Legal guardianship and other alternatives in the care of elders with Alzheimer's disease

This paper discusses planned instructional and proxy interventions for incapacity, legal guardianship, and supplements to care for people with Alzheimer's disease (AD). Service providers are encouraged to identify and initiate care decisions that are consistent with the client's care preferences. Case examples are discussed. Practitioners are encouraged to educate clients, particularly those in the early stages of Alzheimer's disease, to create evidence for care preferences through planning. Service providers' concerns for liability are briefly discussed.

Using the Youk-Kevorkian case to teach about euthanasia and other end-of-life issues

Dr. Jack Kevorkian's actions have generated much controversy and press coverage during the past decade. His appearance on a nationally televised newsprogram with a videotape showing him deliberately causing the death of a man led to his imprisonment. This article discusses how Kevorkian's euthanasia case can be used to teach undergraduate students about end-of-life issues, especially psychosocial aspects of the debate over hastened death.

Guardianship as a therapeutic option

The HIV/AIDS epidemic has posed a significant challenge to our legal system, demanding that it evolve to provide more flexible ways for parents to transfer guardianship of their children to other caring adults in a timely and minimally traumatic manner. Although a number of states have responded to the challenge, adopting new guardianship options such as delegations of parental authority for limited purposes, standby guardianship, co-guardianships, and subsidized guardianships, the majority of states still do not provide this continuum of options. Moreover, few states have established multidisciplinary programs that help parents take full advantage of the new guardianship options. Few have even begun to address the complex needs of the "second" families. Few have developed plans to meet the needs of the older AIDS-affected youth. How well we ensure the quality and continuity of parental care for children whose parents are living with HIV and AIDS, or who later die of it, is one of the tests of our generation. If we fail to meet this challenge, we are knowingly placing thousands of children and youth at enormous, predictable, and potentially fatal risk.

Patient confidentiality and the surrogate's right to know

Physicians treating newly incapacitated patients often must navigate surrogate decision-makers through a difficult course of treatment decisions. Such a process can be complex. Physicians must not only explain the medical facts and prognosis to the surrogate, but also attempt to ensure that the surrogate arrives at decisions that are consistent with the patient's own values and wishes. Where these values and wishes are unknown, physicians must help surrogates make decisions that reflect the patient's best interests.

Impacts of welfare reform on California grandparents raising grandchildren: reflections from the field

Debate over the potential impacts of welfare reform largely has ignored the implications of these changes for the growing number of grandparents who are raising their grandchildren. Results of a qualitative study involving 36 key informants who were intimately involved in the crafting and/or implementation of California's welfare reform plan are presented. Particular attention is focused on time limits on aid, work requirements, and sanctions regarding teenage parenthood as these may impact on grandparent caregivers and their families. Cross-cutting themes also are presented. A case is made for greatly stepping up data collection and evaluative research that may help in determining the actual impacts of the legislation on intergenerational households headed by grandparents.

[On what depends the dependence? Thoughts on the law establishing a specific subsidy of dependence in old age]

The dependency of elderly persons became recently an autonomous issue beside the problem of the pensions or the disability. We can explain this late apparition in the field of social policy by a strong attention paid to problems of the pensions and the lack of interest to the new concept of disability. But the main reason is the disagreement on two main questions. There is no common vision on the resources that the community must devote to help dependent people and their family. Moreover there is no agreement on the quality assurance of the services provided. The public debate for the first law was focused on the measure of the dependency and its budget. The second, in a context of growth of the number of dependent people, must integrate the need of support for an increasing number of families, and the condition for production of care of quality.

In whose best interest? The impact of changing public policy on relatives caring for children with incarcerated parents

Changes in criminal justice policy have resulted in the incarceration of an unprecedented number of parents. Consequently, more children than ever before are living with grandparents and other relatives while their parents are imprisoned. Historically, child welfare and criminal justice policy have been treated as distinct and unrelated areas of policy. This article discusses the interdependence of criminal justice policy, welfare reform legislation, and kinship foster care, and the impact of this interdependence on children whose parents are in jail or in prison.