Tag Archives: #oasisoflove

To Collect Debts, Nursing Homes Are Seizing Control Over Patients

From The New York Times: A New York State statute to protect the infirm has become a routine tool for nursing homes to ensure bills are paid.

Lillian Palermo tried to prepare for the worst possibilities of aging. An insurance executive with a Ph.D. in psychology and a love of ballroom dancing, she arranged for her power of attorney and health care proxy to go to her husband, Dino, eight years her junior, if she became incapacitated. And in her 80s, she did.

Mr. Palermo, who was the lead singer in a Midtown nightclub in the 1960s when her elegant tango first caught his eye, now regularly rolls his wife’s wheelchair to the piano at the Catholic nursing home in Manhattan where she ended up in 2010 as dementia, falls and surgical complications took their toll. He sings her favorite songs, feeds her home-cooked Italian food, and pays a private aide to be there when he cannot.

But one day last summer, after he disputed nursing home bills that had suddenly doubled Mrs. Palermo’s copays, and complained about inexperienced employees who dropped his wife on the floor, Mr. Palermo was shocked to find a six-page legal document waiting on her bed.

It was a guardianship petition filed by the nursing home, Mary Manning Walsh, asking the court to give a stranger full legal power over Mrs. Palermo, now 90, and complete control of her money.

Few people are aware that a nursing home can take such a step. Guardianship cases are difficult to gain access to and poorly tracked by New York State courts; cases are often closed from public view for confidentiality. But the Palermo case is no aberration. Interviews with veterans of the system and a review of guardianship court data conducted by researchers at Hunter College at the request of The New York Times show the practice has become routine, underscoring the growing power nursing homes wield over residents and families amid changes in the financing of long-term care.

In a random, anonymized sample of 700 guardianship cases filed in Manhattan over a decade, Hunter College researchers found more than 12 percent were brought by nursing homes. Some of these may have been prompted by family feuds, suspected embezzlement or just the absence of relatives to help secure Medicaid coverage. But lawyers and others versed in the guardianship process agree that nursing homes primarily use such petitions as a means of bill collection — a purpose never intended by the Legislature when it enacted the guardianship statute in 1993.

At least one judge has ruled that the tactic by nursing homes is an abuse of the law, but the petitions, even if they are ultimately unsuccessful, force families into costly legal ordeals.

“It’s a strategic move to intimidate,” said Ginalisa Monterroso, who handled patient Medicaid accounts at the Mary Manning Walsh Nursing Home until 2012, and is now chief executive of Medicaid Advisory Group, an elder care counseling business that was representing Mr. Palermo in his billing dispute. “Nursing homes do it just to bring money.”

“It’s so cruel,” she added. “Mr. Palermo loves his wife, he’s there every single day, and they just threw him to the courts.”

Brett D. Nussbaum, a lawyer who represents Mary Manning Walsh and many other nursing homes, said Mr. Palermo’s devotion to his wife was irrelevant to the decision to seek a court-appointed guardian in July, when the billing dispute over his wife’s care reached a stalemate, with an outstanding balance approaching $68,000.

The Palermos at the Mary Manning Walsh Nursing Home, which had tried to obtain guardianship over Mrs. Palermo. Credit Piotr Redlinski for The New York Times

“The Palermo case is no different than any other nursing home bill that they had difficulty collecting,” Mr. Nussbaum said, estimating that he had brought 5,000 guardianship cases himself in 21 years of practice. “When you have families that do not cooperate and an incapacitated person, guardianship is a legitimate means to get the nursing home paid.”

Guardianship transfers a person’s legal rights to make some or all decisions to someone appointed by the court — usually a lawyer paid with the ward’s money. It is aimed at protecting people unable to manage their affairs because of incapacity, and who lack effective help without court action. Legally, it can supplant a power of attorney and a health care proxy.

Although it is a drastic measure, nursing home lawyers argue that using guardianship to secure payment for care is better than suing an incapacitated resident who cannot respond.

Mr. Palermo, 82, was devastated by the petition, brought in the name of Sister Sean William, the Carmelite nun who is the executive director of Mary Manning Walsh. “It’s like a hell,” he said last fall, speaking in the cadences of the southern Italian village where he grew up in poverty in a family of eight. “Never in my life I was sued for anything. I just want to take care of my wife.”

