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Dodging the Dementia Bullet

You’ve turned 65 and exited middle age. What are the chances you’ll develop cognitive impairment or dementia in the years ahead?

New research about “cognitive life expectancy” — how long older adults live with good versus declining brain health — shows that after age 65 men and women spend more than a dozen years in good cognitive health, on average. And, over the past decade, that time span has been expanding.

By contrast, cognitive challenges arise in a more compressed time frame in later life, with mild cognitive impairment (problems with memory, decision-making or thinking skills) lasting about four years, on average, and dementia (Alzheimer’s disease or other related conditions) occurring over 1½ to two years.

Even when these conditions surface, many seniors retain an overall sense of well-being, according to new research presented last month at the Population Association of America’s annual meeting.

“The majority of cognitively impaired years are happy ones, not unhappy ones,” said Anthony Bardo, a co-author of that study and assistant professor of sociology at the University of Kentucky-Lexington.

Recent research finds that:

Most seniors don’t have cognitive impairment or dementia. Of Americans 65 and older, about 20 to 25 percent have mild cognitive impairment while about 10 percent have dementia, according to Dr. Kenneth Langa, an expert in the demography of aging and a professor of medicine at the University of Michigan. Risks rise with advanced age, and the portion of the population affected is significantly higher for people over 85.

Langa’s research shows that the prevalence of dementia has fallen in the U.S. — a trend observed in developed countries across the globe. A new study from researchers at the Rand Corp. and the National Bureau of Economic Research finds that 10.5 percent of U.S. adults age 65 and older had dementia in 2012, compared with 12 percent in 2000.

Because the population of older adults is expanding, the number of people affected by dementia is increasing nonetheless: an estimated 4.5 million in 2012, compared with 4.1 million in 2000.

More years of education, which is associated with better physical and brain health, appears to be contributing to this phenomenon.

But gains are unequally distributed. Notably, college graduates can expect to spend more than 80 percent of their lifetime after age 65 with good cognition, according to a new study from researchers at the University of Southern California and the University of Texas at Austin. For people who didn’t complete high school, that drops to less than 50 percent.

This research looks at the older population as a whole and can’t predict what will happen to any given individual. Still, it’s helpful in getting a general sense of what people can expect.

An expanding period of good brain health. With longer lives and lower rates of dementia, most seniors are enjoying more years of life with good cognition — a welcome trend.

Two years ago, Eileen Crimmins, AARP chair of gerontology at the University of Southern California’s Leonard Davis School of Gerontology, and colleagues documented this shift in the United States in research using data about adults 65 and older from the Health and Retirement Study.

In 2000, she found, a 65-year-old woman could expect to live 12.5 years with good cognition, four years with mild cognitive impairment and 2.6 years with dementia, on average. A decade later, in 2010, the period in good cognition had expanded to 14.1 years, with 3.9 years spent with mild cognitive impairment and 2.3 years spent with dementia.

For men, the 2010 figures are different: 12.5 years with good cognition after age 65 (compared with 10.7 in 2000); 3.7 years with mild cognitive impairment (the same as in 2000); and 1.4 years with dementia (compared with 1.8 years in 2010).

Improvements in education and nutrition, better control of hypertension and cholesterol, cognitively demanding jobs in middle age, and social engagement in later life may all contribute to this expanded period of good brain health, the study noted.

Well-being often coexists with impairment. Bardo’s research adds another dimension to this literature by addressing two questions: Do older adults with cognitive impairment feel they have a good quality of life and, if so, for how long?

His study, which has not yet been published, focuses on happiness as an important indicator of quality of life. The data come from thousands of adults 65 and older who participated in the Health and Retirement Study between 1998 and 2012 and who were asked if they were happy “all/most of the time” or “some/none of the time” during the past week.

These answers were combined with information about cognitive impairment derived from tests that examined seniors’ ability to recall words and to count backward, among other tasks.

Findings suggest that cognitive impairment is not a deterrent to happiness. Of the period that seniors spent cognitively impaired, about 5.5 years on average, they reported being happy for 4.8 years — about 85 percent of the time. Of the 12.5 years that older adults spent in good cognitive health, they reported being happy nearly 90 percent of the time.

The bottom line: “Cognitive impairment doesn’t equate with unhappiness,” Bardo said. Still, he cautioned that his study didn’t look at how happiness correlates with the extent of impairment. Certainly, people with moderate to severe dementia experience serious difficulties in their lives, as do their caregivers, he noted.

Amal Harrati, an instructor at Stanford University Medical School, said Bardo’s paper appears sound, methodologically, but wondered whether older adults with cognitive impairment can be trusted to report reliably on their happiness.

Langa of the University of Michigan said the findings “fit my general experience and sense of treating older patients in my clinical work.” In the early stages of cognitive impairment, people often start focusing on enjoying family and being in the “here-and-now” while paying less attention to “small frustrations that can get us down in our daily lives,” he wrote in an email response to questions.

“As cognitive decline worsens, I think it is more likely that one can become unhappy, possibly due to the advancing pathology that can affect specific brain regions” and behavioral issues such as hallucinations and paranoia, he added.

Jennifer Ailshire, an assistant professor of gerontology and sociology at USC’s Leonard Davis School of Gerontology, noted that happiness is often tied to an individual’s personality characteristics. This measure “doesn’t necessarily reflect how individuals with cognitive impairment are interacting with other people or their environment,” she commented.

Laura Gitlin, dean of the college of nursing and health professions at Drexel University in Philadelphia, observed that happiness is only one element of living well with cognitive impairment and dementia. Going forward, she suggested, “there is much work to do” to identify what contributes more broadly to well-being and a positive quality of life in older adults with these conditions.

KHN’s coverage of these topics is supported by John A. Hartford Foundation, Gordon and Betty Moore Foundation and The SCAN Foundation

Reprinted from Kaiser Health News, https://khn.org/news/now-more-of-us-can-count-on-more-time-dodging-the-dementia-bullet

 

We hold these truths to be self-evident

Below are five tips for rightsizing your home, getting a fresh start someplace new, or a new chapter in your current home.

  1. Aim for a Simpler Life. Relationships and experiences are fare more important than materials objects.Rightsizing is liberating and makes you feel in control.
  2. Make a Plan – Sort Rooms One at a Time. If you don’t you will be overwhelmed and freeze. Organize each space with piles of gifts, keep, repurpose/donate, and discard.
  3. Gift Meaningful Items to Loved Ones. Enjoy their enjoyment now rather then in the future.
  4. Digitize Photos and Artwork. Digital files take up much less space than physical photos. Uploading photos onto a flash drive is easiest. This way, you can plug the flash drive into your computer or digital picture frame to enjoy the photos at any time.
  5. Focus On Personalization and Low Maintenance.Your goal is to have a home that is low maintenance and will accommodate your long-term needs – physically and financially.

Retired. Now What? What Boomers Need to Know.

My wife retired a year ago and we are adjusting to this new chapter of life.  Everyone has suggestions, ideas, and paths that we should follow.  Embedded in all the support and advice, there has been a lot of fake news; but there are a few real truths that everyone should consider.

  • Stay in your home, move, rent or buy? According to a 2016 Freddie Mac survey of boomers, most those 55 and older plan to stay in their homes during retirement. For those planning on moving, one in five say they will sell their home and buy a new one.  One in 10 say they will sell their home and rent when they move. Data from TenantCloud, a property management software service, shows that nearly one-third of all urban applications are for renters over age 60.
  • Boomers are not moving when they become empty nesters. This is one of the reasons the housing market is so tight.  The tradition of waiting for kids to move out and putting the big family house up for sale doesn’t appear to be happening nearly as often nowadays.  A leading economist has said a contributing factor to fewer homes on the market is more baby boomers are staying put in their “home sweet home,” rather than downsizing.
  • Boomers aging in place or downsizing are discovering their grown children do not want a lot of their stuff. Many of those seniors are turning to professional help to help them move. When it comes time to move, many boomers have to deal with four decades of memories and stuff, many material things their children either didn’t need nor have room for. So they face a house full of furniture and housewares and knickknacks.
  • Many Baby Boomers are willing to give up homeownership entirely. Recent studies showed 47% would consider selling their home and renting an apartment. Americans remain quite hopeful and are willing to consider a wide range of course corrections in order to enjoy a secure retirement.

