Our mission is to expose and remedy corruption in the Probate Court of Cook County, Illinois. We assist, educate and enlighten families of the dead, the dying, the disabled and the aged to better understand their rights in order to protect themselves from the excesses of the Probate Court of Cook County. ProbateSharks.com is dedicated to networking the human element of people to people. We join together in reforming the corrupt Cook County Probate Court system.
##LEESBURG — An apparent settlement has been reached in the wrongful termination suit brought by former Lee County Associate Probate Judge Kathie Cash against the county and Probate Court Judge John Wheaton, according to an email between county officials.
##In a lawsuit filed in Lee County Superior Court in July of 2013, Cash claimed that she was wrongfully dismissed by Wheaton after she alleged his granddaughter, Amanda Battzell, who is employed as a court clerk in the probate judge’s office, was turning in inflated time sheets. Cash claims her firing was in retaliation for reporting the issue.
##According to an email from county attorney Jimmy Skipper to county manager Ron Rabun, the parties have agreed to a tentative $150,000 settlement in regard to Cash’s dismissal in early February of last year.
##In the July 8 email to Rabun, Skipper wrote, “The purpose of this message is to advise you that I have been advised that the case went to mediation yesterday and was settled for $150,000 to be paid to the Plaintiff (Cash). The settlement will be paid by the county’s insurance carrier, less any applicable deductible. According to the attorney hired by the County’s insurance carrier to defend the case, the settlement was actually less than what he was afraid it might be (or what a jury might award) given so many of the facts were brought out in the case and through discovery were not helpful to Judge Wheaton’s position.
##“Under the County’s insurance policy, the County’s insurance carrier can settle these types of cases without approval of the BOC (Board of Commissioners) since the carrier is paying the settlement and the cost of the litigation on behalf of the County …”
##Rabun then forwarded Skipper’s email to all four county commissioners and chairman Rick Muggridge.
##“Board - hiring relatives is bad business,” Rabun wrote in the forwarded message. “Nepotism policies exist for a reason!”
##“I am trying to think of reasons this case should not be publicized,” Muggridge wrote. “Based on a brief conversation with Skipper the BOC has no authority over the constitutional Officers in regard to hiring or administrating their offices. Currently at least three offices within the County have relatives under the direct supervision of their parent or grandparent. This is wrong. If the BOC has no authority then surely the public does (have authority) and deserves to know the truth.
##“Regardless of Judge John Wheaton’s exemplary service in the past, if the conduct enumerated in this lawsuit are true and it seems objective parties (including the defending attorney) found reason to believe they are, these acts deserve accountability.”
##While Lee County does have a nepotism policy on the books, constitutional officers (probate judge, sheriff, clerk of court and tax commissioner) are not bound by the county policy. They are free to hire and fire at will.
##There was some confusion as to if the settlement has actually been agreed to by both parties. Neither Cash attorney Harlan Miller nor the insurance firm’s attorney, Raleigh Rollins, could be reached for confirmation. Skipper said the delay might be due to the paper work not yet reaching the county clerk’s office.
##Regardless, the parties have a calender call set for Sept. 25 before Lee Superior Court Judge George Peagler.
Bernie Madoff’s son, Andrew, left one-third of his $16 million estate to his estranged wife and $50,000-a-month to fiancée (NY)
September 29, 2014
Bernie Madoff’s son Andrew died with a $16 million estate he’s sharing with his wife and his girlfriend, court papers show.
Papers filed in Manhattan Surrogate’s Court show Andrew Madoff owned an estimated $11 million in “personal property” and $4.5 million in real estate when he died of blood cancer last week.
In his will, which was made public Thursday, the master scammer’s scion left one third of his property to his wife, Deborah West — and $50,000 a month to the woman he’s described as his fiancée, Catherine Hooper.
“I request my executor to pay to Catherine Hooper, so long as she is living, the sum of $50,000 on the first day of each month, commencing 30 days after the admission of this will to probate, for her support until the administration of my estate is completed,” says the will, which was dated July 8.
After the estate is completed, she’ll be paid from a trust which will have an undisclosed sum of money in it.
Also getting trusts are his two children, who were left all of their father’s personal property.
The will reveals that despite his relationship with Hooper, he was still married to West, who filed for divorce from him on the same day Bernard Madoff was arrested for running a multi-billion dollar scam that was the largest Ponzi scheme in history.
The divorce case was withdrawn in February, records show.
Madoff, 48, died of mantle cell lymphoma last week after a long battle with the disease.
He’d beaten back cancer before, but told People Magazine last year that the stress and shame he dealt with after his father’s arrest had caused the lymphoma to resurface.
“One way to think of this is the scandal and everything that happened killed my brother very quickly,” he said, referring to his brother Mark, who committed suicide in 2010, “and it’s killing me slowly.”
He told the magazine he’d made amends with his mother, Ruth, who both he and Mark had stopped talking to because of her support of their father, but that he would never settle things with his dad.
“Even on my deathbed I will never forgive him for what he did,” Andrew said. “He’s already dead to me.”
Both brothers had worked in a legitimate arm of Madoff’s business, and they were the ones who turned their father in after he came clean about his decades long con.
