Benazir Bhutto -- A Great Loss

Benazir Bhutto was the most dynamic and charismatic female leader the world has seen. She leaves a gaping hole in the center of a hope that a woman of energy, brilliance, grace and beauty could in fact change the course of a country that is at the center of both terrorism and the possibility of seriously diminishing it. As Peter Galbraith wrote in the Washington Post on December 30, My friend died. Now her country may not make it. A human being and an indispensable leader.
Her recent, brief return to Pakistan, where she rode from suicide bomb on arrival to house arrest by the illegitimate General Musharraf, to candidate to lead her party into elections in a few days, and her assassination, telescoped in a brief arc the whole of her life.
Born to wealth and elite standing in an impoverished country, educated at Radcliffe and Oxford, elected prime minister at 35 and again at 39, she also spent five years in prison (much in solitary confinement), was married to a man who spent over 8 years in prison for corruption, and spent the last years before her return raising her children.
Many were skeptical of her bona fides going into her next campaign, but as Amina Khan, a lawyer and colleague of Pakistani heritage stated, when she heard Bhutto speak last year at Johns Hopkins of her record in office and commitment to fighting terrorism in Pakistan, "I really believe from hearing the tone of her voice, and the fervor of her voice, that it was a renewed and a very courageous leader," Khan, 38, said. "That's why I think this is especially sad. Because she was, I think, a great leader-in-the-making this time around."
For me personally, and as my friend Judy Shapiro pointed out, Bhutto's assassination contrasts hugely with that of Princess Diana. While the world may have mourned Diana's death in deeply emotional ways, we will mourn Benazir Bhutto's death in larger ways and for longer. She was the best hope of this generation to bring Pakistan out of deepening chaos, and her death is a tsunami that will trigger instabilities not only in Pakistan, but in India and Afghanistan as well as across the Muslim world and beyond to global oil and related markets.
Her death will ultimately be laid at the feet of the Bush administration that cynically brokered her return to balance out the failed presidency of Musharraf while allowing her to be under protected in a climate of extreme danger. Her death was avoidable, and neither Bush nor Musharraf took the necessary measures to prevent it.
Would she have been an effective Prime Minister again, this time around, we will never know. But her death leaves a gaping hole that will be impossible to fill. The next weeks are unpredictable. There are no good options and all of them are high risk. One can only meditate strongly to wish a return to centered coherence. And keep working to make it possible for disputes to be settled by negotiation instead of violence.

Help for the Mentally Ill: NY Law Looks Good

New York leapfrogs over many grinding tragedies by permitting judges to order mentally ill persons to take their meds and to order them back on their meds if they stop.

What may at first quick blush look like a return to the paternalism of four decades ago when the mentally ill were warehoused in barren bedrooms in far away institutions, this new approach looks like it has just the right amount of muscle and the right amount of freedom. At least one person, Susan Wezel, interviewed for the article, is an enthusiastic benefgiciary.

The New York law is definitely not a shoo in for families or the police to force treatment on the mentally ill. Rather, as the Washington Post writes today, to qualify for forced treatment under the 1999 law, among other criteria, a person must "have been hospitalized twice within the previous three years; must have shown violent behavior toward himself or others in the previous four years; and must need treatment to 'prevent a relapse or deterioration which would be likely to result in serious harm to the person or others.'"

As a DC attorney who has watched numerous wards, for whom I have been appointed guardian or conservator, ride the rollercoaster in and out of the mental health system, or bump along the painful lower edges of instability, delusion, unhappiness and poverty, a similar law would help to bring a lot of people back to life.

One current ward leaves endless voicemail messages filled with detailed lists of needs and demands, ranting threats of violence to anyone who would help her and finally pleas for help and declarations that she is very very ill and unhappy. And, of course, she claims to have something very, very wrong with her, that most definitely is not mental illness. She once was a happy family member who took her meds, worked and had a life. When she stopped and refused to take them, she fell into a life on the edge of eviction because she can't keep any order in her apartment, with no income for the time being, and and suffers misery and loneliness, depending entirely on her family and her court appointed conservator.