While the debate continues and decisions are being made, changed, and made anew, the one fact that should be at the top of a To Do List is planning ahead.  The best decisions stem from discussion with spouse, family, friends when there is no emergency.  Pre-planning and careful consideration of health, wealth, and lifestyle choices in the future provides a solid foundation for the next chapter in your life.

The sale began and from my vantage point, the potential buyers were moving about more like thieves than buyers.”

I spoke with a couple downsizing and moving to a senior independent living community. They’re more than a little anxious about whether this estate sale will be successful in liquidating nearly three decades’ worth of belongings—especially prized pieces like their antique, hand-knotted Persian rugs (the one in the living room originally cost $20,000). “We wanted to sell these expensive items in a way that brought closure,” says Mr. Perstein, “and didn’t want them walking out the door for almost nothing.”

Liquidation

The sale began; and, from the Perestin’s vantage point, the potential buyers were moving about more like thieves than buyers. Everything picked up was accompanied by either “I’ll give you $5 for that,” or “This is way overpriced. When do the prices go down?” from the moment the doors open and sale goers storm the 5,000-square-foot home like pirates rushing a ship, virtually no one bothers with plastic. Most bargainers arrive at checkout with a few small items and a displeased look on their faces.

The close of the sale produced about $6000 and a plethora of furniture, the need for floor cleaning in their home, and a bill from the estate sale staff for almost half the profit.

Today, nearly one in 10 U.S. households maintain at least one self-storage unit, 65 percent more than did so in 1995. Filling these spaces, of course, comes naturally to baby boomers. We are a generation accustomed to regularly leaving offerings at the altar of retail.

Transitioning to empty nest and aging phases of life cause us wonder what to do with mountains of accumulated stuff. Our stuff ranges from toys and high school or college notebooks belonging to now-adult children to heirloom china.

The reality is the resale market is glutted with household goods. Your home full of middle-market, traditional-style furniture to sell is just one more load to enter the marketplace.

Dealers say that stuff’s plunged 50 to 75 percent in value. Elaborate silver tea sets are worth more melted than as decorative objects. And huge heavy items like dining-room breakfronts and banker-style desks are often the toughest to unload.

There is an economic significance and emotional struggle associated with this process. The emotional struggle comes with letting go of decades’ worth of memory-laden stuff. David Ekerdt, director of the Gerontology Center of the University of Kansas, says, “They’re not just things. They’re you.” But the disconnect between perceived value and actual value—when the kids don’t want their parents’ stuff and the market is overrun—can be a cold splash of reality.

When preparing to transition, liquidate your own home or an estate, the essential steps T3 Transitions recommends are:

  Identify the complete inventory you wish to liquidate,

Understand and estimate the time you have to liquidate — from this moment in time until the entire inventory must be removed.

How important, or necessary, is it to receive maximum financial return or not.

In consultation with your transition team liquidation specialist, identify the best method of liquidation:  Sale, Consignment, Donation/Repurposing, Disposal.

Everyone has the same concern: What if no-one wants my things?

Every client we work with shares a similar concern – What if nobody wants my things?

The family heirlooms elders have kept safe, polished, and close to their hearts are often not desired by children, grandchildren, or friends, much to the dismay of the elder. A recent article published by The Family Curator (www.thefamilycurator.com) shared a list of the cherished possessions most often asked about:

  1. Photos and Photo Albums
  2. Yearbooks, Wedding Books Scrapbooks
  3. Journals, Diaries, and Letters
  4. Military or Career Memorabilia
  5. Unique and Vintage Treasures

Absent – dining rooms sets, fine china, furniture. The timing of the gift is also suggested – as presents or gifts during the giver’s lifetime.

Matching a gift and heirloom is key.  We recommend investing the time in matching interests with items, selecting the most appropriate platform for the item, and choosing what is a treasure and what is an object.

  • Scan or digitize family pictures, 16-mm films, or videotapes. It is difficult to share pictures. Often, old films or pictures decay. Digitizing your media offers longevity, opportunity to share, and experiences you can share and comment on in real time.
  • Children and grandchildren find old yearbooks as special occasion coffee books, display items, or special items to bring out at family events.
  • Elders and Baby Boomers complain millennial have lost the ability to write a note. Handwritten notes, cards, speeches, academic, business or hobby/interest items creates a living legacy and places thoughts into words for future generations.
  • Medals, service ribbons, uniforms and other pieces that speak to our ancestor’s military service are often welcome heirlooms. Burial flags tell a story and can be displayed.
  • A pin, bracelet, or collectable becomes a treasure because of the story that it tells. Sharing the story of the item – in writing, on video, or face-to-face, makes something small a true treasure.

The dining chest or flat wear purchased and treasured for a lifetime holds special memories for the owner. It brings back a moment in time that is cherished or an investment that became a milestone in a lifetime. We regularly remind our clients (and their families), that what is typically the most meaningful is a story to be shared for generations.

Are You An Elder Hacker?

Are you a hacker? In this case, hacker doesn’t refer to computer programmers. Elder hacking is a phrase coined by Glen Hougan who teaches industrial design. He views an elder hacker as a creative and resourceful repurposer. An elder hacker is able to use common and typically low cost items from office supply or hardware stores to solve everyday problems. A pants hanger holding a cookbook open at eye level or placing a lazy susan in the refrigerator to enable easy reach of everything on the shelf are elder hacker solutions.

Shopping for items that make aging in place simpler are often expensive or employ high-end technology. A fixed income will limit what is purchased. Discomfort with technology may limit an elder adopting a solution. My grandparents lived during the Great Depression. To them, the idea of being resourceful was instilled during childhood and part of their day-to-day lives.

A recent Pew research study found many elders lack digital literacy and comfort with high-end technology. They often see off the shelf solutions as difficult to use, not trustworthy, or they simply don’t address their specific issue. For example, a visit to the Apple App Store finds a number of apps that manage medications. When given to an elder, it may be too difficult to continually enter medications and set up the reminder calendar. A paper option (i.e. calendar on the refrigerator or in the cabinet) is an easier, less expensive, and user-friendly solution.

We all grew up hearing all about generation gaps. The gap between an elder and millennial may feel insurmountable. Elder hacking is an opportunity for the generations to collaborate, be resourceful, and look for solutions to make living longer easier, fun, and a consistent leaning experience.

 

Advocacy: Lose The Throw Rug!

Cold weather, icy walkways, slippery parking lots – stimuli for elder fears of falling and breaking or fracturing a hip increases substantially during the winter months. A recent medical study finds the potential of falling indoors by tripping over an obstacle – power cord, throw rugs, clutter, is far greater than falling in the driveway.

Fear the throw rug!

Author of the study, Dr. Jason Guerico, says, “Given the results of this study, it appears that efforts to decrease fall risk among the elderly living in cold climates should not be preferentially aimed at preventing outdoor fractures in winter…Preventive efforts should focus on conditions present year-round, and especially on indoor risk.” The research was conducted by the North American Partners in Anesthesiology at the Hospital of Central Connecticut in New Britain, Conn.

Analysis of 544 patients with hip fractures concluded greater than 55 percent of the hip fractures occurred during warm months, with the highest rates in May, September and October (around 10 percent each). More than three-quarters of the hip fractures occurred indoors. 60 percent of outdoor fractures occurred from May through October, not in the depths of winter.

The most common cause of both indoor and outdoor hip fracture is tripping over an obstacle. Indoors, throw rugs were the most common obstacle cited; and, falling out of bed was #2.

 

Holidays, Elders, and That Conversation

Holidays are a time when generations of a family will come together. They are often hectic and crowded, or

Observe financial, emotional, physical, or psychological changes.

quiet and alone. For many families, the holiday offers an opportunity to visit with elders in the family.

