private companies, who in turn manage the needs of patients like my father. On paper, these companies cover the full range of required offerings: nursing homes, assisted-living facilities and a suite of in-home support services. In practice, they do what most insurance companies seem to do: obfuscate and evade and force you to beg.
The author writes how the family is piecing together the care the best they can. She writes "[t]he real problem is not my father's level of functionality; it's the lack of available Medicaid beds and the absurdly high cost of any meaningful alternative. For example, there's a lovely assisted-living facility just two miles from my parents' apartment. But it costs $8,000 a month, on average, and does not accept my father's insurance."
BTW, know someone who is a caregiver? Even though National Caregivers' Month (November) is behind us, thank a caregiver.
December 3, 2019 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer's, Health Care/Long Term Care, Medicaid, Medicare | Permalink | Comments (0)
Friday, November 15, 2019
Two Recent Articles About Dementia
Two articles in the news are worth mentioning, in case you missed them. First, the New York Times ran an article, Why Didn't She Get Alzheimer's? The Answer Could Hold a Key to Fighting the Disease. "Researchers have found a woman with a rare genetic mutation that has protected her from dementia even though her brain has developed major neurological features of the disease." The article highlights a recently published study "in the journal Nature Medicine, [in which] researchers say the woman, whose name they withheld to protect her privacy, has another mutation that has protected her from dementia even though her brain has developed a major neurological feature of Alzheimer's disease." The article reminds us to not expect instant therapies-this is going to take time, but even so, it's still very positive news. "[T]his case comes at a time when the Alzheimer's field is craving new approaches after billions of dollars have been spent on developing and testing treatments and some 200 drug trials have failed. It has been more than 15 years since the last treatment for dementia was approved, and the few drugs available do not work very well for very long."
Thanks to Professor Naomi Cahn for alerting me to this article.
The second article I wanted to mention also appeared recently in the New York Times. The Loneliness of Frontotemporal Dementiaoffers this description of the disease:
Frontotemporal dementia attacks people in their fifth or sixth decade, just as retirement comes within reach. Doctors believe the disease affects 60,000 people in the United States alone. Neurons in the front and side of the brain wilt, and along with them, images of peacefully growing old fade. Judgment and complex planning yields to chaotic disorganization. Inhibitions give way to impulsivity and hypersexuality, so that longtime faithful partners look to affairs and excessive pornography. Empathy turns to apathy. Obsessions and compulsions erupt. Language can become laborious; the meaning of words and objects can be lost, and fluent speech can dissolve into fragments of sentences with nonsensical grammar. Jarringly, memory remains largely untouched. Since brain areas that dictate personality are often the first to suffer, most people end up on a therapist's couch long before finding their way to a neurologist.
The article examines the importance of support groups and how some individuals present with the disease. There are some trials underway; "'[b]ecause frontotemporal dementia is often familial, we can get people into a trial before they have symptoms,' [according to one expert] 'By sequencing genes from a blood sample, we know which family members are probably going to get the disease. If we can slow down progression in those people, it's virtually a cure.'"
November 15, 2019 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer's, Health Care/Long Term Care, Other, Science | Permalink | Comments (0)
Friday, November 8, 2019
New Resources on Elder Abuse
Maybe it's just me, but there seems to be a lot of items in the news of late about elder abuse. Here are some new tools to add to your toolbox in the fight against elder abuse. The National Center on Elder Abuse (NCEA) and National Asian Pacific Center on Aging (NAPCA) have released 3 new fact sheets:
- Six Ways to Care for Yourself When Caring for Someone with Dementia
- NAPCA: Emotional Abuse and
- NAPCA: Neglect
All of the fact sheets are available in several languages and are added to an extensive library of fact sheets.
November 8, 2019 in Consumer Information, Crimes, Current Affairs, Dementia/Alzheimer's, Elder Abuse/Guardianship/Conservatorship | Permalink | Comments (0)


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Visayan Electric aids 16 partner schools
VISAYAN Electric recently donated printers and reams of bond papers to its 16 partner schools in Cebu to augment their supplies for this school year's blended learning requirements.
"Even though the budget is limited because of the pandemic, Visayan Electric still sees the need to help our partner schools in meeting the challenges brought about by the new method of teaching and learning this school year. We hope that the 16 schools that we chose will be able to put these items to good use," said Raul Lucero, president and chief operating officer of Visayan Electric.
