NACCM Exam

Elder Abuse Perpertrators

1 out of 10 experience abuse, 90% of abusers are family members, less than 20% get reported, Most elder abuse cases happen in the home or the home of the caregiver, perpetrators usually family members (adult children, spouses, partners or others). Victims are often confused about this abuse.

Professional Ethics

A care manager must demonstrate integrity, loyalty & responsibility, promoting benefits & avoiding harms, respect for clients rights & dignity, justice.

What is a Living Will?

A document in which you state your wishes about life-sustaining medical treatment if you are terminally ill, permanently unconscious, or in the end-stage of a fatal illness. These are not recognized as legal documents in every state

What is a Power of Attorney?

A durable power of attorney is a written instrument that allows an individual, called the "principal", to designate someone else as his or her "attorney-in-fact", or "agent", to act on that principal's behalf. DPOA Authority includes: Property dealings, Ability to contract. Access & use of financial resources, Ability to gift, person can have multiple people assigned as an agent -ensure can work together, Third parties may rely upon the authority granted in the POA until the third party receives written notice otherwise, May contain language to include health care decisions Always request copy -individuals should not give away originals unless necessary Ability to contract & give consent; also ability to make gifts Durable power of attorney survives incapacity Immediately effective once executed (unless "Springing") No longer valid once principal dies, if revoked in writing, if principal is determined totally incapacitated.

Special Needs Trust

A special needs trust is a trust designed for beneficiaries who are disabled, either physically or mentally. It ensures that the person will be taken care of for the rest of their lives and ensures eligibility to obtain public benefits such as Medicaid or SSI. It must be irrevocable.

Legal Assessment

Advanced directives (end of life care), PoA, Healthcare Proxy, Wills and Trusts, Conservatorship/Guardianship,

Substance Abuse

Alcohol Use Screening & Assessment

What is the function of a Healthcare Proxy/Surrogate?

All health care decisions Provide informed consent Make decision believes principal would make if able Best interest (if surrogate does not know your wishes) Withhold or withdraw treatment Written consent for DNR

Risk Reduction Strategies

Assess: Identify risks--Prioritize most serious / imminent risks; Plan: Reduce/eliminate the highest risks, Involve client as much as possible, Think, "least restrictive alternative" Plan Regroup: Engage informal supports if necessary/possible, When serious risks can't be reduced, engage formal systems (APS, courts) if necessary Keep at It: Gradually reduce as many risks as possible, continue to build relationship with the client.

Cornerstones of Ethics in Practice--Cornerstone#1

Autonomy vs. Safety: Freedom of choice, self determination, freedom from coercion & control

Strategies to Overcome Resistance#3

Be peristent: Don't give up, engage others in consultation/supervision (support for the professional, ideas for intervention, did I miss something?)

What is the balancing act?

Between Safety and independence of client

Systems--Ecological Assessment

Bio-psychosocial -Age related change is a fact of life •Physical (Illness, ADL's, IADL's) •Cognitive (calculation, orientation, memory) •Psychological (personality, mood, affect) •Social (Lifestyle, socialization, support) •Spiritual (making meaning, connectedness) •Ecological -Focus on person-in-environment •Considers the person in relation to the larger social context •Environmental Press

Strategies to Overcome Resistance#1

Build Trust: Establish therapeutic alliance / rapport •Start where the client is (narrative, culture) •Set realistic goals with the client •Pace interventions

Americans With Disabilities Act Req's.

Came into law in 1990. The ADA is a civil rights law that prohibits discrimination against individuals with disabilities in all areas of public life, including jobs, schools, transportation, and all public and private places that are open to the general public. The purpose of the law is to make sure that people with disabilities have the same rights and opportunities as everyone else. It covers employment, State or Public programs, activities, transportation, physical layouts re: businesses or enabling people to serve people better with communication issues, the telecommunication area (making it easier for people), finally (not allowing state laws to discriminate, etc.).

Care Planning: Identifying Goals

Client focused-measurable--realistic--clear and concise--mutually agreed upon--time limited.

Obstacles that impact implementation

Communication problems, Conflict, Denial, Resistance, Apathy, Psychological illness, Dependency, Behavior problems, Cultural misunderstandings

Cornerstones of Ethics in Practice--Cornerstone#2

Confidentiality: An agreement to not reveal any information about a person or situation except under conditions agreed to by that person or mandated by law.