And she is one among many many such persons.

The mentally ill in the District of Columbia, which has a more useful threshold for involuntary committment than Virginia, for example, could benefit immensely from an expansion into something like the New York law.

Such a law would have to establish threshholds for commitment, including prior failures of less intrusive measures, a present danger to self and/or others, and a likelihood of continued danger and instability. Such a law would also have to be accompanied by a revamping of the mental health system and its funding to free case workers to actually have few enough clients to be able to monitor successfully the clients they have and to provide the support system of health care workers and medications to maintain essential levels of service.

What a liberating law! DC officials -- from the doctors at St. Elizabeth's to the lawyers assigned to help -- now simply must shrug their shoulders, with sympathy, but helplessness, at the rollercoaster life of those they are charged with caring for.

Such a law would go a long way, also, to bringing a number of the homeless off the streets. Not that clearing the streets of the homeless is the objective, but that giving people back the choice of living a life they choose freely rather than being driven by their demons into dungeons of glassy-eyed despair is the right and the kind thing to do.

We have the medications. Do we have the sensible wisdom to give the law the possibility of nudging those who can't admit their illness into a better orbit?

Help for the Mentally Ill: NY Law Looks Good

New York leapfrogs over many grinding tragedies by permitting judges to order mentally ill persons to take their meds and to order them back on their meds if they stop.

What may at first quick blush look like a return to the paternalism of four decades ago when the mentally ill were warehoused in barren bedrooms in far away institutions, this new approach looks like it has just the right amount of muscle and the right amount of freedom. At least one person, Susan Wezel, interviewed for the article, is an enthusiastic beneficiary.

The New York law is definitely not a shoo in for families or the police to force treatment on the mentally ill. Rather, as the Washington Post writes today, to qualify for forced treatment under the 1999 law, among other criteria, a person must "have been hospitalized twice within the previous three years; must have shown violent behavior toward himself or others in the previous four years; and must need treatment to 'prevent a relapse or deterioration which would be likely to result in serious harm to the person or others.'"

As a DC attorney who has watched numerous wards, for whom I have been appointed guardian or conservator, ride the rollercoaster in and out of the mental health system, or bump along the painful lower edges of instability, delusion, unhappiness and poverty, a similar law would help to bring a lot of people back to life.

One current ward leaves endless voicemail messages filled with detailed lists of needs and demands, ranting threats of violence to anyone who would help her and finally pleas for help and declarations that she is very very ill and unhappy. And, of course, she claims to have something very, very wrong with her, that most definitely is not mental illness. She once was a happy family member who took her meds, worked and had a life. When she stopped and refused to take them, she fell into a life on the edge of eviction because she can't keep any order in her apartment, with no income for the time being, and and suffers misery and loneliness, depending entirely on her family and her court appointed conservator.

And she is one among many many such persons.

The mentally ill in the District of Columbia, which has a more useful threshold for involuntary committment than Virginia, for example, could benefit immensely from an expansion into something like the New York law.

Such a law would have to establish threshholds for commitment, including prior failures of less intrusive measures, a present danger to self and/or others, and a likelihood of continued danger and instability. Such a law would also have to be accompanied by a revamping of the mental health system and its funding to free case workers to actually have few enough clients to be able to monitor successfully the clients they have and to provide the support system of health care workers and medications to maintain essential levels of service.

What a liberating law! DC officials -- from the doctors at St. Elizabeth's to the lawyers assigned to help -- now simply must shrug their shoulders, with sympathy, but helplessness, at the rollercoaster life of those they are charged with caring for.

Such a law would go a long way, also, to bringing a number of the homeless off the streets. Not that clearing the streets of the homeless is the objective, but that giving people back the choice of living a life they choose freely rather than being driven by their demons into dungeons of glassy-eyed despair is the right and the kind thing to do.

We have the medications. Do we have the sensible wisdom to give the law the possibility of nudging those who can't admit their illness into a better orbit?