A court evaluator eventually reported that Mr. Palermo was the appropriate guardian, and questioned why the petition had been filed. But the matter still dragged on, and Mr. Palermo, who had promised to pay any arrears once Medicaid completed a recalculation of the bill, grew distraught as his expenses fighting the case reached $10,000.

In the end, Medicaid’s recalculation put his wife’s monthly copay at $4,558.54, almost $600 less than the nursing home had claimed, but still far more than the $2,642 Mr. Palermo had been paying under an earlier Medicaid calculation. As soon as the nursing home cashed his check for the outstanding balance, it withdrew the guardianship petition.

“They chose to use a strong-arm method, asking for somebody to be appointed to take over her funds, hoping for a rubber stamp to do their wishes,” said Elliott Polland, Mr. Palermo’s lawyer.

Many judges go along with such petitions, according to lawyers and others involved in the process. One judge who has not is Alexander W. Hunter Jr., a longtime State Supreme Court justice in the Bronx and Manhattan. In guardianship cases in 2006 and 2007, Justice Hunter ordered the nursing homes to bear the legal costs, ruling they had brought the petitions solely for the purpose of being paid and stating that this was not the Legislature’s intent when it enacted the statute, known as Article 81 of the Mental Hygiene Law.

Last year Justice Hunter did appoint a guardian in response to a petition by Hebrew Home for the Aged at Riverdale, but in his scathing 11-page decision, he directed the guardian to investigate and to consider referring the case for criminal prosecution of financial exploitation.

The decision describes a 94-year-old resident with a bank balance of $240,000 who had been unable to go home after rehabilitative treatment because of a fire in her co-op apartment; her only regular visitors were real estate agents who wanted her to sell. After Hebrew Home’s own doctor evaluated her as incapable of making financial decisions, the decision says, the nursing home collected a $50,000 check from her; it sued her when she refused to continue writing checks, then filed for guardianship.

“It would be an understatement to declare that this court is outraged by the behavior exhibited by the interested parties — parties who were supposed to protect the person, but who have all unabashedly demonstrated through their actions in connection with the person that they are only interested in getting paid,” he wrote.

Photographs of the Palermos from the late 1960s. Mrs. Palermo, now 90, has been living at the nursing home since 2010. Credit Nina Bernstein/The New York Times

Jennifer Cona, a lawyer for the nursing home, called the decision “grossly unfair to Hebrew Home,” but said she could not discuss details because the record was sealed.

Many cases in which judges grant nursing homes’ guardianship petitions never come to light. But one that challenges the legal propriety of such petitions for bill collection is now pending before the Appellate Division of the State Supreme Court. Without explanation, that record, too, is sealed from public scrutiny.

“There is no transparency in the whole process,” said Alexandra Siskopoulos, a lawyer who represents a relative of the nursing home resident in the appellate case — a relative who had wanted to take the resident home. “Unfortunately, people’s eyes are not opened until it’s their family member, and at that point, it’s too late.”

Throughout the country, data is lacking on the most basic facts about guardianships, even how many there are. In New York State, with different rules in 62 counties and no centralized database, it has taken a team of researchers more than two years to collect information from a fraction of case files in 14 counties, said Jean Callahan, the director of the Brookdale Center on Healthy Aging at Hunter College.

Preliminary findings of the center’s study are not expected until later this year, but at the request of The Times, the researchers undertook a breakdown of the petitioners in a sample of the 3,302 guardianship cases filed in Manhattan from 2002 to 2012. More frequent petitioners than nursing homes (12.4 percent) were hospitals (16.1 percent), friends and family (25.3 percent) and Adult Protective Services (40.1 percent).

New York’s guardianship statute was part of a national movement to limit guardianships to the least restrictive alternatives necessary to prevent harm. A petition is supposed to be brought only by someone with the person’s welfare at heart, and guardianship is to be tailored to individual needs, taking into account the person’s wishes.

Instead, Ms. Callahan said, “it has become a system that’s very focused on finances.”

One afternoon, Mrs. Palermo dozed in her wheelchair while her husband described their careful preparations for old age, and the shock of discovering that papers drawn up by an elder law specialist were insufficient protection.