In July, the trustee for Madoff’s victims filed a $153 million suit against Andrew and Mark’s estate, charging they “knew, saw, and were simply too intelligent to plausibly feign ignorance about the fraud that was occurring.”
Madoff, 76, is serving a 150 year sentence for securities fraud.
The executor of Andrew’s estate, his longtime lawyer Martin Flumenbaum, did not return a call for comment. Attribution:
Bernie Madoff’s son, Andrew, left one-third of his $16 million estate to his estranged wife and $50,000-a-month to fiancée Andrew Madoff, 48, also left behind all his personal property to his children, according to the will filed Thursday in Manhattan Surrogate’s Court. Dareh Gregorian September 11, 2014 New York Daily News http://www.nydailynews.com/new-york/bernie-madoff-son-andrew-leaves-money-estrange-wife-fiancee-article-1.1936636
When Robin Lynn, who suffers from depression, was prescribed a generic version of a popular anti-depressant medication, she didn't think it was going to be a big deal.
"I thought thatgeneric drugsare the exact same thing as the name brand drug," Lynn said.
But after taking Budeprion XL 300, a generic form of brand-name Wellbutrin XL, Lynn, who is from New York, said she noticed over time that the drug wasn't helping.
"I would have a lot of energy, but by middle of the day I would have no energy, I would crash, and it wasn't really controlling my depression symptoms either," she said. "My outlook on life was different in a matter of hours. I knew that was just not normal, that’s not how things are supposed to be."
In 2007, Lynn went looking for answers and reached out to pharmacologist Joe Graedon, who wrote the best-selling book, "The People's Pharmacy," with his wife Terry Graedon, and hosts a popular radio show. Around that same time that he heard from Lynn, Graedon said he began to receive complaints about Budeprion XL 300, with users reporting some intense side-effects not seen with using the brand name drug.
"They were getting very jittery. They were experiencing headaches. They were havingstomachproblems,insomnia, just a whole range of side effects, and it just wasn't clearing up their depression the way the brand name drug was," Graedon said. "And some of them even expressed suicidal thoughts."
"It was like getting a shot of adrenaline first thing in the morning," Lynn said. "It would make my hands shake, my heart would pound."
Eight out of 10 prescriptions written in the United States are filled with the no-brand name, generic version of the drug prescribed by a doctor, and every year generic drugs save American consumers more than $200 billion in prescription costs.
For years, Joe and Terry Graedon were strong advocates for the use of generic drugs.
"We were huge supporters of generic drugs, because you can save an amazing amount of money," Joe Graedon said. "I mean a brand name drug forheartburnor for depression can cost a couple of hundred dollars a month. The generic might cost only $5 or $10 a month... So if they were identical, I mean, What's not to like?"
But when hundreds of people started writing in with their negative experiences with Budeprion XL 300, the Graedons became concerned and contacted the U.S. Food and Drug Administration, asking them to investigate.
"Pretty much we heard nothing back," Joe Graedon said. “The FDA didn't seem very responsive to our concerns."
So Graedon decided to take the investigation into his own hands. He took the drug Budeprion XL 300 to ConsumerLab.com, which independently tests generic drugs for universities, businesses, hospitals and government agencies, and asked them to test how Budeprion XL 300 dissolves, and whether it dissolves the same way as the brand-name drug, Wellbutrin XL.
The FDA mandates that generic forms ofprescription medicationcontain the same active ingredient as the brand name, but the agency allows the generic version to use different inactive ingredients, including binders to hold the pill together and time release agents to disperse it.
After U.S. District Judge Amy Berman Jackson restored protection of Wyoming’swolvesunder the Endangered Species Act on Tuesday, Gov. Matt Mead immediately appealed.
The judge on Friday ordered the federal government and conservative groups to respond to the appeal by Monday, according toThe Associated Press.
The Obama administration in 2012 removed federal protection for the species in Wyoming. At the time, 270 wolves lived in the state outsideYellowstone National Park. According toThe New York Times, in the year that followed, trophy hunters killed 62 wolves, and an undetermined number were legally shot or trapped.
On Tuesday, Jackson ruled that the state’s management plan—which designated the wolf as a trophy-game species and a predator that could be killed in four-fifths of the state—was ineffective, saying that officials were “arbitrary and capricious” in enforcing it.
In response, Mead the next day issued an emergency rule that would enforce Wyoming’s initial pledge to preserve at least 100 wolves and 10 breeding pairs outside Yellowstone National Park.
“Now that Wyoming has resolved the court’s concern, I hope the court will amend its ruling and allow Wyoming’s continued management of gray wolves,” Mead said in a statement.
Since 2012, the United States Fish and Wildlife Service has proposed removing protection for the wolf everywhere except in New Mexico and southern Arizona.
Editor's note: How many times have concerned family members been held in contempt in the Probate Court of Cook County? How few cases have been appealed and even heard? Lucius Verenus, Schoolmaster, ProbateSharks.com
Woman jailed over probate court case wins appeal
The 5th District Court of Appeals recently reversed a ruling by Stark County Probate Court Judge Dixie Park involving a woman who was jailed for contempt of court in a guardianship case.