The schools that received the donations were Sta. Cruz Elementary School and Calero Integrated School in Liloan; Tugbongan Elementary School and Jugan Elementary School in Consolacion; Mandaue City School for the Arts and Banilad Elementary School in Mandaue City; Luz Elementary School and Guadalupe Elementary School in Cebu City; Vicenta Manreal Elementary School and Pooc National High School in Talisay City; Vito Elementary School and Calajoan Elementary School in Minglanilla; Balirong Elementary School and Tuyan Elementary School in Naga City; and Sangat Elementary School and Pitalo Elementary School in San Fernando.
Pooc National High School Principal Clote Bayarcal thanked the electric distribution utility for the timely gift.
"We really appreciate this. Your assistance came at a time when we need more supplies to produce the modules that our students need. Thank you!" she said.
Visayan Electric, the second largest electric utility in the country, serves the cities of Cebu, Mandaue, Talisay and Naga and the municipalities of Liloan, Consolacion, Minglanilla and San Fernando.
The company's non-energy community outreach programs are key in promoting education, environment and community development within its franchise area and are geared toward guiding the youth, the future movers of the nation.


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Recent archaeological excavations on Rakahanga Atoll, Northern Cook Islands, produced one of the earliest examples of dog (Canis familiaris) remains found on East Polynesian atolls. Direct dating of these and other Pacific Island fauna by AMS is complicated by a number of factors. (1) The animals' diets may consist of marine and terrestrial protein. (2) Marine 14C is itself a mix of carbon pools with localized offsets that vary over time and space. (3) The region is potentially impacted by inter-hemispheric mixing of atmospheric 14C. Stable isotope analysis of gelatin extracted from dog teeth was used to estimate marine/terrestrial dietary components and paired terrestrial and marine samples were used to constrain local atmospheric and marine carbon offsets. The dates were modeled as a phase in a Bayesian chronological framework using mixed calibration curves. The resulting models confirm the presence of dogs on Rakahanga shortly after the initial colonization of the region and suggest that dogs were among the species that accompanied voyagers as they discovered and settled new islands. These methods can be applied to accurately date any marine-influenced terrestrial vertebrate remains in Remote Oceania.
Radiocarbon dating is rarely used in historical or contact-era North American archaeology because of idiosyncrasies of the calibration curve that result in ambiguous calendar dates for this period. We explore the potential and requirements for radiocarbon dating and Bayesian analysis to create a time frame for early contact-era sites in northeast North America independent of the assumptions and approximations involved in temporal constructs based on trade goods and other archaeological correlates. To illustrate, we use Bayesian chronological modeling to analyze radiocarbon dates on short-lived samples and a post from four Huron-Wendat Arendarhonon sites (Benson, Sopher, Ball, and Warminster) to establish an independent chronology. We find that Warminster was likely occupied in 1615–1616, and so is the most likely candidate for the site of Cahiagué visited by Samuel de Champlain in 1615–1616, versus the other main suggested alternative, Ball, which dates earlier, as do the Sopher and Benson sites. In fact, the Benson site seems likely to date ~50 years earlier than currently thought. We present the methods employed to arrive at these new, independent age estimates and argue that absolute redating of historic-era sites is necessary to accurately assess existing interpretations based on relative dating and associated regional narratives.
In coastal and island archaeology, carbonate mollusk shells are often among the most abundant materials available for radiocarbon (14C) dating. The marsh periwinkle (Littorina irrorata) is one of these such species, ubiquitously found along the Atlantic and Gulf coasts of the United States in both modern and archaeological contexts. This paper presents a novel approach to dating estuarine mollusks where rather than attempting to characterize the size and variability of reservoir effects to "correct" shell carbonate dates, we describe a compound-specific approach that isolates conchiolin, the organic matter bound with the shell matrix of the L. irrorata. Conchiolin typically constitutes <5% of shell weight. In L. irrorata, it is derived from the snail's terrestrial diet and is thus not strongly influenced by marine, hardwater, or other carbon reservoir effects. We compare the carbon isotopes (δ13C and Δ14C) of L. irrorata shell carbonate, conchiolin, and bulk soft tissue from six modern, live-collected specimens from Apalachicola Bay, Florida, with samples that represent possible sources of carbon within their environment including surface sediments, marsh plant tissues, and dissolved inorganic carbon (DIC) in water. Ultimately, this paper demonstrates that samples obtained from wet chemical oxidation of L. irrorata conchiolin produces accurate 14C dates.
