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Home My WebLink About07-21-06 - F \FILES\DA T AFILE\General\Current\ 120961 ,amendedorder Created 9'20/04 006PM Revised 7 i21 /06 3 :26PM 12096 I IN RE: VIRGINIA M. TAYLOR ALLEGED INCAP ACIT A TED PERSON IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-06-0435 IN RE: HOWARD 1. TAYLOR ALLEGED INCAP ACIT A TED PERSON NO. 21-06-0436 ["..) PETITION FOR AN AMENDED ORDER ~. ~-" AND NOW, come Virginia M. Taylor and Howard 1. Taylor, by and through:!J}eir att@eys, MAR TSON DEARDORFF WILLIAMS & OTTO, and hereby Petition this Honorable Court to ~end-' , the Order of Court it issued on July 6, 2006, to permit completely unrestricted visitation, or in the alternative, to permit unsupervised visitation by any individual each day during the period of 10:00am- 11 :OOam and 5:30pm-7:30p.m., and in support thereof aver as follows: 1. Virginia M. Taylor and Howard J. Taylor (hereinafter "Taylors"), were adjudicated by this Court as totally incapacitated persons on July 7, 2006. 2. On that same date, this Court also appointed Cheryl E. Watson (hereinafter "Cheryl") as plenary guardian of the person and estate ofthe Taylors, and appointed SandraNye as alternate plenary guardian. 3. Since early June, 2006, the Taylors have been housed in the Ecumenical Community, a nursing home operating in Dauphin County, Pennsylvania and licensed by the Commonwealth of Pennsylvania. 4. Specifically, the T aylors have been participating in the Meadows Program, which is a sub- program of the nursing home, specializing in the treatment and care of Alzheimer's Patients. 5. Despite their adjudication as "totally incapacitated," both Howard and Virginia Taylor are able to communicate preferences. Howard, in particular, is high-functioning, and has only been diagnosed with mild/moderate cognitive impairment. 6. When the T aylors were living at home, they frequently interacted with three sets of families in their neighborhood, the Burches, the Morrets, and the Shueys (hereinafter collectively referred to as "the Neighbors"). They have known and have been friends with the Neighbors for forty years. - 7. On average, the neighbors have attempted to visit the T aylors in Ecumenical Community about every other day to every three days, although they are unable to do so under the current order. 8. Around mid-June, Cheryl's relationship with the Neighbors began to grow tense. 9. Cheryl sought to restrict the Neighbors from visiting with the Taylors because she felt that whenever the Neighbors visited the Taylors, Howard became "agitated." 10. In order to protect the Taylors' right to visit with their friends offour decades, the Taylors petitioned this Court on June 16,2006 for an Order granting the Taylors unsupervised visitation with the Neighbors. 11. A hearing was held on July 6, 2006 to dispose of this motion. Evidence was received in the form oftestimony that Cheryl believed that the Neighbors' occasional visitation agitated the Taylors, particularly Howard. 12. Cheryl testified to her belief that it took generally three days from a visit for Howard to "calm down." 13. No evidence was presented that restricting visitation to a particular range of hours had any effect on Howard's agitation. 14. In preparation for the July 6,2006, hearing, the Taylors were examined by Dr. Daniels, who agreed generally with Cheryl that the Taylors were in no position to be living by themselves at home. He also found, however, that there is no reason for restricting visitation (although instructing visitors to avoid certain subjects was appropriate). A true and accurate copy of Dr. Daniels' report is attached hereto as Exhibit "A" and incorporated herein. 15. The Taylors direct the Court's attention to page three of the doctor's report. Under the heading "Recommendation," Dr. Daniel states: "No limitation in visitation is recommended, though inappropriate encouragement ofthe Taylors to return to their home by well-meaning friends should be discouraged. " 16. Following the hearing, this Court issued an order permitting unsupervised visitation every day between the hours of 1 O:OOam-l :OOpm. 17. The Taylors wish the Court to reconsider this Order, because some of the neighbors hold full-time employment and restricting visitation to those hours has the effect of forcing those neighbors to wait until the weekend to visit. - 18. The Taylors wish to visit with their neighbors and are upset by this time schedule because it means they are not able to see the neighbors as much as they would like. 19. Counsel for the T aylors contacted Cheryl's attorney to see if Cheryl would agree to a change in the visitation schedule. A true and accurate copy ofthe letter the Taylor's counsel sent is attached hereto as Exhibit "B." 20. Cheryl declined to concur with the instant Petition. 