A woman who spent several days in jail in 2013 stemming from a guardianship case in Stark County Probate Court has won her appeal.
The 5th District Court of Appeals last month reversed a ruling by Probate Judge Dixie Park, concluding that Park had abused her discretion by finding the woman in contempt of court.
Barbara Lockhart, formerly of Alliance, was jailed for around 10 days on the orders of Park after Lockhart missed some court hearings — and failed to provide requested documents — in the guardianship case of an 83-year-old man, according to probate court records.
A guardian was seeking to revoke the power of attorney Lockhart held on behalf of the man, and Park had requested records regarding his finances, court records said.
Attorney Jeffrey Jakmides, who handled Lockhart’s appeal, said Lockhart was jailed without bond in October 2013. He noted that the woman — 56 years old during her jail stay — did not have a criminal record.
Lockhart has “recovered from (her jail stay) at this point, at least as much as she can recover from an experience like that, and is just wanting to move forward with her life,” Jakmides said.
Some of the probate court hearings took place in August 2013. Lockhart showed up at a Sept. 17 hearing, and then missed a Sept. 24 hearing, resulting in the contempt charge and Lockhart’s arrest and jailing on Oct. 1. Court records indicate Lockhart thought the last hearing had been continued.
Park set another hearing for Oct. 2, but Lockhart couldn’t provide the requested documents to purge her contempt charge because she was transported directly from the Stark County Jail to the hearing, according to the appeals ruling.
Lockhart was eventually released on Oct. 11 after a motion was filed to suspend the rest of her 30-day jail sentence. She later supplied the court with the financial documents.
During the case, the power of attorney was revoked for Lockhart. Park found that Lockhart put about $12,000 in Social Security and pension funds belonging to the elderly man in an account under her own name.
In court records, Park wrote that Lockhart had admitted she opened the bank account in her name even though she knew the man’s bank accounts had been frozen by the court.
The funds were either retained or used for the benefit of Lockhart or the man’s daughter, Park wrote in court records. The judge ordered Lockhart to return $12,239 to the estate.
Those issues were not part of the appeals ruling, which included two claims of error 5th District Judges William B. Hoffman, W. Scott Gwin and John W. Wise agreed with.
Editor's disclaimer: Your ProbateShark abhors any form of violence and condemns the plots against Nigerian judges. This Shark holds no malice against Nigerian officials who have withheld the 20 million dollars promised to him. However, this Shark confesses his fish brain has fantasized about catching certain probate court judges in 4 feet of sea water. Lucius Verenus, Schoolmaster, ProbateSharks.com
Nigeria Metro We'll Blow Up the Houses of Lagos Probate Judges - MEND
This elder cleansing fiasco is 'out of hand.' There is just too much money for the miscreants to overlook. First we have helpless people with lifetime savings. In the Mary Sykes case there was a million dollars in untraceable gold coins. All the miscreants have shown signs of wealth that is unusual. The guardian prior to her appoint was a serial insolvent with a chronically unemployed husband living well beyond her means. Her husband has been now remodeled, she sports expensive jewelry, has money for lavish vacations, parties etc. Where did she get the money?
The Alice Gore case and the Seth Gilliam disclosures taught us more about the guardians, the corrupt judicial and political figures. Referral fees are very generous. Indeed, they should be. A senior goes into a nursing home or other sheltered care facility run by thebenefactorsandthe senior is treated to about $1500.00 per month worth of services at a cost to the taxpayers or insurance carriers, etc of an average of $8500 a month. It may vary some facilities charge as low as $5000.00 or as high as $30,000.00. Every service has multi-layers of profit centers. As an example - physical therapy in many cases consists of being taken out of bed and placed in a wheel chair. (Some facilities have costs that exceed $1500 per month and some facilities actually provide a service - however, or focus is upon the elder cleansing centers).
Americans with Disabilities Title 2 legislation seeks to obviate this discriminatory situation and Ms Sykes' lawsuit attached are in my opinion a first rate effort. This Federal Court lawsuit is submitted to the Complaint department of the ADA so that they can hopefully act upon it and help make it a model to eradicate the War on the elderly and the disabled.
(If you received copies of Ms. Sykes complaint previously, I apologize. Shortly after I received my copies of the complaint, my computer suddenly started to act up and even Ms Dension was not receiving my communications - A few hours later - and after I faxed a copy of the complaint to Mr. Larkin at the IARDC (in Springfield, Illinois) all the correspondence failures ceased. I make no allegations - I just love coincidences. )
Editor's note: This Shark believes as long as the Kawamotos, Solos and their clones of the world exist...this injustice will continue. Lucius Verenus, Schoolmaster, ProbateSharks.com
Fighting to Honor a Father’s Last Wish: To Die at Home
Photo
Maureen Stefanides at NewYork-Presbyterian Hospital with her father, Joseph Andrey, waiting to move to a nursing home despite their efforts to arrange for 24-hour care at his apartment.Credit Victor J. Blue for The New York Times
Joseph Andrey was 5 years old in 1927 when his impoverished mother sold him to the manager of a popular vaudeville act. He was 91 last year when he told the story again, propped in a wheelchair in the rehabilitation unit of a nursing home where it seemed as though age and infirmity had put a different kind of price on his head.