This holiday may be a time you notice an aging family member or friend isn’t who you remember. Physical changes, emotional changes, or psychological changes may be apparent. This may be confusing to you and uncomfortable.

Feelings

Family Members: You are in a difficult position. You understand that your elder wants to remain independent and feel a sense of empowerment and self worth. While you want to respect and honor these feelings, your desire to keep the elder(s) safe conflicts with their wishes. Understanding when and how to intervene is difficult.

Elders: Possibly aware of the changes or not. For couples, the desire to hide changes exhibited by your partner in order to remain together is very common. Awareness of change may or may not be present. Fear of loss is significant – loss of independece, fear of loosing family wealth, fear of illness.

Signs an Elder Need Assistance

  1. Personal Hygiene: Have you noticed a change in their hygiene habits? Is their clothing appropriate for the time of day and season of the year? Changes in this area can be signs an older adult is having trouble with personal care.
  2. Less Social:Has an always involved and social elder withdrawn from favorite pastimes and organizations? It might be a sign they are having problems with transportation or that they are aware something is wrong but aren’t sure what it is.
  3. Depression:Elders who are isolated or live alone are at higher risk for depression. If the elder appears tired, uninterested in carrying on a conversation or is sleeping a lot, it might be time to intervene. Make an appointment with their primary care physician.
  4. Falls:Have they experienced any falls or near falls? Is your elder struggling with balance problems or are they a little unsteady on their feet? Older homes may not be the safest environment for a senior who is experiencing mobility issues. Falls remain the leading cause of fatal and non-fatal elder injuries.
  5. Accidents:When an elder driver bumps their car in to things like a curb or the garage door, it might not seem like a serious concern. But small accidents can indicate they may not be safe behind the wheel of a car any longer. Slower reflexes, problems with vision and hearing loss are just a few reasons why.
  6. Housekeeping:If your elder has always kept a tidy house it is usually easy to spot when there might be a problem. Is laundry piled up? Is the trash overflowing? A dirty house is not only a sign a loved one is struggling, it can also present health and safety risks.
  7. Finances:Is your elder safely managing their finances? There are a few ways to tell. Are bills stacked up unopened on their counter or desk? Another tip off is calls from bill collectors. When an elder is having trouble keeping their financial house in order, they may pay some bills twice while neglecting others.
  8. Being Scammed:Criminals target seniors. They believe them to be lonely and confused. It puts older adults at higher risk for fraud and scams such as fake sweepstakes prizes, phony roofing companies and identity theft. If your loved one has fallen victim to a scam, it might be a sign they need to make a move.
  9. Nutrition:Look inside the pantry and refrigerator. Are they full of out-of-dated foods? Does your senior loved one’s diet seem to consist primarily of fast food? Poor nutrition can contribute to a variety of health conditions, as well as increase their risk for a fall
  10. Mismanaging Medication:Mistakes with medication are a leading reason elders are taken to emergency departments. Some take too much medication and others forget to take it altogether. That’s why medication management is one of the most commonly utilized services in senior living communities.

It may be time to have ‘that’ conversation with your family and the elder(s).   If one or two of these behaviors are observed, it is time to consider aging in place, transition to a senior community, or minor changes in the home. The goal is to provide the elder a safe environment, independence, and preserve family wealth.

T3’s Advocacy and Traditional Transition services will lift the weight of aging off your shoulders.

How The Elderly Lose Their Rights

The following is an article that appeared initially in The New Yorker. It is outstanding!  The realization that guardians can sell the assets and control the lives of elders without their consent is hard to understand.  The fact the guardians are able to do this and reap the financial benefits is disheartening.

By Rachel Aviv (Reprint; 10.9.17)

 After a stranger became their guardian, Rudy and Rennie North were moved to a nursing home and their property was sold.

For years, Rudy North woke up at 9 a.m. and read the Las Vegas Review-Journal while eating a piece of toast. Then he read a novel—he liked James Patterson and Clive Cussler—or, if he was feeling more ambitious, Freud. On scraps of paper and legal notepads, he jotted down thoughts sparked by his reading. “Deep below the rational part of our brain is an underground ocean where strange things swim,” he wrote on one notepad. On another, “Life: the longer it cooks, the better it tastes.”

Rennie, his wife of fifty-seven years, was slower to rise. She was recovering from lymphoma and suffered from neuropathy so severe that her legs felt like sausages. Each morning, she spent nearly an hour in the bathroom applying makeup and lotions, the same brands she’d used for forty years. She always emerged wearing pale-pink lipstick. Rudy, who was prone to grandiosity, liked to refer to her as “my amour.”

On the Friday before Labor Day, 2013, the Norths had just finished their toast when a nurse, who visited five times a week to help Rennie bathe and dress, came to their house, in Sun City Aliante, an “active adult” community in Las Vegas. They had moved there in 2005, when Rudy, a retired consultant for broadcasters, was sixty-eight and Rennie was sixty-six. They took pride in their view of the golf course, though neither of them played golf.

Rudy chatted with the nurse in the kitchen for twenty minutes, joking about marriage and laundry, until there was a knock at the door. A stocky woman with shiny black hair introduced herself as April Parks, the owner of the company A Private Professional Guardian. She was accompanied by three colleagues, who didn’t give their names. Parks told the Norths that she had an order from the Clark County Family Court to “remove” them from their home. She would be taking them to an assisted-living facility. “Go and gather your things,” she said.

Rennie began crying. “This is my home,” she said.

One of Parks’s colleagues said that if the Norths didn’t comply he would call the police. Rudy remembers thinking, You’re going to put my wife and me in jail for this? But he felt too confused to argue.

Parks drove a Pontiac G-6 convertible with a license plate that read “crtgrdn,” for “court guardian.” In the past twelve years, she had been a guardian for some four hundred wards of the court. Owing to age or disability, they had been deemed incompetent, a legal term that describes those who are unable to make reasoned choices about their lives or their property. As their guardian, Parks had the authority to manage their assets, and to choose where they lived, whom they associated with, and what medical treatment they received. They lost nearly all their civil rightsWithout realizing it, the Norths had become temporary wards of the court. Parks had filed an emergency ex-parte petition, which provides an exception to the rule that both parties must be notified of any argument before a judge. She had alleged that the Norths posed a “substantial risk for mismanagement of medications, financial loss and physical harm.” She submitted a brief letter from a physician’s assistant, whom Rennie had seen once, stating that “the patient’s husband can no longer effectively take care of the patient at home as his dementia is progressing.” She also submitted a letter from one of Rudy’s doctors, who described him as “confused and agitated.”

Rudy and Rennie had not undergone any cognitive assessments. They had never received a diagnosis of dementia. In addition to Freud, Rudy was working his way through Nietzsche and Plato. Rennie read romance novels.

Parks told the Norths that if they didn’t come willingly an ambulance would take them to the facility, a place she described as a “respite.” Still crying, Rennie put cosmetics and some clothes into a suitcase. She packed so quickly that she forgot her cell phone and Rudy’s hearing aid. After thirty-five minutes, Parks’s assistant led the Norths to her car. When a neighbor asked what was happening, Rudy told him, “We’ll just be gone for a little bit.” He was too proud to draw attention to their predicament. “Just think of it as a mini-vacation,” he told Rennie.

After the Norths left, Parks walked through the house with Cindy Breck, the owner of Caring Transitions, a company that relocates seniors and sells their belongings at estate sales. Breck and Parks had a routine. “We open drawers,” Parks said at a deposition. “We look in closets. We pull out boxes, anything that would store—that would keep paperwork, would keep valuables.” She took a pocket watch, birth certificates, insurance policies, and several collectible coins.

The Norths’ daughter, Julie Belshe, came to visit later that afternoon. A fifty-three-year-old mother of three sons, she and her husband run a small business designing and constructing pools. She lived ten miles away and visited her parents nearly every day, often taking them to her youngest son’s football games. She was her parents’ only living child; her brother and sister had died.