In southwestern Florida, USA, terraformed landscapes built almost entirely of oyster shells (Crassostrea virginica) reflect a unique pre-Columbian tradition of shell-built architecture. The ability to reliably date oyster shells is essential to identifying spatial, temporal, and functional relationships among shellworks sites, yet to date there has been no systematic attempt to quantify or correct for carbon reservoir effects in this region. Here we present 14 radiocarbon (14C) ages for 5 known-age, pre-bomb oyster shells collected between AD 1932–1948, as well as 6 14C ages for archaeological oyster/charcoal pairs from the Turner River Mound Complex, Everglades National Park. We report our current best estimate of ΔR = 92 ± 74 yr for Greater Southwest Florida, and ΔR = –15 ± 42 yr for the Turner River archaeological site. Future research should focus on paired archaeological specimens to obtain spatially and temporally relevant estimates of ΔR.
Biogeochemical analyses of eastern oysters (Crassostrea virginica) are frequently included in environmental monitoring and paleoecological studies because their shells and soft tissues record environmental and dietary signals. Carbon isotopes in the mineral phase of the shell are derived from ambient bicarbonate and dissolved inorganic carbon (DIC), while organic carbon present in soft tissue is of dietary origin. Mineral-bound organic matter within the carbonate shell matrix ("conchiolin") is studied less frequently. The purpose of this study was to compare carbon isotope composition (δ13C and Δ14C) of conchiolin to those of shell carbonates and soft tissues in eastern oysters and assess the extent to which conchiolin can provide insight into paleoecological records. Eleven oyster specimens were live-collected from Apalachicola Bay, USA, as well as a set of environmental samples (water, sediment, and terrestrial plants). Overall, the δ13C values in all studied oyster tissue types record environmental signals related to carbon sources, with conchiolin being enriched in 13C by an average of 2.3‰ relative to bulk soft tissues. Δ14C values in oyster shell carbonates generally reflect the marine versus riverine source of DIC, while conchiolin Δ14C values are impacted by variable relative contributions of young and old organic matter. Environmental samples indicate a significantly large difference in Δ14C among sources, from –127‰ in particulate organic matter to approximately +15‰ in DIC. Conchiolin is significantly depleted in 14C relative to other tissue types, by as much as 56.6‰, posing a major obstacle to the use of conchiolin as an alternative material for radiocarbon dating.
Archaeological investigations of the age and origins of marine shell beads are important for understanding the emergence and maintenance of long-distance trade networks in prehistory. In this paper we expand upon and re-examine the incremental carbon (14C and δ13C) and oxygen (δ18O) isotope data from two Olivella biplicata shell beads from the LSP-1 Rockshelter, Oregon, USA, to address two common problems in dating marine shell trade goods: (1) the source region is large, adding to uncertainty regarding the appropriate specification of ΔR; and (2) the 14C activity within individual specimens is variable. Although this combination of factors severely limits the dating precision that is possible, we recommend a sampling and calibration approach that accounts for these added sources of uncertainty and minimizes the loss of precision. We recommend (1) sequential sampling in order to quantify the range of variability in 14C within shells; (2) a Bayesian calibration procedure that models the 14C dates as an ontogenetic sequence, in this case constrained by stable isotope sclerochronology; and (3) specifying ΔR in a manner that accounts for the full range of possible reservoir offsets in the source region.
Over the past 30 years, the number of US doctoral anthropology graduates has increased by about 70%, but there has not been a corresponding increase in the availability of new faculty positions. Consequently, doctoral degree-holding archaeologists face more competition than ever before when applying for faculty positions. Here we examine where US and Canadian anthropological archaeology faculty originate and where they ultimately end up teaching. Using data derived from the 2014–2015 AnthroGuide, we rank doctoral programs whose graduates in archaeology have been most successful in the academic job market; identify long-term and ongoing trends in doctoral programs; and discuss gender division in academic archaeology in the US and Canada. We conclude that success in obtaining a faculty position upon graduation is predicated in large part on where one attends graduate school.