Craning his neck, he sought the eyes of his daughter, Maureen Stefanides, who had promised to get him out of this place. “I want to go home, to my books and my music,” he said, his voice whispery but intense.
He was still her handsome father, the song-and-dance man of her childhood, with a full head of wavy hair and blue eyes that lit up when he talked. But he was gaunt now, warped like a weathered plank, perhaps by late effects of an old stroke, certainly by muscle atrophy and bad circulation in his legs.
Now she was determined to fulfill her father’s dearest wish, the wish so common among frail, elderly people: to die at home.
But it seemed as if all the forces of the health care system were against her — hospitals, nursing homes, home health agencies, insurance companies, and the shifting crosscurrents of public health care spending.
Her father had been discharged by a hospital to a nursing home like this one, supposedly for rehabilitation, so many times that even she had lost count. The stays, long or short, had only left him weaker, harder to care for at home with a shrinking allotment of help from aides and more prone to the infections that sent him back to the hospital.
This time she had fiercely opposed his being discharged to anywhere but home, a small walk-up apartment in Manhattan that her parents shared for half a century before her mother’s death. Yet over her protests and his own, he had been transferred here anyway, to Jewish Home Lifecare in Morningside Heights, a sprawling institution an hour from where she lived. Later, he would ask, “Are you sure you didn’t put me here?”
“No matter what I do, they want you in a nursing home,” Ms. Stefanides told him, promising the placement would be temporary. “I think they’re making money off you.”
Records would show that her father’s case let the nursing home collect $682.48 a day from Medicare, about five times the cost of a day of home care.
By now Ms. Stefanides was a veteran of battles with the health care system, but it still baffled her. A public-school teacher, she could not afford out-of-pocket home care, and though her father qualified for both Medicaid and Medicare, the flow of money seemed to bypass what he actually wanted at the end of life.
Even hospice was limited. Now mostly for-profit, hospice companies would provide supervision and visits at home a few times a week through Medicare if a doctor certified that Mr. Andrey had only six months to live. The hidden catch: He would lose all Medicaid home care, the daily help he needed to be home at all.
In their last days, older patients are increasingly likely to be shuttled among hospitals, nursing homes and hospices in pursuit of Medicare and Medicaid coverage. Ultimately, most die in an institution, rather than at home.
Among Medicare beneficiaries over 65 who died*
Place of death
Place of care
Percentage receiving treatment in last days**
Transfers
Among facilities and home, average number in last 90 days
70%
3
Hospital
31%
35%
34%
Home
50
Nursing
home
2
Acute
care
hospital
Hospice
33
25
27
30
Intensive
care unit
1
Nursing
home
28
25
27
10
Other
14
13
10
’00
’05
’09
’00
’05
’09
’00
’05
’09
*Excludes Medicare Advantage members. **Patients may get care in more than one place. Those receiving hospice care may get it anywhere, not just in a stand-alone hospice.
Among Medicare beneficiaries over 65 who died*
Place of care
Percentage receiving treatment in last days**
Transfers
Among facilities and home, average number in last 90 days
Place of death
70%
Hospital
3
31%
35%
Home
34%
Nursing
home
50
Acute
care
hospital
2
Hospice
33
25
27
30
Intensive
care unit
Nursing
home
1
28
25
27
10
Other
14
13
10
’00
’05
’09
’00
’05
’09
’00
’05
’09
*Excludes Medicare Advantage members. **Patients may get care in more than one place. Those receiving hospice care may get it anywhere, not just in a stand-alone hospice.
Ms. Stefanides smoothed her father’s hair and touched his cheek, preparing him for her exit.
At 54, she was still slim as a girl and fragile-looking. For most of the past year, she had lifted and rolled and washed her father by herself after the home care aide’s eight-hour shift ended. She would rush to her father’s place from the East Harlem school where she taught fifth grade, feed him supper and get him in pajamas, leave him sleeping under a neighbor’s eye, and then head home, 35 blocks away, to her waiting husband and the dogs she rescued from animal shelters.
She was prepared to do as much again, but she could not quit her job. And now the home care agency had refused to reinstate her father’s aide services.
“He’s in and out of the hospital too much,” an office manager for the agency said when she demanded an explanation. “This is not allowing our girls to make any money.”
Her father was a World War II veteran who had paid taxes all his life, working the night shift in the Murray Hill post office. She was his health care proxy and had power of attorney. But what good was all that?
“It’s a terrible situation they’ve put us in,” Ms. Stefanides said in an agitated phone message left on this reporter’s voice mail. “My father wants to die at home, he knows he’s dying. And here I am proving I’m power of attorney, that I’m guardian, and it means nothing, it falls on deaf ears.”
Her recorded voice continued, rising in anger and resolve as she rushed to explain her father’s straits before being cut off in midsentence.
The message was left at 4:46 p.m. on May 23, 2013, the day after he was taken by ambulance to his fourth or fifth nursing home stint in two years. She would have eight months and eight days to fight for her father before he died.