She knocked on the front door several times and then tried to push the door open, but it was locked. She was surprised to see the kitchen window closed; her parents always left it slightly open. She drove to the Sun City Aliante clubhouse, where her parents sometimes drank coffee. When she couldn’t find them there, she thought that perhaps they had gone on an errand together—the farthest they usually drove was to Costco. But, when she returned to the house, it was still empty.

That weekend, she called her parents several times. She also called two hospitals to see if they had been in an accident. She called their landlord, too, and he agreed to visit the house. He reported that there were no signs of them. She told her husband, “I think someone kidnapped my parents.”

On the Tuesday after Labor Day, she drove to the house again and found a note taped to the door: “In case of emergency, contact guardian April Parks.” Belshe dialled the number. Parks, who had a brisk, girlish way of speaking, told Belshe that her parents had been taken to Lakeview Terrace, an assisted-living facility in Boulder City, nine miles from the Arizona border. She assured Belshe that the staff there would take care of all their needs.

“You can’t just walk into somebody’s home and take them!” Belshe told her.

Parks responded calmly, “It’s legal. It’s legal.”

Guardianship derives from the state’s parens patriae power, its duty to act as a parent for those considered too vulnerable to care for themselves. “The King shall have the custody of the lands of natural fools, taking the profits of them without waste or destruction, and shall find them their necessaries,” reads the English statute De Prerogative Regis, from 1324. The law was imported to the colonies—guardianship is still controlled by state, not federal, law—and has remained largely intact for the past eight hundred years. It establishes a relationship between ward and guardian that is rooted in trust.

In the United States, a million and a half adults are under the care of guardians, either family members or professionals, who control some two hundred and seventy-three billion dollars in assets, according to an auditor for the guardianship fraud program in Palm Beach County. Little is known about the outcome of these arrangements, because states do not keep complete figures on guardianship cases—statutes vary widely—and, in most jurisdictions, the court records are sealed. A Government Accountability report from 2010 said, “We could not locate a single Web site, federal agency, state or local entity, or any other organization that compiles comprehensive information on this issue.” A study published this year by the American Bar Association found that “an unknown number of adults languish under guardianship” when they no longer need it, or never did. The authors wrote that “guardianship is generally “permanent, leaving no way out—‘until death do us part.’ ”

When the Norths were removed from their home, they joined nearly nine thousand adult wards in the Las Vegas Valley. In the past twenty years, the city has promoted itself as a retirement paradise. Attracted by the state’s low taxes and a dry, sunny climate, elderly people leave their families behind to resettle in newly constructed senior communities. “The whole town sparkled, pulling older people in with the prospect of the American Dream at a reasonable price,” a former real-estate agent named Terry Williams told me. Roughly thirty per cent of the people who move to Las Vegas are senior citizens, and the number of Nevadans older than eighty-five has risen by nearly eighty per cent in the past decade.

In Nevada, as in many states, anyone can become a guardian by taking a course, as long as he or she has not been convicted of a felony or recently declared bankruptcy. Elizabeth Brickfield, a Las Vegas lawyer who has worked in guardianship law for twenty years, said that about fifteen years ago, as the state’s elderly population swelled, “all these private guardians started arriving, and the docket exploded. The court became a factory.”

Pamela Teaster, the director of the Center for Gerontology at Virginia Tech and one of the few scholars in the country who study guardianship, told me that, though most guardians assume their duties for good reasons, the guardianship system is “a morass, a total mess.” She said, “It is unconscionable that we don’t have any data, when you think about the vast power given to a guardian. It is one of society’s most drastic interventions.”

After talking to Parks, Belshe drove forty miles to Lakeview Terrace, a complex of stucco buildings designed to look like a hacienda. She found her parents in a small room with a kitchenette and a window overlooking the parking lot. Rennie was in a wheelchair beside the bed, and Rudy was curled up on a love seat in the fetal position. There was no phone in the room. Medical-alert buttons were strung around their necks. “They were like two lost children,” Belshe said.

She asked her parents who Parks was and where she could find the court order, but, she said, “they were overwhelmed and humiliated, and they didn’t know what was going on.” They had no idea how or why Parks had targeted them as wards. Belshe was struck by their passive acceptance. “It was like they had Stockholm syndrome or something,” she told me.

Belshe acknowledged that her parents needed a few hours of help each day, but she had never questioned their ability to live alone. “They always kept their house really nice and clean, like a museum,” she said. Although Rudy’s medical records showed that he occasionally had “staring spells,” all his medical-progress notes from 2013 described him as alert and oriented. He did most of the couple’s cooking and shopping, because Rennie, though lucid, was in so much pain that she rarely left the house. Belshe sometimes worried that her father inadvertently encouraged her mother to be docile: “She’s a very smart woman, though she sometimes acts like she’s not. I have to tell her, ‘That’s not cute, Mom.’ ”

When Belshe called Parks to ask for the court order, Parks told her that she was part of the “sandwich generation,” and that it would be too overwhelming for her to continue to care for her children and her parents at the same time. Parks billed her wards’ estates for each hour that she spent on their case; the court placed no limits on guardians’ fees, as long as they appeared “reasonable.” Later, when Belshe called again to express her anger, Parks charged the Norths twenty-four dollars for the eight-minute conversation. “I could not understand what the purpose of the call was other than she wanted me to know they had rights,” Parks wrote in a detailed invoice. “I terminated the phone call as she was very hostile and angry.”

A month after removing the Norths from their house, Parks petitioned to make the guardianship permanent. She was represented by an attorney who was paid four hundred dollars an hour by the Norths’ estate. A hearing was held at Clark County Family Court.

The Clark County guardianship commissioner, a lawyer named Jon Norheim, has presided over nearly all the guardianship cases in the county since 2005. He works under the supervision of a judge, but his orders have the weight of a formal ruling. Norheim awarded a guardianship to Parks, on average, nearly once a week. She had up to a hundred wards at a time. “I love April Parks,” he said at one hearing, describing her and two other professional guardians, who frequently appeared in his courtroom, as “wonderful, good-hearted, social-worker types.”

Norheim’s court perpetuated a cold, unsentimental view of family relations: the ingredients for a good life seemed to have little to do with one’s children and siblings. He often dismissed the objections of relatives, telling them that his only concern was the best interest of the wards, which he seemed to view in a social vacuum. When siblings fought over who would be guardian, Norheim typically ordered a neutral professional to assume control, even when this isolated the wards from their families.

Rudy had assured Belshe that he would protest the guardianship, but, like most wards in the country, Rudy and Rennie were not represented by counsel. As Rudy stood before the commissioner, he convinced himself that guardianship offered him and Rennie a lifetime of care without being a burden to anyone they loved. He told Norheim, “The issue really is her longevity—what suits her.” Belshe, who sat in the courtroom, said, “I was shaking my head. No, no, no—don’t do that!” Rennie was silent.

Norheim ordered that the Norths become permanent wards of the court. “Chances are, I’ll probably never see you folks again; you’ll work everything out,” he said, laughing. “I very rarely see people after the initial time in court.” The hearing lasted ten minutes.

The following month, Even Tide Life Transitions, a company that Parks often hired, sold most of the Norths’ belongings. “The general condition of this inventory is good,” an appraiser wrote. Two lithographs by Renoir were priced at thirty-eight hundred dollars, and a glass cocktail table (“Client states that it is a Brancusi design”) was twelve hundred and fifty dollars. The Norths also had several pastel drawings by their son, Randy, who died in a motorcycle accident at the age of thirty-two, as well as Kachina dolls, a Bose radio, a Dyson vacuum cleaner, a Peruvian tapestry, a motion-step exerciser, a LeRoy Neiman sketch of a bar in Dublin, and two dozen pairs of Clarke shoes. According to Parks’s calculations, the Norths had roughly fifty thousand dollars. Parks transferred their savings, held at the Bank of America, to an account in her name.