21. The Court is required to consider the least restrictive means of preventing agitation to the Taylors. See 20 Pa. C.S.A. 95512.1(a)(6)(requiringthat"the Court shall preferlimitedguardianship."). 22. The T aylors continue to believe that the least restrictive means in this case would be to instruct the neighbors about appropriate conduct, but permit completely unrestricted visitation. 23. Ifthe Court still feels that some restriction is appropriate, the Taylors submit that granting a change in permissible visitation times would be consistent with the least restrictive means analysis. 24. Counsel for the Taylors has interviewed each of the neighbors and it seems that the following schedule would work better for everyone (including the Taylors who have hmch during the current visitation schedule): lO:OOam-ll:00am and 5:30pm-7:30p.m. WHEREFORE, Petitioners request the Court amend its July 6,2006 Order of Court to permit completely unrestricted visitation, or, in the alternative, Petitioners request the Court amend the order to permit unsupervised visitation by any individual each day during the period ofl 0:00am-II :OOam and 5:30pm-7:30p.m. Respectfully Submitted, MARTSON DEARDORFF WILLIAMS & OTTO 7ItL~ ILLY ) {/\ DATE: 07/2-\ , George B. Faller, Jr., E PA Attorney 1.0. No. 49813 Michael J. Collins, Esquire P A Attorney 1.D. No. 200427 10 East High Street Carlisle, P A 17013 (717) 243-3341 Attorneys for Petitioner ,2006 - EXHIBIT A - 0'/05/2005 07:35 71 74853022 THREE SPRINGS FAM PR PAGE 02/04 30 June, 2006 Summary Virginia M. Taylor and Howard J. Taylor were evaluated to determine their current cognitive function. This was i.nitiated by their attorney for the purposes of estabHshing their mental capacity and recommending the least restrictive appropriate degree of guardianship. Mrs. Taylor has excellent physical health but has severe dementia of the Alzheimer type. She is completely cognitively incapacitated, and requires full-time supportive care. Mr. Taylor has advan.ced cardiac disease an.d mild/moderate dementia, most consistent clinically with multi-infarct dementia. While he is currently capable of Activities of Daily Living and some Executive Functions, he has deficits in short-term memory and judgment; his most significant deficiency is a limited awareness and/or acceptance of his wife's and his failing cognition. He should no longer drive, live alone or manage his financial affairs without supervision. The Taylors function best as a couple; they should remain together as long as pennitted by Mrs. Taylor's progressive dementia and Mr. Taylor's failing cardiovascular health. In view ofthis interdependency, the best living arrangement is 1he current one. which provides the safety and support more needed by Mrs. Taylor. Activities and visitation typical of an Assisted Living Care Facility are appropriate without special restriction other than prevention of elopement. Supervised day furloughs outside the facility and liberal access to visits from friends and family are within. the Taytors' physical, mental and emotional capacity, and will enhance the quality of their rematni:t:lg years. Financial decisions made on. the Taytors' behalf should include Mr. Taylor as much as possible, but ultimately must be directed by his guardian(s). Report of CORSU JtatiOD. Virginia M. Taylor, DOB 07flO/1930, and Howard J. Taylor, DOB 08/0311.926, were evaluated at Three Springs Family Practice clinic on 29 June, 2006, from 1300 to 1415 bours. they were interviewed and examined together, and in the presen.ce of Mr. Michael Collins, who represents their legal interests. The Taylors have no children, and no other family members were present. The Taylors were recently adjudicated totally incapacitated by a law judge, and their nieces were appointed as plenary and permanent guardians. Consultation was requested by their attorney for the purposes of evaluating the Taylors' mental capacity and establishing tbe least restrictive degree of guardianship. Outpatient medical records were provided in advance of the consultation and were reviewed in their entirety. There were no records of Mrs. Taylor's May 2006 geriatric psychiatric hospitalization., Mr. Taylor's May 2006 medical hospitalization, or their current nursing home care. Patient history was obtained by records review and intctview. Focused physical and mental status exams were completed, including administration of the MiniMental Status Exam (MMSE) and Clock Drawing. Mrs. Taylor Mrs. Taylor has a history of hypothyroidism following thyroid I131 ablation, hysterectomy for fibroid infarction, hyperlipidemia, and progressive dementia She - 07/05/2005 07:35 71 74853022 THREE SPRINGS FAM PR PAGE 03/04 presented in. February 2001 with se1.f-reporte? decreased memory; a fam~ly ~ist~ry o~ dementia in her 91 year old mother was obtamed. A. MMSE was 26/30, mdicatIng m1ld dementia; an MRl showed age related