Dying in America
Photo
Photographs from Mr. Andrey’s life, on display at his funeral. He performed vaudeville as a child and fought in World War II.Credit Victor J. Blue for The New York Times
While Joseph Andrey’s daughter battled the health care system, a national panel appointed by the federally funded Institute of Medicine was preparing a sweeping critique of how the system handles just such cases. The report, “Dying in America,” released last week, calls for a fundamental overhaul of the country’s end-of-life care.
For most people, death does not come suddenly, the report points out. With 48 times as many people reaching 85 than a century ago, and triple the number who turn 65, the likely course of death is long and unpredictable. In the new demographic reality, the immediate family is older, too, often literally unable to do the heavy lifting for the long haul.
Yet the system was never engineered to support families through this, and its financial incentives reward harmful transitions among homes, hospitals and nursing homes, said Dr. Joan M. Teno, a gerontologist and one of the report’s authors.
“We have these frail older people moving about in the medical-industrial complex that we’ve constructed,” Dr. Teno said. “It’s all about profit margins. It’s not about caring for people.”
Many geriatric experts say that if the wasteful medical spending on this stage of life could be redirected, it could pay for all the social supports and services actually needed by today’s fragile elders and their families. Instead, public money has been shuffled in the same system, benefiting health care businesses but not necessarily patients.
A prime example is the abuse of short-term rehabilitation in nursing homes, improper charges that cost the public more than $1.5 billion a year, federal inspectors for the Department of Health and Human Services reported in 2012. Medicare will pay premium rates for up to 100 days of services in a nursing home to rehabilitate patients. While such efforts can be beneficial, government investigations and lawsuits document a pattern of excessive or fraudulent orders for such services, often just before death.
As for dying at home, “you can’t believe the forces of the system that are arrayed against it,” said Jack Resnick, once a health system executive and now a doctor with a geriatric house-call practice on Roosevelt Island. “The way the reimbursement system works, these decisions are not made on the basis of what the individuals need. They’re based on what the institutions need.”
To Dr. Joanne Lynn, a veteran hospice physician consulted for the Institute of Medicine report, the problem goes beyond perverse financial incentives. Most developed countries spend much less on medical care over all than the United States, but nearly twice as much on social supports.
“Why can I get a $100,000 drug but I can’t get supper?” she asked, pointing to the budget sequestration that slashed federal spending on meals for seniors last year.
In the end, only a humane case-by-case approach can provide the right care for the last chapter of a long life like Joseph Andrey’s, added Dr. Lynn, who directs the Center for Elder Care and Advanced Illness at the Altarum Institute, a research organization based in Ann Arbor, Mich.
Photo
In 1927, a New York newspaper published a request that “a prosperous family” adopt Mr. Andrey, far left, then 5, and a brother.
“You have to get to know the real situation, what this person really needs to live comfortably and to have some meaning in their lives,” she said. “They are more than just bodies with heart beats.”
Mr. Andrey was the oldest child in a family so poor they begged in the street. His mother appealed to one of New York’s newspapers. “Wants Her Sons Adopted,” the front-page headline said on Aug. 7, 1927, above a family photograph “taken before domestic dissension set in.”
In the picture, little Joseph stands solemnly with a younger brother before their father, a Greek immigrant. His Irish Catholic mother holds a baby on her lap. “As a result of her husband’s failure to support her and the children,” the caption says, she had decided “to seek a good home with a prosperous family for the two older boys.”
The publicity drew the show business agent for the Loomis Twins, singing sisters looking for a sidekick. Money changed hands. And just like that, 5-year-old Joseph went from hunger in the tenements to room service at the Waldorf-Astoria and beyond, to the dining cars of trains speeding to vaudeville stages around the country.
“It was the best thing that happened in my life,” he rasped from his wheelchair last year, recalling the highlight of his childhood: Dancing the leading toy soldier in a Christmas show at Radio City Music Hall.
Just as abruptly, at age 7, the idyll ended. His mother demanded him back, or else more money. He was returned to finish out a ragged childhood. To support the family, he left school at 14 for menial jobs, always longing to get back to the stage.
The draft took him instead to the Pacific theater in World War II. It was the ultimate escape from his parents’ squalid fights, as he told it. Still in uniform, he met Florence Agnew, his future wife, at New York’s Roseland Ballroom.
“They danced together all the time,” their daughter remembered. “They danced around the house, for no reason at all. And then he danced with me.”
Photo
A photo of Mr. Andrey, his wife, Florence, and their daughter, Maureen, taken in a photo booth.
Just for fun, all three would pile into a photo booth at Woolworth’s, her father cracking them up with his Mighty Mouse voice when the shutter lights flashed.
By then he was sorting mail all night and working in hotel security on the side. He regretfully gave up his Broadway dreams. But he had achieved another fervent childhood goal: a happy marriage.
“It was like a dream,” his son-in-law, Dean Stefanides, would say later, recalling how the couple laughed at their own infirmities.
The medical histories repeated again and again in hospital records were not such a big deal. Yes, she had an early hysterectomy, and in his 50s, he lost the tip of his penis to a cancer that never recurred. Yes, he had a stroke before 70; he seemed to recover completely, though five years later he would have to take medication daily to control seizures, and by 80, began having trouble with his legs.