Rennie repeatedly asked for her son’s drawings, and for the family photographs on her refrigerator. Rudy pined for his car, a midnight-blue 2010 Chrysler, which came to symbolize the life he had lost. He missed the routine interactions that driving had allowed him. “Everybody at the pharmacy was my buddy,” he said. Now he and Rennie felt like exiles. Rudy said, “They kept telling me, ‘Oh, you don’t have to worry: your car is fine, and this and that.’ ” A month later, he said, “they finally told me, ‘Actually, we sold your car.’ I said, ‘What in the hell did you sell it for?’ ” It was bought for less than eight thousand dollars, a price that Rudy considered insulting.

Rudy lingered in the dining room after eating breakfast each morning, chatting with other residents of Lakeview Terrace. He soon discovered that ten other wards of April Parks lived there. His next-door neighbor, Adolfo Gonzalez, a short, bald seventy-one-year-old who had worked as a maître d’ at the MGM Grand Las Vegas, had become Parks’s ward at a hearing that lasted a minute and thirty-one seconds.

Gonzalez, who had roughly three hundred and fifty thousand dollars in assets, urged Rudy not to accept the nurse’s medications. “If you take the pills, they’ll make sure you don’t make it to court,” he said. Gonzalez had been prescribed the antipsychotic medications Risperdal and Depakote, which he hid in the side of his mouth without swallowing. He wanted to remain vigilant. He often spoke of a Salvador Dali painting that had been lost when Parks took over his life. Once, she charged him two hundred and ten dollars for a visit in which, according to her invoice, he expressed that “he feels like a prisoner.”

Rudy was so distressed by his conversations with Gonzalez that he asked to see a psychologist. “I thought maybe he’d give me some sort of objective learning as to what I was going through,” he said. “I wanted to ask basic questions, like What the hell is going on?” Rudy didn’t find the session illuminating, but he felt a little boost to his self-esteem when the psychologist asked that he return for a second appointment. “I guess he found me terribly charming,” he told me.

Rudy liked to fantasize about an alternative life as a psychoanalyst, and he tried to befriend the wards who seemed especially hopeless. “Loneliness is a physical pain that hurts all over,” he wrote in his notebook. He bought a pharmaceutical encyclopedia and advised the other wards about medications they’d been prescribed. He also ran for president of the residents, promising that under his leadership the kitchen would no longer advertise canned food as homemade. (He lost—he’s not sure if anyone besides Rennie voted for him—but he did win a seat on the residents’ council.)

He was particularly concerned about a ward of Parks’s named Marlene Homer, a seventy-year-old woman who had been a professor. “Now she was almost hiding behind the pillars,” Rudy said. “She was so obsequious. She was, like, ‘Run me over. Run me over.’ ” She’d become a ward in 2012, after Parks told the court, “She has admitted to strange thoughts, depression, and doing things she can’t explain.” On a certificate submitted to the court, an internist had checked a box indicating that Homer was “unable to attend the guardianship court hearing because______,” but he didn’t fill in a reason.

The Norths could guess which residents were Parks’s wards by the way they were dressed. Gonzalez wore the same shirt to dinner nearly every day. “Forgive me,” he told the others at his table. When a friend tried to take him shopping, Parks prevented the excursion because she didn’t know the friend. Rennie had also tried to get more clothes. “I reminded ward that she has plenty of clothing in her closet,” Parks wrote. “I let her know that they are on a tight budget.” The Norths’ estate was charged a hundred and eighty dollars for the conversation.

Another resident, Barbara Neely, a fifty-five-year-old with schizophrenia, repeatedly asked Parks to buy her outfits for job interviews. She was applying for a position with the Department of Education. After Neely’s third week at Lakeview Terrace, Parks’s assistant sent Parks a text. “Can you see Barbara Neely anytime this week?” she wrote. “She has questions on the guardianship and how she can get out of it.” Parks responded, “I can and she can’t.” Neely had been in the process of selling her house, for a hundred and sixty-eight thousand dollars, when Parks became her guardian and took charge of the sale.

The rationale for the guardianship of Norbert Wilkening, who lived on the bottom floor of the facility, in the memory-care ward, for people with dementia (“the snake pit,” Rudy called it), was also murky. Parks’s office manager, who advertised himself as a “Qualified Dementia Care Specialist”—a credential acquired through video training sessions—had given Wilkening a “Mini-Mental State Examination,” a list of eleven questions and tasks, including naming as many animals as possible in a minute. Wilkening had failed. His daughter, Amy, told me, “I didn’t see anything that was happening to him other than a regular getting-older process, but when I was informed by all these people that he had all these problems I was, like, Well, maybe I’m just in denial. I’m not a professional.” She said that Parks was “so highly touted. By herself, by the social workers, by the judge, by everyone that knew her.”

At a hearing, when Amy complained to Norheim that Parks didn’t have time for her father, he replied, “Yeah, she’s an industry at this point.”

As Belshe spoke to more wards and their families, she began to realize that Lakeview Terrace was not the only place where wards were lodged, and that Parks was not the only guardian removing people from their homes for what appeared to be superficial reasons. Hundreds of cases followed the same pattern. It had become routine for guardians in Clark County to petition for temporary guardianship on an ex-parte basis. They told the court that they had to intervene immediately because the ward faced a medical emergency that was only vaguely described: he or she was demented or disoriented, and at risk of exploitation or abuse. The guardians attached a brief physician’s certificate that contained minimal details and often stated that the ward was too incapacitated to attend a court hearing. Debra Bookout, an attorney at the Legal Aid Center of Southern Nevada, told me, “When a hospital or rehab facility needs to free up a bed, or when the patient is not paying his bills, some doctors get sloppy, and they will sign anything.” A recent study conducted by Hunter College found that a quarter of guardianship petitions in New York were brought by nursing homes and hospitals, sometimes as a means of collecting on overdue bills.

It often took several days for relatives to realize what had happened. When they tried to contest the guardianship or become guardians themselves, they were dismissed as unsuitable, and disparaged in court records as being neglectful, or as drug addicts, gamblers, and exploiters. (Belshe was described by Parks as a “reported addict” who “has no contact with the proposed ward,” an allegation that Belshe didn’t see until it was too late to challenge.) Family who lived out of state were disqualified from serving as guardians, because the law prohibited the appointment of anyone who didn’t live in Nevada.

Once the court approved the guardianship, the wards were often removed from their homes, which were eventually sold. Terry Williams, whose father’s estate was taken over by strangers even though he’d named her the executor of his will, has spent years combing through guardianship, probate, and real-estate records in Clark County. “I kept researching, because I was so fascinated that these people could literally take over the lives and assets of people under color of law, in less than ten minutes, and nobody was asking questions,” she told me. “These people spent their lives accumulating wealth and, in a blink of an eye, it was someone else’s.”

Williams has reviewed hundreds of cases involving Jared Shafer, who is considered the godfather of guardians in Nevada. In the records room of the courthouse, she was afraid to say Shafer’s name out loud. In the course of his thirty-five-year career, Shafer has assumed control of more than three thousand wards and estates and trained a generation of guardians. In 1979, he became the county’s public administrator, handling the estates of people who had no relatives in Nevada, as well as the public guardian, serving wards when no family members or private guardians were available. In 2003, he left government and founded his own private guardianship and fiduciary business; he transferred the number of his government-issued phone to himself.

Williams took records from Shafer’s and other guardians’ cases to the Las Vegas police department several times. She tried to explain, she said, that “this is a racketeering operation that is fee-based. There’s no brown paper bag handed off in an alley. The payoff is the right to bill the estate.” The department repeatedly told her that it was a civil issue, and refused to take a report. In 2006, she submitted a typed statement, listing twenty-three statutes that she thought had been violated, but an officer wrote in the top right corner, “not a police matter.” Adam Woodrum, an estate lawyer in Las Vegas, told me that he’s worked with several wards and their families who have brought their complaints to the police. “They can’t even get their foot in the door,” he said.

Acting as her own attorney, Williams filed a racketeering suit in federal court against Shafer and the lawyers who represented him. At a hearing before the United States District Court of Central California in 2009, she told the judge, “They are trumping up ways and means to deem people incompetent and take their assets.” The case was dismissed. “The scheme is ingenious,” she told me. “How do you come up with a crime that literally none of the victims can articulate without sounding like they’re nuts? The same insane allegations keep surfacing from people who don’t know each other.”