Relational Autonomy (Holstein)

Considers the narrative & relational aspects of autonomy Autonomy is supported & maintained through relationships Give voice to those involved (narrative) Work toward fulfilling the person's needs Does the choice have meaning for the person or is it a false choice? (offer meaningful choices, not just choices)

Cross Cultural Perspectives

Cultural Competence" is an admirable goal; BUT . . . ? •Can we really know everything about a culture? •WE ALL have unconscious stereotypes of 'others; •Our stereotypes become a safety net to explain behavior. •Cultural Humility is a life long process •Cultural Humility is about accepting our limitations •Cultural Humility is about increasing our awareness of our own biases •Cultural Humility requires vigilant self-awareness •Cultural Humility requires the 'client is the expert'

Fine Print for Durable Power of Attorney

DPOAs are NOT recognized by federal agencies such as the VA and the Social Security Administration -each has its own process for determining representation or fiduciary •DPOAs can be very broad or have restrictions •DPOAs do not expire yet many places refuse to recognize "old" documents (more than a few years old) so may need to be re-certified by the attorney who originally executed. •Many people download forms from the internet but then not tailored for their specific situation

Ethical Challenges: Decisions

Decisional capacity is rarely all or nothing

Def. of Client Relationship: Professionalism of the Practice (ALCA Standards of Practice)

Definition of role, Plan of care, Knowledge of employment laws, Undertaking fiduciary responsibilities, Continuing education, Certification

Kubler-Ross: "Stages" of Grief

Denial, anger, bargaining, depression, and acceptance.

Alcohol Abuse: Treatment

Detoxification should be done in hospital setting. Inpatient programs, day treatment or outpatient therapy. Disulfiram (Antabuse) -not recommended due to increased risk of serious side effects.

Definition of a Will

Document executed by an individual directing how his/her estate is to be distributed after his/her death •Does NOT give authority to the executor (or other responsible person as the titles differ by state) to do anything during the individual's lifetime •Must have legal capacity to execute a will •Will s may be simple or very complex

Ethical Challenges : Dual & Contradictory Mandates

Dual & Contradictory Mandates: honor the client's choices and protect the client from harm.

Definition of Elder Abuse

Elder mistreatment (i.e. abuse and neglect) is defined as intentional actions that cause harm or create a serious risk of harm (whether or not harm is intended) to a vulnerable elder by a caregiver or other person who stands in a trust relationship to the elder. This includes failure by a caregiver to satisfy the elder's basic needs or to protect the elder from harm.

Strategies to Overcome Resistance#2

Engage Support Networks: Informal & Formal

Developmental Theories

Explain human cognitive and moral development of the individual •Provides context for understanding connectedness, capacity and motivation of individual •Although relevant, they are dated and not without some controversy

Alcohol Abuse and the Elderly

Fastest growing problem, frequently underestimated, underdiagnosed, and undertreated, 4 out of 5 seniors seeking treatment for substance abuse have problems with alcohol vs. other drugs, 9% of Medicare beneficiaries drink 30+ drinks per month and more than 4 drinks in one sitting

Elder Abuse

Federal Law doesn't address the elder abuse. Federal legislation does fund the national center for elder abuse NCEA. all 50 states have APS programs for victims. Most elder abuse laws are similar to child abuse laws and don't have an age cap. There is an elder mistreatment assessment.

Def. of Client Relationship: Business Policies

Fees for service, Advertising & Marketing, Disclosure of business relationships, NACCM

Death and Dying: Hospice care

Focuses on quality rather than length of life Humane and compassionate care during last phases of life Generally not started soon enough Covered under Medicare

Interaction of Formal or informal support systems

Formal supports are typically individuals from organizations or agencies that provide help or a service to the family (e.g., early intervention provider, physician, social service case manager, meal program, day center, referral to professionals, home health). Informal supports are people who are part of the family's personal social network. They might be related to the family (e.g., maternal grandmother, sister) or they might be a friend, a neighbor, a colleague from work, or members of a faith-based community. Semi-formal: faith community, clubs.

Examples of Human Development Theory: Freud

Freud's Theory of Psychosocial Development. -- personality develops during childhood. The personality develops through a series of childhood states with pleasure seeking energies of the ID, with psychosocial energy, or libido (driving force of the behavior). If the stages aren't completed, fixation can occur (remain stuck). Stages (oral, anal, phallic, latent period (development of ego and superego), genital phase. Integration of ID, Ego, and Supereo into a "whole-healthy-gestalt. Could help to explain person's capcity for change, motivations, and behaviors.