But for years love and humor seemed to trump the toll of aging. Unable to extract each other from a cab one day, they told a funny story about it. Hard of hearing, they made fractured conversation another comedy routine.
Then Alzheimer’s changed everything. At the couple’s 50th wedding anniversary party, two weeks after the Sept. 11 attacks, relatives drew Ms. Stefanides aside: “Something is wrong with your mom.” She had been calling a cousin from her apartment at 3 a.m., saying she wanted to go home.
She was 80. Her steep decline would last eight years.
Like many of the 15 million Americans caring for a relative with Alzheimer’s, Ms. Stefanides and her father learned that Medicare does not cover long term day-to-day help, in any setting. They would have to turn to Medicaid, the shared state and federal program for poor and disabled people.
They were lucky. Under New York’s unusually expansive version of Medicaid, a home attendant went daily to their fourth-floor walk-up in the Yorkville neighborhood to provide eight hours of unskilled “personal care assistance.” Eventually, it was not enough.
The calls from her father would start at 5 a.m.: “I’m scared. What is it with your mother?”
She sometimes brought her mother to her place so her father could sleep, but that put new strains on her marriage.
She and her husband, an art director, had bought their duplex near Beekman Place in the early 1990s, before the advertising industry imploded. Now the apartment doubled as his freelance work space.
One day in 2007, her father broke down. Florence was banging on other tenants’ doors, seeking her childhood room.
“I can’t take it anymore,” he said. “I can’t run after her. Is there like a really nice place where we can put her?”
“I was so ignorant of what nursing homes are,” Ms. Stefanides would say later. “My mother kept holding on to my sleeve, saying, ‘Take me out of here.’ ”
One day the nightgown slipped off her emaciated shoulders, revealing a mass of bruises. The woman in the next bed confided that Ms. Andrey, then wordless, had been beaten by an aide when she resisted some daily routine.
“The roommate told me that she cried under the covers when she heard my mother’s screams,” Ms. Stefanides recalled.
Now, the nursing home declines to discuss the case. At the time, her own complaints to the administration, the State Health Department and the police went nowhere. Fruitlessly, she hunted for a better place until her mother died.
‘Where’s My Dad?’
Photo
“I want to go home, to my books and my music,” Mr. Andrey said while in a nursing home and as his daughter continued to try arrange care for him at home.Credit Victor J. Blue for The New York Times
Mr. Andrey’s health worsened after he was widowed in 2009. But the less he could walk, the more he loved being home after brief hospital stays, nested with his Nat King Cole albums, cared for by live-in aides through Medicaid.
Ms. Stefanides was not prepared for the abrupt end of that way of life. Her father was in Lenox Hill Hospital for a urinary tract infection in spring 2011 when a discharge worker called her at school: He would not be sent home, because his home health agency, Excellent, had ended his services, and no one was there to care for him. Instead, he was to go to a nursing home for rehabilitation.
“Absolutely not,” Ms. Stefanides declared, rushing over. His hospital bed was empty. “Where’s my dad?” she cried.
He had been whisked to Kateri Residence, a Catholic nursing home on West 87th Street. And for more than a year, as his legs atrophied and he begged to go home, she was unable to get him out: No home health agency would take him.
Agencies like Excellent no longer wanted high-hours home care cases like her father’s, explained Jack Halpern, the chief executive of MyElderAdvocate.com, when she briefly hired him to try to get her father home. Such cases were no longer lucrative.
She came to realize that it was the start of a larger upheaval. The administration of Gov. Andrew M. Cuomo was shifting billions in public spending on long-term care to private managed-care companies, which were paid a flat Medicaid rate for each enrollee. Key players were shunning fragile clients like her father in favor of seniors robust enough to bike to a social adult day care center for table tennis.
“They don’t want heavy-care people, so they’re denying them services,” Mr. Halpern said later. “Everyone’s getting shoved into nursing homes.”
The nursing home, Kateri (which has since been sold and renamed), had financial incentives to keep Mr. Andrey: For up to 100 days, Medicare would pay roughly double Medicaid’s daily rate for regular nursing home care. Later, he was relegated to a unit with so little staff that he rarely left bed. Finally, in spring 2012, when he was showing signs of dementia, Kateri declared him a permanent resident and moved to take his whole income.
At the last moment, Ms. Stefanides cobbled together his escape: She persuaded Gentiva Health Services, a national company, to provide eight hours of home care on weekdays — much less than the live-in care he had before — while her husband, still freelancing, signed papers promising to do the rest. In reality, the schedule relied on her visits and a neighbor’s vigilance.
They managed, barely, for a year. But in 2013, they faced the same problem, only worse. The home care company, under new ownership, dropped her father, and NewYork-Presbyterian Hospital sent him for rehabilitation — to DeWitt.
“When the elevators open, you get this terrible stench,” Ms. Stefanides said of DeWitt’s upper floors at night. “I was hearing people screaming for help and nobody coming. My father was on the verge of tears — in his defecation for three hours, and he kept ringing the bell.”