A Great Loss

Benazir Bhutto was the most dynamic and charismatic female leader the world has seen. She leaves a gaping hole in the center of a hope that a woman of energy, brilliance, grace and beauty could in fact change the course of a country that is at the center of both terrorism and the possibility of seriously diminishing it. As Peter Galbraith wrote in the Washington Post on December 30, My friend died. Now her country may not make it. A human being and an indispensable leader.
Her recent, brief return to Pakistan, where she rode from suicide bomb on arrival to house arrest by the illegitimate General Musharraf, to candidate to lead her party into elections in a few days, and her assassination, telescoped in a brief arc the whole of her life.
Born to wealth and elite standing in an impoverished country, educated at Radcliffe and Oxford, elected prime minister at 35 and again at 39, she also spent five years in prison (much in solitary confinement), was married to a man who spent over 8 years in prison for corruption, and spent the last years before her return raising her children.
Many were skeptical of her bona fides going into her next campaign, but as Amina Khan, a lawyer and colleague of Pakistani heritage stated, when she heard Bhutto speak last year at Johns Hopkins of her record in office and commitment to fighting terrorism in Pakistan, "I really believe from hearing the tone of her voice, and the fervor of her voice, that it was a renewed and a very courageous leader," Khan, 38, said. "That's why I think this is especially sad. Because she was, I think, a great leader-in-the-making this time around."
For me personally, and as my friend Judy Shapiro pointed out, Bhutto's assassination contrasts hugely with that of Princess Diana. While the world may have mourned Diana's death in deeply emotional ways, we will mourn Benazir Bhutto's death in larger ways and for longer. She was the best hope of this generation to bring Pakistan out of deepening chaos, and her death is a tsunami that will trigger instabilities not only in Pakistan, but in India and Afghanistan as well as across the Muslim world and beyond to global oil and related markets.
Her death will ultimately be laid at the feet of the Bush administration that cynically brokered her return to balance out the failed presidency of Musharraf while allowing her to be under protected in a climate of extreme danger. Her death was avoidable, and neither Bush nor Musharraf took the necessary measures to prevent it.
Would she have been an effective Prime Minister again, this time around, we will never know. But her death leaves a gaping hole that will be impossible to fill. The next weeks are unpredictable. There are no good options and all of them are high risk. One can only meditate strongly to wish a return to centered coherence. And keep working to make it possible for disputes to be settled by negotiation instead of violence.

Freedom or Folly: Who Is or Should be In Charge?

The New York Times article about an elder scam or elder caper, depending on your point of view, raises a lot of excellent questions about the degree of intrusion the so-called able should have in the affairs of the not so able older person.

The story is familiar: an older person with a reasonable amount of money decides to undertake one or another project and ends up loosing all of his or her money. The loss is often due to a combination of larceny on the part of those who are aiding and abbeting the project and more importantly, of the freely chosen desire of the older person.

Benny Kass, who writes for the Washington Post on a number of related topics, described the process for the appointment of a conservator where a grandchild is worried that Grandma is spending her money foolishly. And yes, the courts will perform a thorough inquiry into the question of whether Grandma is really so incapacitated that she can no longer handle her money.

But how do we decide, before Grandma or Dad lets their bills go unpaid and a huge mess accumulates, that he or she is spending their money foolishly, or associating with flatterers who are actually trying to fleece them?

Example, Grandma has a tidy investment, she is well cared for in an assisted living facility. She is lonely and a very nice handyman befriends her. He fixes all of the equipment in her apartment, repaints her living room, to her delight, takes her on shopping trips to buy a new rug, he takes her out to lunch on these trips (of course, she pays the bill), visits often and entertains her. She really loves being with him. She would much rather be with a younger person than the doddering biddies in her facility.

Everyone in the family, all of whom live across the country, is delighted at first. Grandma has a companion who seems just right for her and who is useful to boot. Gradually, of course -- you can see where this is going -- disquieting signs begin to appear. Grandma wants to buy him expensive presents, wants to help him with his medical bills. She has a certain amount of dementia, but on the surface has nothing alarming.