Eastern oyster (Crassostrea virginica) is an ubiquitous estuarine shellfish taxon in eastern North America and one of the most abundant materials available for radiocarbon (14C) dating. We examine spatiotemporal variability in carbon reservoir effects among pre-bomb oysters from Apalachicola Bay, USA, a river-influenced estuary on the northern Gulf of Mexico. Shells were sampled at multiple points along the valve to produce time-series records of 14C variation during the lives of the mollusks. Conventional ages within shells differed by as little as 36 14C yr to as much as 295 14C yr. Reservoir offsets varied sub-regionally within the estuary, increasing from 92±37 yr in the eastern edge of study region to 227±110 yr in the west, reflecting the influence of 14C-depleted dissolved inorganic carbon from the Apalachicola River. Dynamic carbon reservoirs can pose problems for the estimation of ΔR and for building coastal chronologies. Estimating sub-regional ΔR values can be useful for assessing the range of variability in reservoir offsets within an estuary, and for correcting sample ages if the shell origin is known. Greater variability and/or uncertainty in ΔR lead to greater uncertainty in the calibrated age.
Strombus alatus and Busycon sinistrum are large marine gastropods that are frequently recovered from archaeological contexts in southeastern North America. We previously proposed a reservoir age offset (ΔR) for B. sinistrum from the northern Gulf of Mexico region based on known-age pre-bomb 20th-century specimens. We also reported significant variability in radiocarbon both among and within S. alatus specimens, which precluded a reliable estimation of ΔR for this taxon. In this paper, we present a complementary data set from archaeological contexts to re-evaluate marine reservoir effects in the northern Gulf Coast region at multiple spatial and temporal scales. The new data set consists of a total of 13 14C age determinations from well-associated marine (B. sinistrum and S. alatus) and terrestrial (Odocoileus virginianus) samples from a closed context at the Bayou St. John (1BA21) archaeological site. We suggest a slightly updated ∆R value of –2±53 14C yr for late Holocene-age B. sinistrum from the northern Gulf Coast region. S. alatus, and possibly other species of strombid conchs, are poor candidates for 14C dating due to the highly variable 14C content observed within and among specimens. Though subregional variability in inputs of 14C-depleted waters is likely, life-history factors related to ontogenetic niche and/or habitat shifts appear to be a major influence in shell 14C for S. alatus.
This article presents radiocarbon data for known-age, pre-bomb marine gastropods, Busycon sinistrum and Strombus alatus, collected between AD 1924 and 1946 from nearshore environments of the Florida Panhandle, on the northern Gulf of Mexico. Δ14C was measured in whole crushed juvenile specimens (n = 7) and terminal edges of adult specimens (n = 6). A subsample of adult specimens (n = 3) was subjected to additional, intrashell sampling to observe short-term variability in 14C conditions. Δ14C values were consistent within and among B. sinistrum specimens, and we propose a reservoir age offset (ΔR) of −9 ± 25 14C yr for B. sinistrum from the northwest coast of Florida. S. alatus shells exhibited significant variability from one individual to another, and also within individual specimens. ΔR values for S. alatus range from −3 ± 30 to 659 ± 30 14C yr. These differences may result from a combination of factors, including subregional variability in inputs of 14C-depleted waters and life-history factors including mobility, mode of feeding, and ontogenetic niche shifts.
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He Hit Me & It Felt Like A Kiss
From the Memoirs of C. Phoenix
That night nov 18, 2017, I was sleeping when "Mr. Walking Hard On" needed to get laid. I must've not been cooperative as balled fists filled with who knows what emotion came flying at my face as a my wake up call.
I'm awake now.
I hear him.
"Go fuck him. Give him your pussy." The only thing I hear as his fists land one after the other on my face.
I don't know what the fuck he's talking about. I don't know what the fuck is going on. I grunt loudly and dramatically from the pain. My arms eventually went up in front of my face to block the blows, unfortunately too late.
He kept landing them.
He stopped.
I get up, grab the keys and go to the car. My face hurts. I get in and I'm hit with a chill because it's fucking cold outside at 3 in the morning in November. On some level he was confident enough in knowing that I wouldn't leave. He was right.
I grab a black & mild from the ash tray. I pull down the passenger side visor and open the mirror. The light turns on. My right eye is already swollen shut and the surrounding skin has split right underneath it from the instant swelling.
Sobbed and smoked.
Sobbed and smoked.
I go back inside and turn on the bedroom light. He's looking right at me.
"Look at what you did. What the fuck is wrong with you? Look at my face!! What am I going to do now? I can't go to work like this!"
He stares at me with a blank look on his face. He's not the least bit worried. It's Wednesday morning and his court ordered domestic violence class is every Wednesday night for a year. This is his third class. He stares at me.