(DeWitt’s lawyer, Neil Ptashnik, now says: “The only comment the facility has is: We’re well run, adequately staffed, we’ve had no problems with the Department of Health, and our residents seem quite happy.”)
The nursing home sent him to the hospital after 10 days, with a recurrent infection from an improperly placed catheter, medical records show. The hospital soon discharged him to the next nursing home, Jewish Home Lifecare, where orders for therapy and skilled services brought the price of his care up to $682.48 daily under Medicare.
Ben Taylor, a lawyer at the New York Legal Assistance Group, thought he could break the cycle. By law, he said, the state should require Gentiva to reinstate eight hours of daily home care pending a fair hearing. Meanwhile, Ms. Stefanides should contact managed-care plans, which were not supposed to rule out round-the-clock home care.
But she reached receptionists who said 24-hour care was unavailable. Jewish Home insisted her father could not safely go home with less. And day by day in the nursing home, he was sinking.
On arrival May 22 last year, Mr. Andrey was “alert and verbal,” with a good appetite, clinical notes said. Less than a week later, he was eating only half his food. On Day 12, he was found on the floor: He had fallen from bed, hurting his knee.
By Day 14, when Medicare had spent nearly $10,000 on his care, a pressure sore was eroding the flesh of his right heel. Despite treatment, ulcers later covered his left buttock and feet. When physical therapy ended, the wounds became another reason for the institution to extend his stay, now costing Medicare $585.49 a day.
In late July, Mr. Taylor won a state directive for Gentiva to restore home services, if the doctor approved. Separately, a social worker at one managed-care company, GuildNet, told Ms. Stefanides that Mr. Andrey might be accepted for home care if the nursing home agreed.
But the nursing home said he was too weak to be released. Instead, it transferred him to a long-term-care wing.
Nursing Home Limbo
Photo
Mr. Andrey in the cafeteria of Jewish Home Lifecare in August 2013.Credit Nina Bernstein/The New York Times
On a Wednesday evening in mid-August 2013, in the dining room, Mr. Andrey poked at the lid of his ice cream cup with a fork. Beside him, a blind woman fumbled to find the food on her tray, the staff too short-handed to help. At the next table, a woman with dementia kept screaming. Mr. Andrey’s voice could not be heard above the din.
On this wing, emaciated Alzheimer’s patients wandered into his shabby room. From a skinny 138 pounds on admission, he was dwindling to 128.
“Why am I with these people?” he would ask his daughter. “Why am I losing this weight?”
“Dad, this is all through atrophy,” she told him. “We have to get you moving again.”
“They never move me,” he answered. “I’m lucky if they come to change me.”
On some days he went hungry, he told his daughter. Rushed workers left his food tray on the air-conditioner, where he could not reach it. Several times, he fell out of bed trying.
Medicaid now paid the home $307.70 a day for his care, much less than Medicare did before. On Aug. 20, two days after his Medicare stint ended, so did his protein supplements. If his daughter wanted him to drink Ensure, the staff told her, she should buy it herself.
In rehab, a psychologist had noted that Mr. Andrey brightened when he spoke of “the pleasure he derived from the arts.” Now there was not even a television in his room. Visitors found the bathroom filthy, garbage uncollected and Mr. Andrey left half-covered in a diaper. A friend, Dyandria Darel, was so appalled that she documented the scene in photos.
(Jewish Home’s chief medical officer at the time, Mark Levy, who secured Ms. Stefanides’s permission to discuss the case, strongly defends the care provided, calling it “professional, compassionate and well done.” At the same time, he said, “if you fit it all together from the perspective of Mr. Andrey, I don’t think the United States health care system did a great job of meeting his needs.”)
Mr. Andrey’s only hope of escape now was GuildNet, the managed-care company. He was interviewed; the apartment was inspected; both passed. But the nursing home’s assessment was missing.
One Sunday evening that summer, Ms. Stefanides and her husband found her father falling from bed, in agony from his contracted legs. His pain medication, Oxycodone, had been halted over the weekend — “doctor’s orders,” the head nurse said when Ms. Stefanides confronted her, adding something about preventing kidney damage.
“My father’s dying, put him on goddamn morphine!” Ms. Stefanides cried. The flustered nurse gave her a number to reach a doctor. But the one who picked up said angrily that he was off the clock, and hung up. Not until Monday could a doctor be found.
By then, Ms. Stefanides felt as though she were petitioning for her father’s release from prison. Another month went by. All told, four months, 11 days and $61,033.62.
But at 6:45 p.m. on Oct. 2, 2013, Joseph Andrey left the nursing home by stretcher as a GuildNet enrollee, his daughter at his side. He was carried up the stairs to the old apartment, newly equipped with a special bed. Soon the smell of good cooking filled the air. An aide fed him with a spoon.
The first week, his daughter crowed, he gained five pounds.
More Than Aides Can Handle
Photo
Maureen Stefanides in her father's bedroom after he died.Credit Victor J. Blue for The New York Times
It was the aides who mattered most and earned the least, Ms. Stefanides reflected. The primary care physician whom GuildNet assigned to her father never met him. The nurses who showed up to treat his deep ulcers kept changing. Yet the two aides who split the week as “live-ins” were paid so little by a subcontractor that they had to take second jobs, they told her.