What are family members to do? They have their own lives, children, jobs, friends, in their home towns, far away. Do they visit and take Grandma to visit a gerontologist? Get an evaluation of her mental capacities? One grandchild will argue that Grandma has the right to spend her money as she sees fit, it's hers afterall, and it gives her a pleasure she would never find elsewhere, to shower gifts on her new found friend. A son will argue that the handyman is taking total advantage of his mother, that he needs to be run out of dodge and that a conservator should be appointed to manage her money. A daughter will argue that she has the power of attorney, that she can step in a control Mom's spending.

Mom is flabbergasted at the concern of her children and grandchildren. She retreats into anger. Children, becoming more and more concerned, hire a lawyer. Lawyer advises that they should seek the appointment of the nearest living child as conservator and guardian. They file the petition and get Mom's internist to state that Mom has enough dementia to be incapacitated as defined by the law. Mom gets very alarmed, stops trusting her children, hunkers into her friendship ever more tenaciously. The court appoints a attorney to represent her.

The story ends in tragedy. Mom is alientated from her children; handyman is more closely entrenched in Mom's heart; even if a conservator is eventually appointed, the conservator inherits the problem: how far should he or she go in yielding to the desires of his or her ward? The law mandates that the conservator and or guardian provide the maximum amount of self-determination to the ward.

The children put pressure on the conservator to get rid of the handyman. Mom of course, begins to dislike the conservator and becomes ever more anxious, angry and ensconsed in her idea that she and her handyman should buy a house together and he will take care of her.

Assume that she is able to buy the house and Grandma willingly and happily puts the handyman's name on the deed.

If she were to later change her mind or if her children wanted to reverse the deal, what legal recourse would they have? Can Grandma or the children claim that her dementia should excuse her from her bad deal? If a child can get a contract voided for lack of capacity, can a dementer older person get the same benefit? How can the older person prove that -- despite their desire to enter into the transaction -- they lacked the judgment to do so and a court should void the deal? Does it make good public policy to allow certain states of mind a pass on the liability of freely chosen but later regretted transactions? Where does a legislature and then a court draw the line.

An alternative scenario is for one of the children to bring Mom to live with them. They shower her with love. She loses interest in her handyman as she plunges into the world of her grandchildren.

There are, of course, many other scenarios that could play out. Grandma here is lucky to have children and grandchildren. Many elderly persons have no one. The unscrupulous can take advantage very quickly.

The fundamental questions remain: how to balance the competing interests of the individual, the family (if there is one), the sanctity of contracts freely entered into, the medical and legal definition of incapacity that could help to define the boundaries of a new legal opt out. If medicine and law find that a line can be drawn, what are the risks of endless litigation?

On the more human level, what right does a child (heir or legatee) have to direct the way their parent lives their life or spends their money? Where does love and responsibility intersect with a parent's need for and right to autonomy? How healthy is it for a child or social worker or attorney or conservator to say, "I know better what is good for Grandma than Grandma herself" regardless of her "mental capacity" or judgement? How can an elderly person be protected from the wiles of the unscrupulous, when the elder person is gaining tremendous pleasure in the company of that villain or in donating large sums to televangelists? Should they be protected from themselves? At what point?

The longer we live, the longer we will enter into dementia, the more children and professional caretakers will be called upon to care for aging parents and the more difficult decisions will have to be addressed. With love, compassion, self-awareness, a sense of humor, and a dollop of common sense.

Fwd: God and evolution

-----Original Message-----

From: cforbes@forbeselderlaw.com
Subj: God and evolution
Date: Sat Dec 22, 2007 10:15
Size: 1K
To: Chrisforbesblog.blogspot.com

A friend gave me a book of that title. I will read it but first here is my take: religion is as much a product of evolution as the eye or the opposing thumb or the cockroaches susceptibility to peer pressure.

Religion is the expression of human love that like a giant basket carries many of our deepest, most ineluctable questions . . . . And some of our similarly ineluctable answers.