Elder Abuse: APS

Funded through the state government. Interventions include Receiving and investigating reports •Evaluating victim •Assessing victim's ability to understand risk and give informed consent •Drafting a case plan •Arranging for care •Monitoring of care

Assessing Mood

Geriatric Depression Scale, Cornell Scale for Depression in Dementia

Working Through Dilemmas

Get the facts: Identify the ethical issues (if any), Identify stakeholders, Consult colleagues and supervisors, Review relevant ethical codes, standards, laws, policies, regulations and literature, Obtain legal consultation if necessary, Evaluate the alternatives, Make a decision and test it, Document decision-making steps, Reflect on the decision and make adjustments if necessary

Overview of Care Mgmt Across Settings

Goal: Achieve & maintain optimal functioning, Coordinate care, Improve outcomes Process: Find out what's needed & why (assess) Orchestrate best plan, Track outcomes (metrics) Method: Assess, Advocate, Mobilize, Stabilize, Monitor, Continuity, Reassess, Terminate Approach: Person-centered, Across continuum, Empowering

Grief and Loss

Grief is experienced after the loss of a spouse and sometimes leads to depression.

Importance of Supervision

Helps clarify the issues--Deals with transference/counter transference--Offers opportunities for more options--Mediates among various "rights"--Assures flexibility over time--Enhances cultural sensitivity--Self evaluation/development

Risk Management Documentation

History of the client interactions & plans (continuity of care), Protection against liability (risk management), Attempts to educate decision makers about all realistic options, Demonstrates advocacy & fostering of self determination, Clarifies conflicts, values and potential outcomes within the dilemmas

Assessment -- Outcome

Identify & prioritze problems, set goals, implement plan, achieve success!

Care Planning

Identify areas of concern, Prioritize issues with input from client, Identify options/interventions including their pros/cons, Develop plan based on the priorities and goals of the client, Determine tasks that need to be done and by when, Determine how often to see the client

Implementation of the Care Plan

Identify: Resources, services and referrals -- Educate: General, Specific -- Manage Expectationss: Client, Providers, Stakeholder -- Communicate: Client, Provider, Stakeholders -- Implement: Plan, Coordinate, Evaluate. All this is done in a timely, prioritized, agreed upon manner.

Def. of Client Relationship : Client Relationship (ALCA Standards of Practice)

Identifying the client, Self determination, Right to privacym Recognition of personal values & beliefs, Professionalism of the relationship, Continuity of Service, Termination

Capacity--Risk Assessment Model (Soniat/Micklos)

If High risk/high capacity: accept client's right to self determination. If High risk/moderate capacity: reduce resistance; reduce risk; increase capacity If High risk/low capacity: Intervention required up to and including legal guardianship.

Adult Learning Theory

Image result for Adult learning theory The Adult Learning Theory - Andragogy. Malcolm Shepherd Knowles (1913 - 1997) was an American educator well known for the use of the term Andragogy as synonymous to the adult education. According Malcolm Knowles, andragogy is the art and science of adult learning, thus andragogy refers to any form of adult learning. Adult learning is self-directed/autonomous, Adult learning utilizes knowledge & life experiences, Adult learning is goal-oriented, Adult learning is relevancy-oriented, Adult learning highlights practicality, and Adult learning encourages collaboration.

Financial Assessment

Income, resources & assets, expenses, benefits, entitlements.

Cornerstones of Ethics in Practice--Cornerstone#3

Informed Consent or Authorization to exchange information: Extent of information, Client expectations/understanding/agreement, Care manager obligations

Care Management Process Flow

Intake-assessment-care planning-implement care plan and monitoring-reassessment-termination of services.

Practice of Care Management

Is consumer/client/patient/person centered, Involves care coordination, Requires specific skills, Promotes service quality, Attempts to use resources efficiently, Requires on-going training & experience, Requires knowledge of populations

Indicators that client is at risk for financial exploitation

Isolation, loneliness, recent losses, physical or mental disabilities, lack of familiarity with financial matters, having family members who are unemployed and/or have substance abuse problems.

Change Theory

Kurt Lewin introduced his field theory concepts, emphasizing that the group differs from the simple sum of its parts. Lewin coined the term group dynamics in 1939. His field theory states that "one's behavior is related both to one's personal characteristics and to the social situation in which one finds oneself." Theory of Change is essentially a comprehensive description and illustration of how and why a desired change is expected to happen in a particular context.

