Medical Aid-in-Dying Act signed by Governor Murphy

On April 12th, New Jersey joined seven other States which have enacted laws authorizing a terminally patient to self-ingest a drug that would end their life. Oregon was the first State to allow this, in 1997. The New Jersey bill was A1504/S1072. It will go into effect on August 1, 2018. Over two dozen other States are actively considering such legislation.

The Act specifies criteria for who is eligible to take advantage of its protections: The individual must be an adult over 18 and able to self-ingest the medication. They must have a terminal diagnosis with a prognosis of six months of less, and they must be determined to have full mental capacity. The Act allows such an individual to make and carry out an “informed decision” to ingest a fatal drug. Informed decision is defined as:

   “a decision by a qualified terminally ill patient to request and obtain a prescription for medication that the patient may choose to self-administer to end the patient’s life in a humane and dignified manner, which is based on an appreciation of the relevant facts and after being fully informed by the attending physician of:

(1)   the patient’s medical diagnosis;

(2)   the patient’s prognosis;

(3)   the potential risks associated with taking the medication to be prescribed;

(4)   the probable result of taking the medication to be prescribed; and

(5)   the feasible alternatives to taking the medication, including, but not limited to, concurrent or additional treatment opportunities, palliative care, comfort care, hospice care, and pain control.

 

There are many steps in the procedure protocol. First, the individual must originate the request by making two spoken (oral) requests to the physician, with a 15 day waiting period in between; the doctor must bring in a consulting specialist to confirm capacity; the doctors may refer the individual for psychological or psychiatrist for further capacity evaluation if capacity is not clear; the doctor must offer the patient the option to rescind his or her request. The individual also must complete a specific form and submit it to their doctor; the form will be titled “REQUEST FOR MEDICATION TO END MY LIFE IN A HUMANE AND DIGNIFIED MANNER.”

The written request must be witnessed in a manner similar to other legal documents, in which two witnesses attest to the individual’s capacity (competence) and willful voluntary act. One of the witnesses must be “disinterested” — not standing to benefit in any way from this death. The physician must also refer the individual to an appropriate health care professional for a discussion about other treatments or palliative care at the end of life. Ultimately, the doctor can then prescribe the medication.

The law contains requirements related to patient record-keeping so that every step of the process is well documented. Persons who participate in good faith with the process, or to decline to participate, are given immunity against criminal and civil liability, and are protected against professional disciplinary action related to their licenses. There are also protections that prevent life insurance and other contracts from restricting an individual’s rights under the Act, and each step of the way must be carried out by the individual and not by a proxy.  For example, neither a legal guardian, agent under power of attorney, or health care representative could act in the place of the individual.

For individuals facing harrowing end of life decisions, the new Act will provide important and welcome relief from suffering. A plan can be put in place to assure that the transition for the individuals, and the safety and security of those left behind, can be as peaceful as possible.

Talk to us about life care planning and elder care planning… 732-382-6070

Lauren S. Marinaro Presents on Variety of Elder Law Topics in 2019

At NJ NAELA’s Unprogram on April 10, 2019 in Morristown, New Jersey, Lauren S. Marinaro presented and facilitated a member discussion group on the Affordable Care Act, Expansion Medicaid eligibility and Medicare.  The discussion focused on the eligibility differences between being on Medicaid through the Affordable Care Act (ACA) and being on Aged, Blind, and Disabled Medicaid, as well as how to transition from one to the other when Medicare eligibility is achieved.  Also discussed was the use of the ACA Marketplace for certain individuals over the age of 65.  On June 5, 2019, Lauren S. Marinaro will present at the 81st Semi-Annual Tax and Estate Planning Forum in New Brunswick on the “Use of Restricted Credit Cards by Trustees and Trust Beneficiaries.”  Marinaro will also be presenting at NJ ICLE programs in November and December of 2019.