Both aides seemed nurturing, but one, a recent immigrant, was inexperienced in washing a bed-bound patient. The other rebuked Mr. Andrey when he woke her up, his daughter later learned.
Nearly immobile now, his skin frayed and flesh gaping, he needed more care than they could give, especially at night. When an aide asked for more help, Ms. Stefanides first called the subcontractor, Allen Home Care, and then the GuildNet case manager.
The case was already too costly, she was told. In fact, a caseworker confided, the only reason GuildNet had taken her father was that he was not expected to live long.
(GuildNet declined to comment. Calls to the chief nurse and marketing director at Allen Home Care were not returned, but a team coordinator said, “We basically do what we’re told by the insurance company.”)
In theory, GuildNet was now coordinating all of her father’s care. In practice, he careened between the sleep-deprived aides and a dozen different doctors at NewYork-Presbyterian Hospital.
When he had trouble breathing, his aide called 911, and he went by ambulance to the emergency room. The aide was told to check back in three days for the results of a urine culture, but she forgot. The bad news reached the family 10 days late: The bacteria were resistant to his prescribed antibiotic. By then he had a septic ulcer in his scrotum.
The result: Emergency surgery, a different antibiotic, 13 days in the hospital ($108,895.37), followed by a brief discharge home without pain pills or a refill for his antiseizure medicine — and a seizure that sent him back. Two days in medical isolation while doctors ruled out multidrug-resistant bacteria ($20,721.82). Home again, increasingly incoherent.
On Christmas Eve, suffering chills, fever and mental confusion, he went back to the hospital for the third time in three months.
A Father’s Question
“Thank you for keeping me alive,” he told his daughter, teary with gratitude, when he emerged from days of delirium. “When are you taking me home?”
He still wanted to live, she realized. But the doctors said there was nothing more to be done. Now they wanted him sent somewhere else to die.
She felt they were bullying her to disregard her father’s wishes. “They almost told me I was wasting their oxygen and their medicine,” she said.
His sepsis would keep recurring. His system, likely colonized by bacteria acquired in health care institutions, was breaking down. Demented, contracted, hurting — he had no quality of life, doctors said, urging hospice.
But as the hospital’s own social workers had explained, hospice benefits from Medicare came with a catch: Her father would lose all Medicaid home care. In home hospice, that would leave huge gaps, unless she could tend to him around the clock. The alternative was hospice in a nursing home.
Not that, she vowed, vividly recalling her mother’s monthlong death in hospice at DeWitt, after a doctor said withholding liquids was “the humane way.” Once, arriving for her daily visit, she had unthinkingly carried in a cup of tea. Not quickly enough, she hid it behind a curtain, seeing her mother pass her tongue over parched lips.
“She was suffering, and I contributed to that,” she said, sobbing. “I will never forgive myself.”
For her father, she was determined to do better. She told the doctors she needed more time to consider home hospice, and wrestled with her inability to make the open-ended commitment. School administrators had long since lost patience with her absences, and all but accused her of using her parents’ health as an excuse to miss work. She had weeks to go until early retirement, and she had been postponing surgery to replace a hip injured in an icy fall.
The hospital finally proposed another option: Haven, a hospice inside Bellevue Hospital Center run by Visiting Nurse Service of New York. On Jan. 29, with her father unintelligible again, she reluctantly signed the papers.
The people who met them wore masks. Suddenly alert, her father grabbed her sleeve. “Don’t leave me here,” he said. “Something’s going to happen here. Why did you bring me to Bellevue?”
A hospice worker strapped him down, looking for a vein. As the painkiller reached his bloodstream, his daughter saw him gasp for life. She ran out in distress, asking for a priest.
“My God, the last rites, you’re at a hospice!” Ms. Stefanides said later. “No priest to be found.”
(A Haven official later expressed deep concern, saying, “We are reviewing this case to make sure this is the isolated case we believe it is.”)
As she and her husband took turns at his side, Ms. Stefanides’s father lived on — one day, two days. Death came the third morning, before she arrived, on Feb. 1 of this year, three weeks before his 92nd birthday.
Photo
At a Manhattan funeral home. Mr. Andrey died on Feb. 1, three weeks before his 92nd birthday.Credit Victor J. Blue for The New York Times
The funeral home director told her the deep pressure ulcers on her father’s body were the worst he had ever seen. The records she obtained showed that in the last year of his life, his care cost at least a million dollars. Was that the best, she wondered, that a million dollars could buy?
“He didn’t die in his bed, and that’s what he wanted,” she said. “I still feel that I let him down.”
After the wake, she stayed behind with his body. In a last rite of her own, she placed her hand on his chest and said the act of contrition: “Please forgive my father for all his sins.”
Nearby, on display, was his life in pictures: dashing soldier, dancing husband, loving and demanding father. Through the winter gloom, it still gleamed.
Correction: September 25, 2014 An earlier version of a picture caption with this article gave an incorrect location. Joseph Andrey was shown in the cafeteria of Jewish Home Lifecare, not NewYork-Presbyterian Hospital.