He motions for me to come lay next to him.
I crawl in bed into his arms.
" What the fuck am I going to do now, I don't want to lose you." quickly he replied "What do you mean?"
Me,- "As soon as someone sees this, your going to jail!"
He stares at me. We fall asleep.
7:00am and I wake up, I go to the bathroom and take a picture and send it to my bosses. " Last night my boyfriends ex wife attacked me with a rock. We called the police and she's in jail. I'm going to the hospital to be examined then to court to file an injunction against harassment. If I make it out of court in time, I will come in. I'll keep you informed. Immediately the replies started coming in, with condolences from everyone at work. I'm ashamed.
My face hurts.
My head hurts.
Thanksgiving was less than a week away. I waited a couple days before lying to my family. In a family group chat. I sent a picture claiming one of our mental health patients was the cause. I could tell they didn't believe me.
Who would??
Week 2…. again it's Wednesday and I'm sitting in the parking lot. The sun went down about an hour ago so street lights are on. It's the end of November, the temperature is cooler than normal Phoenix temp. There's a random dog barking in the distance while the yellow glow from the parking lot lights shine in the car.
Positive Changes Institute. The knots on the back of my head don't feel very positive. I didn't have my ibuprofen in my purse so I had to bare through the pain all day at work. As soon as he dropped me off, I received a text message from him… "I'm sorry".
I woke up at 4:00am to use the bathroom. He was sitting at the edge of the bed going through my purse. It wasn't unusual for him to go through my purse. I kept things in there like Tylenol, antacids or gum. I asked him what he was looking for on my way out of the bedroom door as I headed to pee, with the intention of helping him out. No response. On my return I noticed he was still going through it so I asked him again, "what are you looking for baby?" He quickly snapped back, "None of your fucking business dumb bitch." I sat on the bed, shocked for a minute. My jaw dropped then I said, "you don't need to talk to me like I'm a piece of shit" Mistake of the day! He turned around and hopped on the bed so fast. His feet were planted on the bed so now he was standing on it. I knew what was coming. Immediately I went into the fetal position and I blocked my face behind my arms and buried it in the pillows and blankets on the bed. He's not fucking up my face this time. Five blows to the back of my head when I decided to wrap my hands behind my head at some lame attempt to soften the painful blows. A few more blows. I grunted loudly from the pain.
He stopped.
I put my hair up in a bun.
I went to the closet and pulled out a sweater. I put it on. I looked for my slippers for a second until I remembered they were in the bathroom. I had left them in there when I showered before bed. I grabbed the car keys. Walked out of the room, went to the bathroom for my slippers. My favorite slippers, cute furry ones with plastic solid soles. I went to the car, grabbed a cigar from the ash tray and smoked while I sobbed. My fucking head hurts. My right index finger is already swelling.
Smoked and sobbed. All I could think about was work. I gotta work in a few hours. Better get back to sleep. I went back inside and lied down. At least an hour passed before I fell asleep. Like clockwork, my alarm went off and I got ready.
He dropped me off, "I'm sorry".


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Silent Stereo is the brainchild of drummer, guitarist, and songwriter – Peachy Policarpio.
Originally started out as a duo and a project band in 2017, the group was able to
perform in various gigs and was able to release their first single "Drive" last January
2020. Peachy also known as Silent Stereo considers herself as an emotional type of
songwriter. Her songs are inspired by real life experiences that the listeners could
easily relate to.
"Drive", the first song she was able to make. It served as an outlet during that time when she was frustrated with her professional career and found comfort behind the steering wheel. To
most people, this should definitely be part of your playlist when going on a road
Listen here:
Peachy describes her journey as an artist as challenging but inspiring at the same time. She shares that not all people will appreciate what you do though there will be some who will support you along the way, and a few may even come as a surprise. "Sometimes kung sino pa ang hindi mo inaasahangsusuporta sayo, sila pa ang mas maniniwala sa kakayahan mo. They are the ones who will motivate you to keep on going."
Going out of her comfort zone as a usual drummer or guitarist in her previous bands, wasn't easy and she believes that the people around her are also not used to it yet. "For sure maraming nagulat because I always say that I don't sing, but I guess it's about time I try something exciting. Matagal ko na rin itong gustong subukan and I'm happy that I'm able to tick it off my bucket list already." - Peachy, Silent Stereo