changes, and metabolic studies were n.ormaL A diagnosis of Alzheimer~s dementia was made. She was followed intennittently for her routine medical problems until May 2006. when she decompenstated during her husband's hospitalization. Her niece. Sandy Nye, came from her residence in Colorado to provide supportive care, and initiated outpatient evaluation accomplished 10 May, 2006. Geriatric psychiatric hospitali7.a.tion occurred two days later, and Mrs. Taylor was eventually transferred to Country Meadows (a nursin.g home). On physical exam, Mrs. Taylor was neatly and casually dressed, unguarded, reserved but socially interactive. She appeared YOWlger than her chronologie age of 75 years. Her general physical exam was unremarkable. Her mental status exam demonstrated severe dementia, with profound impairments of recent and remote memory, situational awareness, and judgment. The quality of her speech was unimpaired, but tbe content was severely limited. She routinely deferred to her husband for assistance in answering questions, and he gently directed her answers. No delusional thinking was identified. Mr. Taylor Mr. Taylor has history oflongstanding and significant coronary artery disease dating from 1976, complicated by myocardial infarction, coronary bypass surgery, ischemic cardiomyopathy (ejection fraction of 15% since 1997), congestive heart failure and cardiac dysrhythmia necessitating placement of an internal cardiac deti.brillator and chronic anticoagulation. He has hyperlipidemia, osteoarthritis, benign prostatic hypertrophy, pulmonary fibrosis, gout and reflux esophagitis. He was hospitalized in May 2006 for congestive heart failure, complicated by hyponatremia, acute renal insufficiency and delirium. Psychiatric, neurologic and Social Services consultations were obtained; a diagnosis of Alzheimer's dementia is recorded in the outpatient summary, as well as an assessment that the patient was <'n.ot able to take care of himself and n.ecds either rehab or an assisted living facility." He was discharged to Country Meadows. Mr. Taylor was neatly and casually dressed. for the evaluation, and appeared younger than his chronological age of 79 years. He is a physically imposing person, and retains a demeanor consistent with his occupational history of being a supervisor. He was cooperative and open. His general physical exam was surprisingly good in view of his severely depressed cardiac ftmction, and no evidence of congestive heart failure or cardiac decompensation was noted. He was patient, gentle and protective of Mrs. Taylor during her examination. His thought form was well organj1,:ed, and flow was tmrestricted. Content included frustration and anger over loss of control, and was directed towards his nieces. He voiced suspicion about their management of his finances, and anger that he and his wife were prevented from living in their own home. He asserted that he could take care of his wife and himself, that she could drive, and that she would take care of the interior house responsibilities while he would manage the exterior/yard. He denied problems with paying the bills, and was able to appropriately describe balancing a check book (there was no additional information available to corroborate Mr. Taylor's efficiency at these Executive Functions prior to his hospitalization.) He reporred that he liked the room and food at Country Meadows, but was bored; he apparently enjoys 07/05/2005 07:35 7174853022 THREE SPRINGS FAM PR PAGE 04/04 crafting "ditty bags" (a plastic frame with yam bindings and designs), and has asked that his nieces bring him those suppHes. He demonstrated some repetition of themes, recounting twice and in quite similar detail the number and fashion of ditty bags he's completed. MMSE was 27130, with misidentification of season, late recall of the President, and failed recollection of one ofthree words on short~tenn memory testing. Proverb interpretation was concrete, and judgment was fair. Visuospacial testing was good, and Clock Drawing was excellent. Impression Mrs. Taylor has advanced dementia of the Alzheimer's type. She requires a protected environment, and while she does not require full-time supervision she is incapable of self-administration of medications, financial decision making, or driving. She is dependent on her husband for orientation and emotional security, which he appears to provide effectively and without reservation. Mr. Taylor has mild/m.oderate cognitive impairment, most consistent with multi- infarct dementia. This distinction is based on wen preserved visuospacial function (which is usually an. early and progressive loss in Alzheimer's dementia) and a significant history ofvasculopathy; no conf1nnatory radiographic stUdies were available for review. This form of dementia typically progresses in a stairstep pattem, with episodic deterioration interspersed witb