He recalled the fear and anger he felt when he first read the nursing home’s petition, on his bus ride back to a rent-stabilized apartment on East 36th Street filled with mementos of their happy marriage. They have no children. “Who better than me, the husband for 47 years, that she gave power of attorney?” he asked.

As his voice grew anguished, Mrs. Palermo began to moan and cry out incoherently. “Are you O.K., baby?” he asked, jumping up to embrace her. “Now, don’t do that. Come on, give me a hug.”

He soothed her in Italian, speaking of the polenta he had made for her that morning. He wheeled her to the dining room. Later, he would serenade her.

But in the night, again he could not sleep for worry. He fingered drafts of his own petitions, hand-lettered pages that he debated sending to nursing home administrators. One was addressed “To God and to whom it may concern.”

“I’m trapped in a web of people and lawyers that will exhaust my 50 years of sacrifices and savings,” he wrote. “Please, dear God, grant me strength and wisdom to take care of my wife.”

If not now, then when?

Love Is The Best Medicine & The Soul Of A Farmer
By Lisa

I would describe Jatayu’s situation as being similar to watering a garden with roundup. Dying a slow death.

He has been a farmer and lived on fresh vegetables his whole life. In tune with nature, in touch with the seasons, one with the outdoor world. Almost every day of his adult life in contact with sunshine, fresh air.

Now he lives on a diet of prescription drugs, confined in a small hospital room where fluorescent lighting has replaced the sun, and the stale, cold recycled air is filled with sickness and death. There are no birds or trees and you never see the sky. There is constant, amplified, artificial, surround sound disturbing noises coming from all directions that even ear plugs would not allow one to escape.

They keep him sedated to keep him calm. Yes he has a heart condition, but he doesn’t like having to take to take ten different drugs or endure their severe and countless side effects.

He enjoyed the carrot juice I brought for him but was so weak he could barely hold the cup to drink it. We joked that I didn’t grow the carrots but I juiced them. We wanted to take him for a walk outside, in a wheelchair, a little fresh air after almost 3 weeks in this environment. But the nurse said no. That they didn’t want to stimulate him because he could get upset. I would be more than upset in his condition too. So we opted for a few slow laps around the nurses stations on his floor. He brightened up as we began softly chanting while we walked. Passing door after door, you could not avoid seeing or hearing the sufferings of his neighboring patients. He said he had seen it all since he had been there. Even though a few of the nursing staff were exceptionally joyful and happy to see him, it was a sliver of light in what could be the scene of a twilight zone nightmare movie.

Once you are in this system, you may never get out. I’ve worked in nursing homes before. With all its good intentions and well meaning staff, the patients were kept sedated too, because there wasn’t enough personalism to meet their needs if they were too functional. Many of them wanted to die than live in this kind of hellish prison. I could understand why. I would too. After a few months of seeing the inside of an elder home system and crying myself to sleep on a nightly basis with the sadness I felt, not being able to really help the residents, I quit and went into private duty caregiving, where I could have more personal care and time with the elderly in need.

Jatayu was functional but barely. He has round the clock supervision and is definitely not able to care for himself. He was shaky, unsteady, and had a risk of falling sign on his door and wristband, likely due to the medication. He said there is not much personalism in there and was confused why they can’t they pay the staff more to give better care. His room was a mess and he lacked proper warm clothes and a suitcase. I understand that his state of mind at the time of his car accident was in rough shape, and that all of his possessions are in mixed chaos in his van.

Devaki dd had brought him a cd player, headphones and chanting music to listen to, but the staff don’t have time or interest to manage helping him play it and he thought the batteries had died. So it just sat on his bedside table unused. I asked him what was his favorite kirtan music and he said Prabhupada chanting. So I pulled up one of Prabhupada’s YouTube videos on my phone and played it next to his ear as he laid in bed. He smiled, started crying saying Prabhupada, Prabhupada and soon drifted to sleep.

As my friend Gajendra and I prepared to leave, we leaned over to whisper goodbye. He started to cry again as he expressed to us how grateful he was we came to visit him and began telling us about Haridas Thakur in relation to Sri Chaitanya, how the company of devotees is the most meaningful thing in life.

He said being in a place like that, on so many medications, with no exercise or sunshine makes you wither away. He didn’t think he has long to live and wants to die in the company of devotees. He said he has never suffered like this before and you could tell the experience has left him with a heavy heart, a fragile body and a confused mind.