Guardianship/Conservatorship Disadvantages

Last resort Intrusion of the court into the individual's life and into the life of the family Rigid and burdensome reporting requirements; The expense of setting up and maintaining a guardianship The delay in transacting the financial affairs of the ward because of necessary court approvals

What are examples of Advanced Directives?

Living will -as noted, may not be recognized as legal document in every state •Five Wishes -a nationally recognized format for individuals to give instruction to their health care agents •Personal Directive -individually drafted instructions -there are written formats developed by many organizations •MOLST (Medical Order for Life Sustaining Treatment) or POLST (Physician Order for Life Sustaining Treatement) -becoming more widely used in various states to document wishes and to ensure that wishes are followed across the care continuum. Wishes include DNR, DNI, DNH, feeding tubes, antibiotics and more •Comfort Care -generally a physician directed order regarding DNR (do not resuscitate) orders

Estate Planning Documents

Living will, Powers of Attorney/Durable Powers of Attorney, health care proxy, HIPAA Releases, Advanced Directives

Death and Dying: Signs and Symptoms

Loss of appetite Excessive fatigue and sleep Increased physical weakness Mental confusion Labored breathing Social withdrawal Changes in urination Swelling in feet and ankles Coolness in tips of fingers and toes Mottled veins

Ethical Challenges: Complex Issues

Many complexities to every situation

Impact of spirituality on health

Many researchers believe that certain beliefs, attitudes, and practices associated with being a spiritual person influence health. ... Qualities like faith, hope, and forgiveness, and the use of social support and prayer seem to have a noticeable effect on health and healing. Faith. There is an Assessment of Spirituality in Older Adults FICA Spiritual History Tool

Medicare

Medicare -Care for Aged and Disabled Federally funded Entitlement program-if you paid into the system, you are entitled to the benefits For persons 65+ or disabled by Social Security standards (plus 2 year waiting period -except for special rules for persons with End Stage Renal Disease and ALS) Relatively consistent set of rules as not means tested Does NOT pay for long term care beyond rehab days

Cognition -- Assessment

Memory, Comprehension, Judgment/Executive function, Problem solving, Financial management, Consistency with prior lifestyle and preferences

Self Neglect

Mentally competent person understands consequences that their acts do threaten health and their safety.

Communicable Diseases such as MRSA, TB, HIV

Methicillin-resistant Staphylococcus aureus (MRSA) infection is caused by a type of staph bacteria that's become resistant to many of the antibiotics used to treat ordinary staph infections. Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis (MTB). Tuberculosis generally affects the lungs, but can also affect other parts of the body. Most infections do not have symptoms, known as latent tuberculosis. HIV: human immunodeficiency virus, acquired immunodeficiency syndrome. As HIV progresses, the virus attacks and destroys immune cells, leaving the immune system unable to fight off other diseases and infections. When this happens, the HIV infection can lead to the development of AIDS. Acute HIV is contagious.

Hospice Care: Services

Pain and Symptom Control Home Care and Inpatient care Spiritual guidance Family meetings Respite Care Bereavement care Team Approach

Categories of Elder Abuse

Physical abuse, sexual abuse, emotional and psychological abuses, financial exploitation, abandonment/neglect, and self neglect.

Caregiver Assessment

Preparedness for Caregiving Scale, The Modified Caregiver Strain Index

3 Main HIPAA Rules

Privacy Rule focuses on when and to whom confidential patient information can be disclosed., Transaction Rule addresses technical aspects of the electronic health care transaction process and requires the use of standardized formats whenever health care transactions, such as claims, are sent or received electronically., Security Rule seeks to assure the security of confidential electronic patient information.

If Healthcare Proxy is not designated

Proxy provisions vary by state law but typically is a spouse, child/children or other family members.

Decision making process includes

Quality of life issues, Cultural identity of client & family system, Relationships with entire support system, Religious/spiritual/philosophical beliefs, Economic issues, Personal ability to handle loss, pain, etc., Clarification of what is important, possible & desired

Neglect

Refusal or failure to fulfill any personal obligations for this individual

Cornerstones of Ethics in Practice--Cornerstone#4

Relationships: Trust, nature of contact, goals and actions.

What is autonomous decision making?

Requires a competent person -- Who is informed; Who has a range of options & choices; Who can absorb information about options & choices; Who wishes to be autonomous; & Who can form a partnership with a provider to obtain their choices and articulate their choices.