In 2002, in a petition to the Clark County District Court, a fifty-seven-year-old man complained that his mother had lost her constitutional rights because her kitchen was understocked and a few bills hadn’t been paid. The house they shared was then placed on the market. The son wrote, “If the only showing necessary to sell the home right out from under someone is that their ‘estate’ would benefit, then no house in Clark County is safe, nor any homeowner.” Under the guise of benevolent paternalism, guardians seemed to be creating a kind of capitalist dystopia: people’s quality of life was being destroyed in order to maximize their capital.

When Concetta Mormon, a wealthy woman who owned a Montessori school, became Shafer’s ward because she had aphasia, Shafer sold the school midyear, even though students were enrolled. At a hearing after the sale, Mormon’s daughter, Victoria Cloutier, constantly spoke out of turn. The judge, Robert Lueck, ordered that she be handcuffed and placed in a holding cell while the hearing continued. Two hours later, when Cloutier was allowed to return for the conclusion, the judge told her that she had thirty days in which to vacate her mother’s house. If she didn’t leave, she would be evicted and her belongings would be taken to Goodwill.

The opinions of wards were also disregarded. In 2010, Guadalupe Olvera, a ninety-year-old veteran of the Second World War, repeatedly asked that his daughter and not Shafer be appointed his guardian. “The ward is not to go to court,” Shafer instructed his assistants. When Olvera was finally permitted to attend a hearing, nearly a year after becoming a ward, he expressed his desire to live with his daughter in California, rather than under Shafer’s care. “Why is everybody against that?” he asked Norheim. “I don’t need that man.” Although Nevada’s guardianship law requires that courts favor relatives over professionals, Norheim continued the guardianship, saying, “The priority ship sailed.”

When Olvera’s daughter eventually defied the court’s orders and took her father to live at her seaside home in Northern California, Norheim’s supervisor, Judge Charles Hoskin, issued an arrest warrant for her “immediate arrest and incarceration” without bail. The warrant was for contempt of court, but Norheim said at least five times from the bench that she had “kidnapped” Olvera. At a hearing, Norheim acknowledged that he wasn’t able to send an officer across state lines to arrest the daughter. Shafer said, “Maybe I can.”

Shafer held so much sway in the courtroom that, in 2013, when an attorney complained that the bank account of a ward named Kristina Berger had “no money left and no records to explain where it went,” Shafer told Norheim, “Close the courtroom.” Norheim immediately complied. A dozen people in attendance were forced to leave.

One of Shafer’s former bookkeepers, Lisa Clifton, who was hired in 2012, told me that Shafer used to brag about his political connections, saying, “I wrote the laws.” In 1995, he persuaded the Nevada Senate Committee on Government Affairs to write a bill that allowed the county to receive interest on money that the public guardian invested. “This is what I want you to put in the statute, and I will tell you that you will get a rousing hand from a couple of judges who practice our probate,” he said. At another hearing, he asked the committee to write an amendment permitting public guardians to take control of people’s property in five days, without a court order. “This bill is not ‘Big Brother’ if you trust the person who is doing the job,” he said. (After a senator expressed concern that the law allowed “intervention into somebody’s life without establishing some sort of reason why you are doing it,” the committee declined to recommend it.)

Clifton observed that Shafer almost always took a cynical view of family members: they were never motivated by love or duty, only by avarice. “ ‘They just want the money’—that was his answer to everything,” she told me. “And I’m thinking to myself, Well, when family members die they pass it down to their children. Isn’t that just the normal progression of things?”

After a few months on the job, Clifton was asked to work as a guardian, substituting for an absent employee, though she had never been trained. Her first assignment was to supervise a visit with a man named Alvin Passer, who was dying in the memory-care unit of a nursing home. His partner of eight years, Olive Manoli, was permitted a brief visit to say goodbye. Her visits had been restricted by Shafer—his lawyer told the court that Passer became “agitated and sexually aggressive” in her presence—and she hadn’t seen Passer in months. In a futile attempt to persuade the court to allow her to be with him, Manoli had submitted a collection of love letters, as well as notes from ten people describing her desire to care for Passer for the rest of his life. “I was absolutely appalled,” Clifton said. “She was this very sweet lady, and I said, ‘Go in there and spend as much time with him as you want.’ Tears were rolling down her cheeks.”

The family seemed to have suffered a form of court-sanctioned gaslighting. Passer’s daughter, Joyce, a psychiatric nurse who specialized in geriatrics, had been abruptly removed as her father’s co-guardian, because she appeared “unwilling or (more likely) unable to conduct herself rationally in the Ward’s best interests,” according to motions filed by one of Shafer’s attorneys.

She and Manoli had begged Norheim not to appoint Shafer as guardian. “Sir, he’s abusive,” their lawyer said in court.

“He’s as good as we got, and I trust him completely,” Norheim responded.

Joyce Passer was so confused by the situation that, she said, “I thought I was crazy.” Then she received a call from a blocked number. It was Terry Williams, who did not reveal her identity. She had put together a list of a half-dozen family members who she felt were “ready to receive some kind of verbal support.” She told Passer, “Look, you are not nuts. This is real. Everything you are thinking is true. This has been going on for years.”

During Rennie North’s first year at Lakeview Terrace, she gained sixty pounds. Parks had switched the Norths’ insurance, for reasons she never explained, and Rennie began seeing new doctors, who prescribed Valium, Prozac, the sedative Temazepam, Oxycodone, and Fentanyl. The doses steadily increased. Rudy, who had hip pain, was prescribed Oxycodone and Valium. When he sat down to read, the sentences floated past his eyes or appeared in duplicate. “Ward seemed very tired and his eyes were glassy,” Parks wrote in an invoice.

Belshe found it increasingly hard to communicate with her parents, who napped for much of the day. “They were being overmedicated to the point where they weren’t really there,” she said. The Norths’ grandsons, who used to see them every week, rarely visited. “It was degrading for them to see us so degraded,” Rudy said. Parks noticed that Rennie was acting helpless, and urged her to “try harder to be more motivated and not be so dependent on others.” Rudy and Rennie began going to Sunday church services at the facility, even though they were Jewish. Rudy was heartened by what he heard in the pastor’s message: “Don’t give up. God will help you get out of here.” He began telling people, “We are living the life of Job.”

At the end of 2014, Lakeview Terrace hired a new director, Julie Liebo, who resisted Parks’s orders that medical information about wards be kept from their families. Liebo told me, “The families were devastated that they couldn’t know if the residents were in surgery or hear anything about their health. They didn’t understand why they’d been taken out of the picture. They’d ask, ‘Can you just tell me if she’s alive?’ ” Liebo tried to comply with the rules, because she didn’t want to violate medical-privacy laws; as guardian, Parks was entitled to choose what was disclosed. Once, though, Liebo took pity on the sister of an eighty-year-old ward named Dorothy Smith, who was mourning a dog that Parks had given away, and told her that Smith was stable. Liebo said that Parks, who was by then the secretary of the Nevada Guardianship Association, called her immediately. “She threatened my license and said she could have me arrested,” Liebo told me.

After Liebo arrived, Parks began removing wards from Lakeview Terrace with less than a day’s notice. A woman named Linda Phillips, who had dementia, was told that she was going to the beauty salon. She never returned. Marlene Homer, the ward whose ailments were depression and “strange thoughts,” was taken away in a van, screaming. Liebo had asked the state ombudsman to come to the facility and stop the removals, but nothing could be done. “We stood there completely helpless,” Liebo said. “We had no idea where they were going.” Liebo said that other wards asked her if they would be next.

Liebo alerted the compliance officer for the Clark County Family Court that Parks was removing residents “without any concern for them and their choice to stay here.” She also reported her complaints to the police, the Department of Health Services, the Bureau of Health Care, and Nevada Adult Protective Services. She said each agency told her that it didn’t have the authority or the jurisdiction to intervene.