periods of stability. He demonstrates little awareness and no acceptance of his cognitive impairment, nor does he think his wife's is particularly problematic. While he re1ains reasonable math and organizational skills. his limitation in awareness makes bis unsupervised management of finances and independent choice of living accommodations inappropriate. Routine involvement of .Mr. Taylor in the discussion of choices made for his wife and him may be helpful in. allaying his suspicions, but ultimately conflicts relating to safety and financial security must be resolved in favor of a guardian. There is nothing on history or exam that suggests routine visitation of friends and family would bann Mr. Taylor, tbough they must be sensitive to Mr. Taylor's inappropriate assessment that Mrs. Taylor and he could live independently, and avoid encouraging that expectation. Recommendation Mr. and Mrs. Taylor should remain i.o an Assisted Living or comparable facility with protection from elopement; their present facility seemS quite appropriate. Every effort should be made to keep them together, even if it would require placing Mr. Taylor in a more restrictive setting than his dementia currently requires. No limitation in visitation is recommended, though inappropriate encouragement of the Taylors to return to tbeir ~ome by wen meaning friends should be discouraged. Financial guardianship is app~opnate, but need not exclude Mr. Taylor's participation, and should allow deference to hlS preferences where the result does not compromise safety or security- Michael Daniels. MD Three Springs Family Practice Mt. Holly Springs, PA EXHIBIT B - ;'v1.\R1'SO:--' DE.\RDORFF '~/ILLIA\IS 6 T1'O MDWSto I~<: nK~k-\,'J()", . An";.; '/\11' "<,-'.(. ,\nOR'.J.Y'; & ('OL'iSf'L:.ORS xr L\I\ !\I' V 01:') III C\RL C R:~\'I! D." 10 ,\. FlllSJ\!O'S CHRISTIFHIR E. Rlu .IL',....llLR L. :)Pf.\KS HII.LIRY A. DI "- \.lll H.\U. J. ("iLl.I", 10 E.\ST Hl<.l! SIPt! r C\RLlSU.. Pi....',.,L\\'-..\ 1~013 \V Ie 1,\\1 F \l\.nslJ'. JOII..... B. h:\\:lR !II D.\'-!!:!: K, Dl'.-\'m',Rll' Td()'! \, J. ',v'LL, \'1";* (jj'dU,[ B. F.\U.IY JR,~ TU.L?I!Il'.I' F.\l'~I\t1LL hTJ:R'LT nl~, 2-U-3341 (-j:) 243-1;,';0 \\.\ lund\\ 11.cul11 . HI, ( . ,<. 'll. TII! \: Si'!' :\1..,'1 July 13,2006 VIA FACSIMILE (245-0829) AND US MAIL Stephen J. Hogg, Esquire RE: Virginia M. Taylor and Howard 1. Taylor Our File No. 12096.1 Dear Mr. Hogg: I write on behalf of my clients, Virginia and Howard Taylor, with respect to the visitation order Judge Ebert issued at our hearing on July 6, 2006. The order permits unsupervised visitation by the neighbors between the hours of 1 0:00am and 1 :30pm. Because of work schedules, this range in times is not convenient and has the effect of forcing some ofthe neighbors to wait until the weekend to visit the Taylors or not visit at all. I am sure Judge Ebert did not intend this result when he issued his order. I am requesting that you ask your client whether it would be possible to agree to a change in the visitation schedule to permit the neighbors to visit with the Taylors during the following hours every day: 1 0:00am-II :OOam and 5:30pm-7:30pm. Granting this request will not afford the neighbors a greater number of visitation hours then they already have, it would just shift the visitation time to hours that are convenient for everyone. I would like to resolve this amicably. Please indicate by the end of the day on Friday, July 12,2006 whether Cheryl will agree to this reasonable change in visitation. Ifthe answer is to the negative, I will be forced to file another motion with the court on behalf of my clients. Very truly yours, MARTSON DEARDORFF ,WILLIAMS & OTTO lit; i" L E yC l~( '\ cc~ Michael 1. Collins \1JCmmp i f-1U:S ll\T\FILL'(J..-n..::nrClllr":llLI2./1\) I ,,11:=i I :-.. FOR \01 A T I 0:'\ . A D V ICE . A D V 0 C ,\ C Y S\l VERIFICATION Michael J. Collins, Esquire, ofthe firm of MAR TSON DEARDORFF WILLIAMS & OTTO, attorneys for Howard and Virginia Taylor, the Alleged Incapacitated Persons, in the within action, certifies that the statements made in the foregoing Petition for an Amended Order are true and correct to the best of his knowledge, information and belief. He understands that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. 1{ tJ-.vY Michael J. Collins CERTIFICATE OF SERVICE 1, Mary M. Price, an authorized agent for Martson Deardorff Williams & Otto, hereby certify that a copy of the foregoing Petition for an Amended Order was served this date by depositing same in the Post Office at Carlisle, P A, first class mail, postage prepaid, addressed as follows: Stephen J. Hogg, Esquire 19 South Hanover Street Carlisle, Pennsylvania 17013 Attorney for Respondent MARTSON DEARDORFF WILLIAMS & OTTO 'Ii ) (ILL (-) . By c ,'" ~ ' , -.4",,, / Mary 1Vl Price Ten East High Street Carlisle, P A 17013 (717) 243-3341 Dated: 7l~/J () {,