Crisis Theory: Resolution

Resolution depends on achieving equifinality Integration into the fabric of life Readiness of face future Severity and Duration of precipitating event Personal resources -Formal & Informal Supports Personal strength -Spiritual Supports Prior experience & Prior Coping Skills)

Ethical Challenges: Freedom is Limited because

Resources are scarce, choices are limited

When evaluating the client you are looking at

Resources, supports, cultural norms, capacity, nature of the problem, consequences, and level of risk.

Care Planning: Process (continued)

Review & reflect all domains of the assessmentm Document findings & recommendations, Report writing when appropriate, Continue educational process, emotional support and prioritizing through the implementation process, Create time and task expectations, Agree on next steps

Maslow's Grand Theory

Self Actualization-Morality, creativity, spontaneity, problem solving, etc. Esteem--Self-esteem, confidence, achievement, etc. Love/Belonging--Friendship, family, sexual intimacy Safety--Security of body, employment, resources, morality, the family, health, property, Physiological--breathing, food, water, sex, sleep, homeostasis, excretion. People are motivated to take care of lower-order needs before higher order needs.

Alcohol Effects and the Elderly

Sensitivity to alcohol increases with age Alcohol causes increased health problems Interacts poorly with prescription meds Signs of Alcohol Abuse •Non adherence with medical appointments •Poorly controlled HTN •Recurrent accidents and falls •Unexpected delerium •Unpredictable coumadin levels

Sexuality Assessment

Sexuality Assessment in Older Adults

Care Planning: Process

Start with the client's definition of needs, Identify areas of risk & risk tolerance, Educate re: issues & resources, Prioritize needs, Clarify process, Team building, Advocacy, Consensus building

Crisis Theory

Suggest that unresolved bereavement from earlier losses (of a person, a relationship, security, capacity, and a dream) affects not only one's reactions to subsequent crises. Situational or Developmental Situational, brief, temporary state Developmental, more predictable Failure of prior problem solving Disorganization & Disequilibrium Vulnerability & Reduced Defensiveness Opportunity for developing resilience Threat of Decompensation and Acute Dysfunction

Another Grand Theory: Systems--Ecological Theory

Systems Theory; A change in any one part of a system, will result in a change in other parts of the system •Micro Level -From cell to self •Working with the Individual •Macro Level -From self to others (family) •Working with Intergenerational Family Systems •Advocating on interdisciplinary teams •MesoLevel -From family to community & Agency to Agency •Working with and advocating for families -providers -policy makers

HIPAA Overview

The Health Insurance Portability and Accountability Act (HIPAA) resulted from a bill sponsored by Senators Nancy Kassebaum(R-KS) and Edward Kennedy (D-MA). HIPAA was signed into law in 1996. •The HIPAA law was designed to: Protect Americans who were previously ill from losing their health insurance when they changed jobs or residences., Streamline the health care system by adopting consistent standards for transmitting electronic health care claims in a uniform manner., Protect the privacy of an individual's health-related information and securing the storage of such information.

Indicators that client is in need of guardian (non-financial decisions--where the ward lives and what type of medical care the ward gets) and conservator (making financial decisions--preserves the estate of the ward).

The court arranges for a person or co. to make certain decisions for another person (the ward). This is set up when the person's decision making capacity is so impaired that the person is unable to care for his/her own personal safety or to provide for his/her necessities. The person must be a risk of physical injury or illness. It protects person unable to help themselves & refuses help. It is a deterrent to individuals who might wish to take advantage of the ward. deterrent to those who might wish to improperly use the wards assets. Both guardianship and conservatorship are court processes -expensive and public •A medical certificate from a physician is required to move forward with a petition

Family Systems Theory

The family systems theory is a theory introduced by Dr. Murray Bowen that suggests that individuals cannot be understood in isolation from one another, but rather as a part of their family, as the family is an emotional unit. Dynamic processes of a family and structures •Families members can't be understood in isolation •Behavior patterns (Roles/Memberships) develop in predictable ways •Homeostasis is goal: Balance or Dysfunction •a system of overlapping and intertwining relationships •Each family member remains constantly connected along with conditions of accessibility & acceptability •Not always clearly stated or understood

Examples of Human Development Theory: Erikson

Theory of Psychosocial Development--series of stages through a lifespan (different than Freud). Ego identity changes due to new experiences. Within each stage there is conflict serving as a turning point in development potential for growth is high, but there is potential for failure. The last stages were added later. * Not every culture rewards autonomy. First Stage: Trust vs. Mistrust --(if child feels safe, they trust the world vs. world is inconsistent/unpredictable, 2nd Stage: Autonomy vs. Shame & Doubt (devl sense of personal achievment vs. self doubt), 3rd Stage: Initiative vs. Guilt (through social interactions, develop a sense of pride or doubt abilitites, 4th Stage; Industry vs. Inferiority, 5th Stage: Identity vs. Confusion, 6th Stage: Intimacy vs. Isolation (developing close committed relationships vs. loneliness), 7th Stage: Generativity vs. Stagnation (during adulthood continue to build lives, career, family. 8th Stage: Integrity vs. Despair (reflecting back on life -- if viewed as unsuccessful then feel life was wasted, if proud of accomplishments, then feel a sense of integrity.