At the beginning of 2015, Parks told the Norths that they would be leaving Lakeview Terrace. “Finances are low and the move is out of our control,” Parks wrote. It was all arranged so quickly that, Rudy said, “we didn’t have time to say goodbye to people we’d been eating with for seventeen months.” Parks arranged for Caring Transitions to move them to the Wentworth, a less expensive assisted-living facility. Liebo said that, the night before the move, Rudy began “shouting about the Holocaust, that this was like being in Nazi Germany.” Liebo didn’t think the reference was entirely misguided. “He reverted to a point where he had no rights as a human being,” she said. “He was no longer the caregiver, the man, the husband—all of the things that gave his life meaning.” Liebo also didn’t understand why Belshe had been marginalized. “She seemed like she had a great relationship with her parents,” she said.

Belshe showed up at 9 a.m. to help her parents with the move, but when she arrived Parks’s assistant, Heidi Kramer, told her that her parents had already left. Belshe “emotionally crashed,” as Liebo put it. She yelled that her parents didn’t even wake up until nine or later—what was the rush? In an invoice, Kramer wrote that Belshe “began to yell and scream, her behavior was out of control, she was taking pictures and yelling, ‘April Parks is a thief.’ ” Kramer called the police. Liebo remembers that an officer “looked at Julie Belshe and told her she had no rights, and she didn’t.”

Belshe cried as she drove to the Wentworth, in Las Vegas. When she arrived, Parks was there, and refused to let her see her parents. Parks wrote, “I told her that she was too distraught to see her parents, and that she needed to leave.” Belshe wouldn’t, so Parks asked the receptionist to call the police. When the police arrived, Belshe told them, “I just want to hug my parents and make sure they’re O.K.” An officer handed her a citation for trespassing, saying that if she returned to the facility she would be arrested.

Parks wrote that the Norths were “very happy with the new room and thanked us several times,” but Rudy remembers feeling as if he had “ended up in the sewer.” Their room was smaller than the one at Lakeview Terrace, and the residents at the Wentworth seemed older and sicker. “There were people sitting in their chairs, half-asleep,” Rudy said. “Their tongues hung out.”

Rennie spent nearly all her time in her wheelchair or in bed, her eyes half-closed. Her face had become bloated. One night, she was so agitated that the nurses gave her Haldol, a drug commonly used to treat schizophrenia. When Rudy asked her questions, Rennie said “What?” in a soft, remote voice.

Shortly after her parents’ move, Belshe called an editor of the Vegas Voice, a newspaper distributed to all the mailboxes in senior communities in Las Vegas. In recent months, the paper had published three columns warning readers about Clark County guardians, writing that they “have been lining their pockets at the expense of unwitting seniors for a very long time.”

At Belshe’s urging, the paper’s political editor, Rana Goodman, visited the Norths, and published an article in the Voice, describing Rudy as “the most articulate, soft spoken person I have met in a very long time.” She called Clark County’s guardianship system a “(legal) elder abuse racket” and urged readers to sign a petition demanding that the Nevada legislature reform the laws. More than three thousand people signed.

Two months later, the Review-Journal ran an investigation, titled “Clark County’s Private Guardians May Protect—Or Just Steal and Abuse,” which described complaints against Shafer going back to the early eighties, when two of his employees were arrested for stealing from the estates of dead people.

In May, 2015, a month after the article appeared, when the Norths went to court to discuss their finances local journalists were in the courtroom and Norheim seemed chastened. “I have grave concerns about this case,” he said. He noted that Parks had sold the Norths’ belongings without proper approval from his court. Parks had been doing this routinely for years, and, according to her, the court had always accepted her accounting and her fees. Her lawyer, Aileen Cohen, said, “Everything was done for the wards’ benefit, to support the wards.”

Norheim announced that he was suspending Parks as the Norths’ guardian—the first time she had been removed from a case for misconduct.

“This is important,” Rudy, who was wearing a double-breasted suit, said in court. “This is hope. I am coming here and I have hope.” He quoted the Bible, Thomas Jefferson, and Euripides, until Belshe finally touched his elbow and said, “Just sit down, Dad.”

When Rudy apologized for being “overzealous,” Norheim told him, “This is your life. This is your liberty. You have every right to be here. You have every right to be involved in this project.”

After the hearing, Parks texted her husband, “I am finished.”

Last March, Parks and her lawyer, along with her office manager and her husband, were indicted for perjury and theft, among other charges. The indictment was narrowly focussed on their double billings and their sloppy accounting, but, in a detailed summary of the investigation, Jaclyn O’Malley, who led the probe for the Nevada Attorney General’s Office, made passing references to the “collusion of hospital social workers and medical staff” who profited from their connection to Parks. At Parks’s grand-jury trial, her assistant testified that she and Parks went to hospitals and attorneys’ offices for the purpose of “building relationships to generate more client leads.” Parks secured a contract with six medical facilities whose staff agreed to refer patients to her—an arrangement that benefitted the facilities, since Parks controlled the decisions of a large pool of their potential consumers. Parks often gave doctors blank certificates and told them exactly what to write in order for their patients to become her wards.

Parks and other private guardians appeared to gravitate toward patients who had considerable assets. O’Malley described a 2010 case in which Parks, after receiving a tip from a social worker, began “cold-calling” rehabilitation centers, searching for a seventy-nine-year-old woman, Patricia Smoak, who had nearly seven hundred thousand dollars and no children. Parks finally found her, but Smoak’s physician wouldn’t sign a certificate of incapacity. “The doctor is not playing ball,” Parks wrote to her lawyer. She quickly found a different doctor to sign the certificate, and Norheim approved the guardianship. (Both Parks and Norheim declined to speak with me.)

Steve Miller, a former member of the Las Vegas City Council, said he assumed that Shafer would be the next indictment after Parks, who is scheduled to go to trial next spring. “All of the disreputable guardians were taking clues from the Shafer example,” he said. But, as the months passed, “I started to think that this has run its course locally. Only federal intervention is going to give us peace of mind.”

Richard Black, who, after his father-in-law was placed into guardianship, became the director of a grassroots national organization, Americans Against Abusive Probate Guardianship, said that he considered the Parks indictment “irrefutably shallow. It sent a strong message of: We’re not going to go after the real leaders of this, only the easy people, the ones who were arrogant and stupid enough to get caught.” He works with victims in dozens of what he calls “hot spots,” places where guardianship abuse is prevalent, often because they attract retirees: Palm Beach, Sarasota, Naples, Albuquerque, San Antonio. He said that the problems in Clark County are not unusual. “The only thing that is unique is that Clark County is one of the few jurisdictions that doesn’t seal its records, so we can see what is going on.”

Approximately ten per cent of people older than sixty-five are thought to be victims of “elder abuse”—a construct that has yet to enter public consciousness, as child abuse has—but such cases are seldom prosecuted. People who are frail or dying don’t make good witnesses—a fact that Shafer once emphasized at a 1990 U.S. congressional hearing on crimes against the elderly, in which he appeared as an expert at preventing exploitation. “Seniors do not like to testify,” he said, adding that they were either incapable or “mesmerized by the person ripping them off.” He said, “The exploitation of seniors is becoming a real cottage industry right now. This is a good business. Seniors are unable to fend for themselves.”

In the past two years, Nevada has worked to reform its guardianship system through a commission, appointed by the Nevada Supreme Court, to study failures in oversight. In 2018, the Nevada legislature will enact a new law that entitles all wards to be represented by lawyers in court. But the state seems reluctant to reckon with the roots of the problem, as well as with its legacy: a generation of ill and elderly people who were deprived of their autonomy, and also of their families, in the final years of their lives. Last spring, a man bought a storage unit in Henderson, Nevada, and discovered twenty-seven urns—the remains of Clark County wards who had never been buried.