New Jersey NAELA Lobbies to Support Medicaid Improvement Bill

New Jersey NAELA has been advocating in support of A4569, which provides for an improved, more accountable, more uniform system for eligibility determination for Medicaid.  On March 11th, 2019, Lauren S. Marinaro, Chapter President of New Jersey NAELA and a partner at Fink Rosner Ershow-Levenberg LLC, testified before the Assembly Human Services Committee in Trenton in support of this important legislation.  The bill has now passed the New Jersey State Senate and is currently waiting to be scheduled and heard in the Assembly Appropriations Committee. The bill’s main drafter and Senate Sponsor, Sen. Joseph Vitale, was awarded NJ NAELA’s first “Legislative Leadership Award” on April 10, 2019.

Remarriage terminates widow’s eligibility for disabled veterans property tax exemption

There are some circumstances in which a person’s eligibility for governmental benefits is affected by his or her marital status. This is certainly the case with Medicaid/MLTSS; Supplemental Security Income; and exemption from inheritance tax on receipt of an inheritance. The NJ Appellate Division had the opportunity recently to decide whether a veteran’s widow would retain her eligibility for his veterans’ property tax relief if she remarried. In  Pruent-Stevens v. Toms River Twp., the property owner’s first husband was an honorably-discharged Viet Nam veteran. He died before 1997 at a time that he had a pending claim for service-connected compensation benefits due to exposure to Agent Orange defoliant. She remarried , and her second husband died in 1997.  eventually, in 2014 (!) the Veterans Administration approved the claim and declared that the first husband had died of a service-connected disability. She then filed for disabled veterans property tax relief from Toms River.

The relevant statute allows a town to grant tax relief to the widow/widower of a disabled veteran  provided that s/he “has not remarried.”  The issue in the case was whether that status only pertained to the time that the application for the exemption was filed, or if it was a blanket cut-off for exemption eligibility for a widow who remarries at any time.  The New Jersey Tax Court  decided that the phrase “has not remarried” should be interpreted to mean that as long as the widow/er wasn’t married at the time of the application for exemption, the exemption would be available. In other words, it could turn on and off. She was unmarried in 2016 when her application was filed, so the Tax Court ruled in her favor. The Town appealed.

The Appellate Division reversed.  Finding that she had no “vested right” at the time of her 1997 remarriage, and that in other areas of New Jersey law, “widow” is defined as a person who has not remarried,  the court ruled that the potential entitlement to the exemption was lost as a result of having ever remarried.

Call us for advice on senior care planning and estate planning ….

732-382-6070

Hearing Monday in Trenton on Social Isolation and Age-Friendly communities

New Jersey is working on efforts to encourage municipalities to become “age-friendly communities.” Age Friendly is spreading across the country, with interesting initiatives in many places. Take a look at South Orange-Maplewood, Chatham, and Elizabeth for starters. Looking for volunteer opportunities? Contact your Mayor — you may be able to get involved with those initiatives or help to jump-start a new process. Age-friendly is an approach to community development that looks at the impact on seniors of a community’s physical space, transportation, recreation opportunities, public building access, access to municipal government and services, housing, etc. etc. and what might be done to improve those systems to make it more feasible for people to “age in place.”

Two new bills will be introduced to the NJ legislature which addressing key issues concerning older adults.  Click here to read the text

https://www.njleg.state.nj.us/2018/Bills/AR/246_I1.PDF

 https://www.njleg.state.nj.us/2018/Bills/A9999/5314_I1.PDF

 A-246 is a Resolution co-sponsored by Assemblyman Herb Conway and Assemblyman Wayne DeAngelo that urges New Jersey counties and municipalities to take the steps necessary to be accepted into the AARP network of age-friendly communities as defined by the World health organization.

A-5314 requires the Commissioner of the Human Senior Services “within 180 days and biennially thereafter” to assess and report to the Legislature on the state of social isolation in New Jersey as if affects individuals who are over 65, have disabilities, are suffering with mental illness, or are otherwise vulnerable. The bill marks a recognition that extreme social isolation is a problem in the State which adversely affects many citizens and might be alleviated if better understood and tackled. The report must also include recommendations for strategies to counter this problem. 

The Committee hearing will take place Monday morning May 19th at 10 am in the Committee Room 11, 4th Floor, State House Annex, Trenton.

If these issues are of interest to you, contact your Legislators, and read more here.

 

Planning for a good old age involves looking at a wide array of issues, and each person’s situation is unique. Call us for individualized elder care legal planning …. 732-382-6070