What is a living will and Durable Powers of Attny for Healthcare

They are both types of Healthcare Advance Directives. The person you name is called your agent, proxy, representative, or surrogate. Any document that gives instructions about your health care and/or appoints someone to make medical treatment decisions for you if you cannot make them for yourself.

Cornerstones of Psychoanalytical Theory

Transference -Displacement of unresolved conflicts onto care manager •Counter Transference -Care Manager's displacement of unresolved conflicts to client •Defense Mechanisms: Repression, Reaction Formation, Denial, Projection, Displacement, Sublimation, Regression and Rationalization •Resistance [non-compliance] is Fear Disguised •DO NOT try to remove/change defense mechanism unless your are certain the person is ready for change!

Family Theory's 8 Core Concepts

Triangles Triangulation = Strangulation Differentiation of self Nuclear Family Emotion Process Family Projection Process Multigenerational Transmission Process Emotional Cutoff Sibling Position Societal Emotional Process

Cognitive Assessment

Unstructured: based on info from family member or asking older adult to perform a sequential task, identifying people in a photo, having informal conversation using factual q's at different times and asking them again at different times to show inconsistencies. Asking older adult how is her/his cognitive functioning -- self perception/lack awareness. Or formal: MMSE (mini-mental status exam) 30 q's -- concentration, language, orientation, memory, and attention. There is also short portable mental status questionnaire (10 q's), clock drawing, etc. SLUMS, Mini-Cog, MoCA, MMSE, Brief Evaluation of Executive Functioning, Clock Drawing, Word Association Test, Trail Making Test (written & oral versions), Confusion Assessment Method (delirium)

Risk Assessment Methods

Use a what-if analysis to identify threats and hazards. What-if questions are asked about what could go wrong and about what would happen if things do go wrong. Use a checklist of known threats and hazards to identify your threats and hazards., Use a combination of checklists and what-if analysis to identify your threats and hazards. Use a hazard and operability study (HAZOP) to identify your threats and hazards. Use a failure mode and effect analysis (FMEA) to identify potential failures and to figure out what effect failures would have. Use a fault tree analysis (FTA) to identify all the things that could potentially cause a hazardous event.

Learning Theory

Watson and Skinner insisted that learning occurs purely through processes of association and reinforcement. Bandura believed in observational learning.

Person Centered Approach

What is Important FORPerson •What is needed to keep person safe and healthy •What do others see as important FOR person to be a valued member of the 'family/community' What is important TOthe Person •What matters to the person? •What are things that generate quality of life? •What are they telling us by words and behaviors?

When is a POA revoked

When principal dies, when principal revokes the document, when Principal is adjudicated as incapacitated -but may remain in place if durable.

Legal and financial vehicles for financing care such as special needs trusts

You can contribute property, stocks, collections, a business, patents, jewelry to the special needs trust. The person who creates a special needs trust often makes the initial transfer of assets into the trust—usually, just a small amount of money. Then, commonly, a parent, grandparent, or other relative leaves property to the trust by: leaving it through a will or revocable living trust directly to the trustee of the special needs trust, or naming the trustee of the special needs trust as a beneficiary on a designation form that controls what happens to a deposit or brokerage account, retirement plan, or stocks and bonds.

Abuse, neglect or exploitation issues

inflicting physical force resulting in bodily injury, inflicting pain or impairment (sexual or non-consensual contact), emotional or psychological abuse, inflicting pain, distress, or creating anguish, or financial or material exploitation -- illegal or improper handling of the elder's funds or properties, abandonment like a desertion of elder/individual for which they have custody or not finding place for this care for

Instrumental activities of daily living

medication, meal prep, shopping, housekeeping, laundry, telephone, travel, and finances.

Activities of Daily Living

transfer, walking, wheeling, bowel, bladder, mobility, bathing, dressing, eating, and feeding.