Religion flows from the conjunction of the human mind and human heartm reaching out to make sense of the world around us.

The problem comes when, as with many human enterprises, we capture those instincts -- like fighting over property or bartering or teaching the young -- in a large organized group, called a bureaucracy, which goes to work to create outcomes, which in the case of religion is to enshrine answers to those questions into a uniformly adhered to set of truths.

What is "true" for one religious bureaucracy is different from the "truth" of another. And in a shrinking world, those truths are held by people in mixed groups. Some become ecumenical and absorb other truths and grow, while others become defensive and inward turned and reject all others.

But the root of the religious impulse is the same: the human expression of a form of love.

Love itself as expressed in the human is the same love seen in all natural forms, a drive for replication. The watermelon has an incredible love of its seeds to create that huge body of fruit flesh to nourrish as compost, its little seeds.

It is the sme love as that of the grandmother who cares for her grandchild, freeing her daughter to reach out to forrage for better and more food.

So, religion is that branch of human love that seeks to create harmony among people and to ask and answer questions about the mysteries.

God is as much a creature of evolution as my cerebral cortex.

Take Thirty Minutes of Light or Take a Vacation in the Sun

Today's Science Section of the New York Times illuminates the mysteries of Seasonal Affective Disorder (SAD), now admitted to the ranks of a true disorder, that evolved in many many life forms, floral and faunal, to respond to the tilting of the earth during its annual rotation. When it gets dark and cold, the body seeks to hibernate, leaves fall off trees, annuals die having long ago sent their seeds -- hardy survivors over the winter -- on for next year's rising. Why we have named it a disorder baffles me, since it would appear to be adaptive. But why quibble.

Some people get very depressed by SAD during the winter months, when days grow shorter and it gets colder. You can evaluate your own body's propensity to respond to short days/long nights by taking the tests, for free, at the Center for Environmental Therapeutics (not a crank site).

It turns out that the best cure for SAD is (drum roll) more light! Apparently, once you have identified the cycles of your receptivity to light, all you need to do is shine some thirty minutes of bright light, and voila, in a few short days, the depression lifts. Much faster results than from taking an antidepressant.

Or, you could take a vacation to a spot on the globe where the sun shines longer.

I couldn't test for my circadian rhythms because the CET site was overloaded. Try again later. Good luck.

Fish on Two World Views

Stanley Fish, who I always thought of as a provocative sometimes infuriating (ly wrong) law professor, and who was also a dean of arts and letters at the University of Chicago, writes today of two quintessential New York experiences, one the endless refractions of character and choice, the other the endless fascination with contingent chaos.

What do I mean? His look at The Fugitive, a 60s TV series that breathlessly propelled its main character into the nooks and crannies of ordinary lives magnified through their stresses on choice, morality, mortality, a later movie (which sounded an awful lot like a low-budget Woody Allen sketch) of the same, but even more plotless spotlight on conflicts between inner worlds, and a new museum of contemporary art that looks like a crash pad after everyone sniffed cocaine and then went out to eat.

And, of course, I liked his admittedly retrograde view of the tensions of the soul as they soundlessly and furylessly confront their mute inner stresses brought on by brief, intense contact with others.

If you have time for a longish read.

From Ancient to Modern: the Meaning of a Clause

The heart of the Second Amendment is to be found the the Latin Ablative Absolute.

As Adam Freedman writes in today's New York Times, forget about the commas and focus on the words: "A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed."

Freedman points out that "the founders — most of whom were classically educated — would have recognized the first two clauses as stating the foundation for the conclusion. Thus the introductory clause "is [a] rhetorical device [known] as the “ablative absolute” of Latin prose. To take an example from Horace likely to have been familiar to them: “Caesar, being in command of the earth, I fear neither civil war nor death by violence” (ego nec tumultum nec mori per vim metuam, tenente Caesare terras)" The main clause flows logically from the absolute clause: “Because Caesar commands the earth, I fear neither civil war nor death by violence.”"