In the wake of Parks’s indictment, no judges have lost their jobs. Norheim was transferred from guardianship court to dependency court, where he now oversees cases involving abused and neglected children. Shafer is still listed in the Clark County court system as a trustee and as an administrator in several open cases. He did not respond to multiple e-mails and messages left with his bookkeeper, who answered his office phone but would not say whether he was still in practice. He did appear at one of the public meetings for the commission appointed to analyze flaws in the guardianship system. “What started all of this was me,” he said. Then he criticized local media coverage of the issue and said that a television reporter, whom he’d talked to briefly, didn’t know the facts. “The system works,” Shafer went on. “It’s not the guardians you have to be aware of, it’s more family members.” He wore a blue polo shirt, untucked, and his head was shaved. He looked aged, his arms dotted with sun spots, but he spoke confidently and casually. “The only person you folks should be thinking about when you change things is the ward. It’s their money, it’s their life, it’s their time. The family members don’t count.”

Belshe is resigned to the fact that she will be supporting her parents for the rest of their lives. Parks spent all the Norths’ money on fees—the hourly wages for her, her assistants, her lawyers, and the various contractors she hired—as well as on their monthly bills, which doubled under her guardianship. Belshe guesses that Parks—or whichever doctor or social worker referred her to the Norths—had assumed that her parents were wealthier than they actually were. Rudy often talked vaguely about deals he had once made in China. “He exaggerates, so he won’t feel emasculated,” Belshe said. “He wasn’t such a big businessman, but he was a great dad.”

The Norths now live in what used to be Belshe’s home office; it has a window onto the living room which Belshe has covered with a tarp. Although the room is tiny, the Norths can fit most of their remaining belongings into it: a small lamp with teardrop crystals, a deflated love seat, and two paintings by their son. Belshe rescued the art work, in 2013, after Caring Transitions placed the Norths’ belongings in trash bags at the edge of their driveway. “My brother’s paintings were folded and smelled,” she said.

The Norths’ bed takes up most of the room, and operates as their little planet. They rarely stray far from it. They lie in bed playing cards or sit against the headboard, reading or watching TV. Rudy’s notebooks are increasingly focussed on mortality—“Death may be pleasurable”—and money. “Money monsters do well in this society,” he wrote. “All great fortunes began with a crime.” He creates lists of all the possessions he has lost, some of which he may be imagining: over time, Rennie’s wardrobe has become increasingly elaborate and refined, as have their sets of China. He alternates between feeling that his belongings are nothing—a distraction from the pursuit of meaning—and everything. “It’s an erasure,” he said. “They erase you from the face of the earth.” He told me a few times that he was a distant cousin of Leon Trotsky, “intellect of the revolution,” as he called him, and I wondered whether his newfound pride was connected to his conflicted feelings about the value of material objects.

A few months after the Norths were freed, Rudy talked on the phone with Adolfo Gonzalez, his neighbor from Lakeview Terrace, who, after a doctor found him competent, had also been discharged. He now lived in a house near the airport, and had been reunited with several of his pets. The two men congratulated each other. “We survived!” Rudy said. “We never thought we’d see each other on the other side.” Three other wards from Lakeview Terrace had died.

Rennie has lost nearly all the weight she gained at Lakeview Terrace, mostly because Belshe and her husband won’t let her lounge in her wheelchair or eat starchy foods. Now she uses a walker, which she makes self-deprecating jokes about. “This is fun—I can teach you!” she told me.

In July, Rennie slipped in the bathroom and spent a night in the hospital. Belshe didn’t want anyone to know about her mother’s fall, because, she said, “this is the kind of thing that gets you into guardianship.” She told me, “I feel like these people are just waiting in the bushes.”

Two days after the fall, Rennie was feeling better—she’d had thirteen stitches—but she was still agitated by a dream she had in the hospital. She wasn’t even sure if she’d been asleep; she remembers talking, and her eyes were open.

“You were loopedy-doopy,” Scott Belshe, Julie’s husband, told her. They were sitting on the couch in their living room.

“It was real,” Rennie said.

“You dreamed it,” Scott told her.

“Maybe I was hallucinating,” she said. “I don’t know—I was scared.” She said that strangers were making decisions about her fate. She felt as if she were frozen: she couldn’t influence what was happening. “I didn’t know what to do,” she told Scott. “I think I yelled for help. Help me.” The worst part, she said, was that she couldn’t find her family. “Honest to God, I thought you guys left me all alone.” ♦

This article appears in other versions of the October 9, 2017, issue, with the headline “The Takeover.”

 

Safety Is Key When Working With Elders

Financial and emotional abuse are the most common forms of elder abuse facing this population today.  In a 2011 report of New York State elder abuse, only 1 in 24 cases of elder abuse were reported to authorities. When working with elders, caregivers, or families during a transition — aging in place, right-sizing, downsizing, or moving & transitioning, our T3 team members often are frontline in identifying cases of elder abuse.  For some elders, a visit to the emergency room is frontline primarily because it may be the only time they leave their home.

The following story recently was published by Kaiser Health News* about an innovative program for protecting elders through intervention in there ER.  We are very proud to say that our team members are trained to identify elder abuse when present.

Abuse often leads to depression and medical problems in older patients — even death within a year of an abusive incident.

Yet, those subjected to emotional, physical or financial abuse too often remain silent. Identifying victims and intervening poses challenges for doctors and nurses.

Because visits to the emergency room may be the only time an older adult leaves the house, staff in the ER can be a first line of defense, said Tony Rosen, founder and lead investigator of the Vulnerable Elder Protection Team (VEPT), a program launched in April at the New York-Presbyterian Hospital/Weill Cornell Medical Center ER.

The most common kinds of elder abuse are emotional and financial, Rosen said, and usually when one form of abuse exists, so do others. According to a New York study, as few as 1 in 24 cases of abuse against residents age 60 and older were reported to authorities.

The VEPT program — initially funded by a small grant from The John A. Hartford Foundation (a Kaiser Health News funder) and now fully funded by the Fan Fox and Leslie R. Samuels Foundation — includes Presbyterian Hospital emergency physicians Tony Rosen, Mary Mulcare and Michael Stern. These three doctors and two social workers take turns being on call to respond to signs of elder abuse. Also available when needed are psychiatrists, legal and ethical advisers, radiologists, geriatricians and security and patient-services personnel.

“We work at making awareness of elder abuse part of the culture in our emergency room by training the entire staff in how to recognize it,” said Rosen. It’s easy for the ER staff to alert the VEPT team and begin an investigation, he said.

A doctor interviews the patient and conducts a head-to-toe physical exam looking for bruises, lacerations, abrasions, areas of pain and tenderness. Additional testing is ordered if the doctor suspects abuse.

“Unlike with child abuse victims, where there is a standard protocol in place for screening, there is no equivalent for the elderly, but we have designed and are evaluating one,” said Rosen.

The team looks for specific injuries. For example, radiographic images show old and new fractures, which suggest a pattern of multiple traumatic events. Specific types of fractures may indicate abuse, such as midshaft fractures in the ulna, a forearm bone that can break when an older adult holds his arm in front of his face to protect himself.

When signs of abuse are found but the elder is not interested in cooperating with finding a safe place or getting help, a psychiatrist is asked to determine if that elder has decision-making capacity. The team offers resources but can do little more if the patient isn’t interested. They would have to allow the patient to return to the potentially unsafe situation.

Patients who are in immediate danger and want help or are found not to have capacity may be admitted to the hospital and placed in the care of a geriatrician until a solution can be found. Unlike with children and Child Protective Services, Adult Protective Services won’t become involved until a patient has been discharged, so hospitalization can play an important role in keeping older adults safe.

During the first three months of the program, more than 35 elders showed signs of abuse, and a large percentage of them were later confirmed to be victims. Changes in housing or living situations were made for several of them.

“It’s difficult to identify and measure appropriate outcomes for elder abuse victims, because each patient may have different care goals,” said Rosen, “but we are working on making a case that detection of elder abuse and intervention in the ER will improve the patients’ lives. We also hope to show that it will save money, because when an elder is in a safe place, expensive, frequent trips to the ER may no longer be needed.

The team’s ultimate goal is to optimize acute care for these vulnerable victims and ensure their safety. They plan to work at continually tweaking VEPT to improve the program and to connect to emergency medical, law enforcement and criminal justice services. Eventually, they hope to help other emergency departments set up similar programs.

* Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.