I left the hospital with my own deep sadness and confusion. How is it possible that there is no solid, functioning, fully funded Krishna Conscious, devotee living option, center(s), for those in need, whether senior citizens, hospice care, disabled, homeless? A kind of spiritual retirement farm of low income or high means, anywhere in Alachua, in Florida, in the US or the entire world? Those residents with means would pay for care and help offset the expenses of those who could not pay.

Jatayu was moved to a senior care center in St. Pete today for rehab, but I don’t think that’s the kind of rehab that will help him. He wants to stay where there is devotee association.

I am aware and very much appreciate what Gurudas, Aradhana and locally, Devaki of the Vedic Care Charitable Trust is trying to do in this arena. It’s an enormous task and the best and only program it seems that is even addressing this issue in the devotee community. But as wonderful as it is, unfortunately they are not receiving adequate support. Is it possible that we can organize a meeting in Alachua with the VCC team to expedite a plan for increasing their resources, organization and funding?

If I am incorrect in my understanding, that there is no established care home or center, anywhere in the world, at this time, where a devotee like Jatayu would be welcomed, cared for and able to live out the rest of his life in peace, with dignity, in the association and protection of devotional caregivers, would someone please contact us with this information.

With the population of aging devotees growing, why isn’t this kind of service or facility a foundational priority, to uphold the core principals of Krishna Consciousness pivotal to the mission Prabhupada stood for?

What is self sufficiency and sustainability that does not care for devotees in their darkest hour?

What is the point of having countless other types of worldwide spiritual projects if we are not able to provide the most basic caregiving, especially at the end of life?

Why not start teaching our children the importance of self sufficiency, that includes increased awareness around death and dying through intergenerational living programs that train and employ younger caregivers, and farmers?

When I first came to the Alachua community more than 10 years ago, I was most inspired by the simple living, high thinking teachings of the Krishna philosophy. I had never heard of any religion or spiritual organization with this focus, and I had never met a spiritual farmer.

Meeting Jatayu and having a direct, real world experience of these combined principals for conscious living was a core element in furthering my association with the temple and devotees, and I would say a pivotal reason I am still here. It gave me a kind of optimism that there really were people on this planet that had an understanding of the right ways to live in harmony with the Earth while seeking God.

It was a natural step to connect with Jatayu. His bright and bubbly personality mixed with his dedication for returning to natural farming was impactful. He lived and breathed having his hands in the soil and I had a longstanding desire for living in a spiritual, green community. He was always at the temple every Sunday with tables full of produce he had picked that morning. He wanted an ox and told stories of his early days as a devotee farmer. It didn’t take long for us to realize our combined talents and optimism would be able to advance his efforts and greater outreach for organic produce education, and I soon joined his farm to create and manage his first Community Supported Agriculture/CSA farm program.

Soon after that, because of him, I started my first real garden. We laughed at how the deer ate the whole thing, right before harvest time, before I could. From there I grew a multitude of new endeavors and ideas, diving even deeper into connecting gardening and healthier living. My kitchen also became an indoor garden (deer proof) where I experimented and watched in wonder as new things came to life, and turned them into everything from kale chips, hummus, kombucha and wheatgrass juice to fermented vegetables and seed butters. And there were always talks and dreams of having a cottage industry farm business in the devotee community.

Working with Jatayu was the most meaningful right livelihood job experiences I have ever had. One that gave me a new lease on life I wanted to share with the world. I watched in awe as the public and devotees alike sprouted new energy and vitality every time we would set up the vegetable stand, both at the temple and local farmers markets. It brought people together and gave them something to believe in, formed lasting friendships, it motivated a priority for better health, it raised awareness about natural living, a vegetarian diet, Krishna. It was a place many stood in line to talk with Jatayu about farming as they filled their baskets with a rainbow of fresh living foods to feed their families. But more than that, I witnessed them filling and feeding their hearts with hope in something deeper than words can describe. There was an air of truth that became evident in this space, where Krishna smiled and gave his blessing. I miss this time and I miss the Jatayu that I witnessed bringing vibrance, life, love, hope and meaning into the lives of many. I will always remember with great affection, the effect he had on my life.