Freedman argues that "when the justices finish diagramming the Second Amendment, they should end up with something that expresses a causal link, like: “Because a well regulated militia is necessary to the security of a free state, the right of the people to keep and bear Arms shall not be infringed.” In other words, the amendment is really about protecting militias, notwithstanding the originalist arguments to the contrary."

We can look forward to a lot of hand wringing as we await the Supreme Court's decision on the DC hand gun ban that was struck down the by Court of Appeals of the DC Circuit. Freedman's view seem by far the most logical. I can't imaging the Founders arguing over the placement of commas. But more likely worrying about the right of the people to protect themselves through local, well regulated, militias and their need for arms.

(My only question about Freedman's argument is that the Latin places the premise after the conclusion. It really reads, in Latin, "I fear neither civil war nor death by violence, because Ceasar commands the earth." It is the English translation the places the causal premise first. So, I would translate the Second Amendment into modern English as: "People need to be able to own guns in order to protect themselves through well regulated militias.")

How Imperfect the Eye

Many say that it is impossible for the eye could have evolved, because it's too complex and too perfect and elegant. Evolution could never do that (thousands of monkeys on typewriters couldn't write King Lear). Thus, some author, God, must have created it.

But, the eye isn't perfect. Not by a long shot. In A Fin is a Limb is a Wing, in the November 2006 National Geographic, Carl Zimmer points out the comic flaws. The light gathering cells point inward, not outward toward the light. And the optic nerve is in front of the retina -- getting in the way of seeing -- and right in the center of the eye, the nerve plunges through a hole to the brain. Creating the blind spot.

Which is why if you want to clearly see a star, you have to look to the side of it, not at it.

The Mobius and the Circle

A thought for the day, or maybe longer:

"If I am who I am because I am who I am and you are who you are because you are who you are then I am who I am and you are who you are, but if I am who I am because you are who you are and you are who you are because I am who I am then I am not who I am and you are not who you are."

Found on a wonderful blog while hunting for some of those word combinations. It also turns out that the play, "Art" in which this is spoken, was written in French by Yasmina Reza, the same writer who followed Nicolas Sarkozy, the new president of France, for a year during his campaign and who will be publishing her observations and jottings next spring.

Comment on Co-Housing as a Great Retirement and End of Life Alternative

Raines Cohen, Cohousing Coach, Planning for Sustainable Communities, Berkeley, CA,

Posted an excellent comment on co-housing.

Thanks for including cohousing on your list of options for alternatives to Nursing Homes. A lot of the types of "experts" you list probably won't be aware of it, because it is a member-led ground-up community movement, only recently forming communities specific for a senior population, and the idea that "we can do it ourselves" is threatening to some of the institutions and even to professionals established in the "industry of aging".

You are fortunate in the DC area to have a large number of built (multigenerational) communities, and a strong regional association: Mid-Atlantic Cohousing (MAC) , which links to communities in the area, both built and forming; the group's leader, Ann Zabaldo, was my classmate in learning about Denmark's "Study Group 1" model curriculum that has led to the proliferation of Senior Cohousing there and is doing some talks in preparation for offering such a class in your area.

Raines Cohen, Cohousing Coach, Planning for Sustainable Communities, Berkeley, CA
writing from the Positive Aging conference at Eckerd College in St. Petersburg, FL, where there's a lot of excitement about alternatives including cohousing and the Beacon Hill Village model I've also studied.

The Joy of Writing

Why does this written doe bound through these written woods?
For a drink of written water from a spring
whose surface will xerox her soft muzzle?
Why does she lift her head; does she hear something?
Perched on four slim legs borrowed from the truth,
she pricks up her ears beneath my fingertips.
Silence - this word also rustles across the page
and parts the boughs
that have sprouted from the word "woods."

Lying in wait, set to pounce on the blank page,
are letters up to no good,
clutches of clauses so subordinate
they'll never let her get away.

Each drop of ink contains a fair supply
of hunters, equipped with squinting eyes behind their sights,
prepared to swarm the sloping pen at any moment,
surround the doe, and slowly aim their guns.

They forget that what's here isn't life.
Other laws, black on white, obtain.
The twinkling of an eye will take as long as I say,
and will, if I wish, divide into tiny eternities,
full of bullets stopped in mid-flight.
Not a thing will ever happen unless I say so.
Without my blessing, not a leaf will fall,
not a blade of grass will bend beneath that little hoof's full stop.

Is there then a world
where I rule absolutely on fate?
A time I bind with chains of signs?
An existence become endless at my bidding?

The joy of writing.
The power of preserving.
Revenge of a mortal hand.

By Wislawa Szymborska
From "No End of Fun", 1967
Translated by S. Baranczak & C. Cavanagh

NURSING HOME SEARCH

A number of newspapers recently reported on the list of the worst nursing homes in the country. Only one was listed in the District of Columbia, but the list should remind us to do a thorough evaluation of all options for housing for the elderly and disabled.

The first line of defense is to start early preparing for later disability, whether for yourself or a parent or family member. This includes developing a network of family and friends whom you can rely on. If you are a child, helping your parents think out ahead. If you are the parent, thinking about how to create or find a network of like-minded support family members and friends.

The second is to begin exploring a lot of options while you or your family member is still able to get around and make choices for themselves. There are many resources on the internet, including co-housing, elder co-housing or finding a vibrant community -- some empty nesters even return to city center to be near shopping, movies, lively restaurants and community centers -- to move into or live near.

The third, when one hasn't been able to do advance planning, is to research the assisted living and nursing home options where you or your family member wants to live. One of the best places to begin is with the ombudsman in your area who monitors these facilities. That person will have tremendous knowledge of the facilities and what level of care they provide, especially what quality of care.

Be prepared to look at a number of places. Also, identify what you or your family member is most interested in in terms of social interactions, setting, environment. Cost is only part of the picture. Expensive places can be sterile and cold; "poor" places can be rich with life and a caring staff. Ask questions of the staff and ask to talk to people who live there. Ask many questions about the things in life you care about. My mother would ask "how many people read the New York Times?"

Consult with experts who may know a lot about the various choices, such as geriatric care managers, the area agency on aging, and elder law attorneys, among others. Perhaps there is a local citizen commission on aging and city office on aging. When you visit, all nursing homes are required to have a book that records the record of performance. Read that.

The two most important things to do are 1. define what kind of a life you or your loved one wants to live and 2. do a lot of comparison shopping as early as possible before your choices are limited by disability or lack of money. And, check on the many resources in your community.

Personal Religion and Professional Performance

Mitt Romney should have a simple answer, the same one for all of us whose professional requirements sometimes may conflict with a personal religious tenet, and that is:

* My religion is personal.
* All religions have the golden rule at the core: do unto others as you would have them do unto you (and variatons on that phrasing).
* That single value infuses my professional actions.
* If there is a conflict between my religious beliefs (and duties) and professional responsibilities and duties, actions in the professional sphere will (must)be guided by the reciprocal kindness rule and performed as required in the professional context.

Separation of church and state should inform the separation of professional actions from religious beliefs, observations and actions.

A deeply devout Christian who doesn't believe in the death penalty may still enforce it if that is the law. He or she can work to change the law, but must obey it until changed.

A pharmacist who doesn't believe in abortion must still sell morning after pills approved by the FDA to those qualified to buy them. The personal religious belief should not override professional actions and responsibilities.

A president of one faith may fully pracitice his or her faith, but must be religion-neutral in dealings with the world's people who hold diverse religions or no religion at all. Advancing a pinched view of religion serves neither religion nor public professional performance and leadership.

What Is Lear's Legacy?

A gruel thin legacy or a basket of love? Bill Thomas asks the question of intergenerational transfers of wealth. My answer:

It all depends on what kind of capital the parents have built up to pass on.

Amassing physical wealth, property, glories, riches, requires constant vigilance to protect. Offspring are held in thrall to the prospects of inheriting some or all of that earthly glory.