People may ask, what about this mistake he made, or this thing he didn’t do. I do not judge these things, that is Krishna’s job. But I do want to honor his efforts and successes where he invested his entire life. I think we all would like that people remember the good we did in the world instead of finding judgement with our faults.
I make this plea for his welfare, to create a path of gratitude, returning our appreciation for what he did do to bring attention and real world application to Prabhupada’s mission for self sufficient farm communities.

We may have lost the ability to have him serve as a role model and teacher for devotional farming, but we should not lose the lessons of the seeds he planted.

His heartbreaking circumstance shines light on a beautiful opportunity and raises important questions that can’t be ignored. I can’t help but ask, if this need is not seriously addressed now, then when?

In service,
Hare Krishna
Lisa

The ‘Vedic Care’ Retreat in Paraty ~ Brazil

The Yoga & Ayurveda Retreat will be held in May 2018, in English, Portuguese and Spanish.

The Eco-Village and the Hotel Dharma Shala are in the mountainous jungle on the coast of Rio.

The Eco-Village has:
Many waterfalls in the mountains, near gorgeous preserved beaches; vegetable gardens, cows, exotic tropical birds, wild bananas, tropical fruit trees, fresh ‘ahimsa milk’ and a beautiful temple.

The Retreat offers:
Vegetarian and Vegan organic meals
Daily hikes to different waterfalls
Bhakti & Asana Yoga classes
Ayurvedic teachings
Shamanic experiences & Guided meditation
Vegetarian & Vegan Cooking classes
Kirtan (spiritual music sessions)
Herbal/Botanical Medicine/Natural healing
‘Cinema and the Psyche’ workshop
Murals and basic painting workshop

We will also have music and other performances during a bonfire on the last night.

Massages, one to one therapy with the Ayurveda, Natural Medicine Doctors and Counselors, day or half-day visits to the historic town and preserved beaches nearby can be arranged but are not included.

ROOMS ~ SEMINARS ~ PRICES
Seven Days and Six Nights

For Prices, Packages and the booking form to secure your place, please go to here.

Package prices include all seminars and workshops, its certificates and all meals. Not included: Flights and pickup /drop off at the Rio de Janeiro International Airport.  Pick-ups with our Van (12 persons) cost $60 each way.

Seminars/workshops descriptions are here

The location is near the costal town of Paraty, in the Rio de Janeiro State ~ Brazil.

See our amazing location in the video below or on Vimeo.


HOSTING AND GIVING SEMINARS

GURUDAS: Guided Meditation”, “We’re the Healers”, “History of Western Vaishnavism” with personal reportage photos and films, and “Introduction to Bhakti Yoga”
ARADHANA DEVI DASI: Introduction to Bhakti Yoga ~ Mantra Meditation
CHAITANYA SWARUP DAS: Ayurveda ~ Self Management of Health Seminar. You will learn a mixture of popular interest and advanced Ayurvedic concepts.
Dr. CAROLLE CHAPMAN: The Healing Power of Herbs ~ Our Friends and Supporters in Life, Health and Healing
Brief Introduction of the ancient use of herbs in all cultures to heal, and Introduction to Bhakti Yoga
MATTHEW JOSEPH MORREALE: Cinema and the Psyche workshop.  ‘Cinema and the Psyche’ is an exploring into the nature of cinema, the psyche and how they interrelate.
JODY VAN BRUNT: Asana & Pranayam. “I believe Yoga starts with the breath, if you can breathe you can do Yoga!”
SUE ANN BECK-RYAN: Murals and basic painting workshop
VEGETARIAN & VEGAN COOKING COURSES: Local teacher
KIRTAN: (spiritual music) bhajan leaders from Brazil

Average Weather in April in Paraty

In Paraty, the month of April is characterized by gradually falling daily high temperatures, with daily highs decreasing by 3°F, from 85°F to 82°F over the course of the month, and rarely exceeding 92°F or dropping below 76°F.

Daily low temperatures decrease by 3°F, from 74°F to 70°F, rarely falling below 65°F or exceeding 77°F.

For further details please visit www.vediccare.org/paraty-retreat

All ‘Vedic Care’ Events are to assist the fundraising of our global endevours and model facility.

The ‘Vedic Care’ ~ An Oasis of Love