Building, nourishing, cultivating family and friendship bonds, links to loved ones, old stories told and retold, are human and spiritual capital that can't be given away and that keep offspring coming back for more.

I was lucky to have parents who continued to earn our love and affection and trust and eager connection until death. They both continued to grow into more full, more exciting, more engaged humans until, so far, only my mother's death. We children vied for who could visit when, with limited bed rooms. We travelled in bunches, carrying our sailing canoes and kayaks to beautiful places where we played and ate and continued the conversations, well into my parents old age.

Now, with my step father still telling amazing stories as he sinks into a wheelchair that we are keeping away from him so he retains his muscletone, he has invented a novel of 24 chapters. A filmmaker son in law will record the telling of those chapters, all about the Civil War, rewritten to a more satisfying outcome.

That is a transfer of wealth that can never be exhausted and that nourishes each one of us.

My biological father, on the other hand, pursued wealth and glory. He died a pauper, having disinherited two sons and shortchanged a third because they "were a disappointment to him". These sons, who will never recover, argued for months that the will should be contested, that the stepmother had poisoned him and stolen all of his money. A gruel thin legacy.

Which basket should one lay one's eggs in?

File Letters of Conservatorship with the Register of Deeds

After all the agony and hoopla of getting appointed conservator of a person lacking capacity to manage their affairs, remember to file the Letters of Conservatorship with the Recorder of Deeds. Should anything happen to the property under your control, you, your ward, and your ward's property are protected.

Disasters can occur when the Letters of Conservatorship have not been filed. Title companies may claim that they didn't find the Letters in the land records, so they were justified in going to closing on what in fact is a fraudulent transfer. Recovering the property requires litigation, expert witnesses, time, money and heartache.
Office of Tax and Revenue: Recorder of Deeds

AND ALL HE HAD WERE ROAD FLARES TIED TO HIS BODY

The tragedy that ended peacefully in New Hampshire today -- unlike those where mentally ill people get guns and end up killing others and/or themselves -- reveals much about our great difficulty in dealing with mental illness.

As Hillary Clinton said, he probably wanted to talk to her to ease his pain. We know the grimy details, a mentally ill man, going through a divorce (marriage apparently characterized by a lot of violence), drinking for 72 hours. He blew over the top.

The prominence of the location -- Hillary Clinton's local campaign office -- contrasted with the repeated pictures of police in counter-terrorist garb and guns together with the media frenzy, is a metaphore for how tragically limited our capability is to assess and deal with a man who went over his threshhold of pain. The word "overkill" doesn't begin to measure the gap between the ailment and the, our, response.

Many obviously don't achieve the heights of aberrational, dangerous and self-destructive behavior as that of Leeland Eisenberg. But the grinding contrast between their desire to reach out and touch and the dysfunctional ways in which those suffering from schizophrenias and bipolar disorders carrom from one failed interaction to another, all have the same pattern.

Intensities, deafness to others, lack of affect, lack of ability to connect, internal demons that at the least distract and at the most produce grandiosity, serious obsessions, impairments of all kinds, all spill over onto the caregiving and responsible families, doctors, caregivers and police.

The core understanding has to start with the knowledge that these manifestations of mental illness are not subject to will, punishment, redirection or any ouside or internal force other than the dis-ease itself. They can't help it. What such a person feels, thinks and does are impervious to control.

And, because in so many cases the person sees him or herself as not only normal but possibly gifted and only suffering from some physical ailment, he or she often refuses medication.

The definitions of behavior that trigger intervention by the law (commitment to a facility or in this case, jail) -- "a danger to himself or others" or a stronger formulation, do not give us a strong hold on helping either the person or the caregivers and restrainers.

The interpretation of "danger to self or others" focuses primarily on a physical danger. Police and hospital personnel will let a deranged person go back on the street if they aren't behaving wildly and can communicate just enough coherence to show a small hold on reality, in that immediate moment. The fact that it is predictable that he or she will proceed to binge on delusions and possibly harm themselves or others, again, doesn't enter into the evaluation.

We are constrained by our laws. But the laws only reflect the prevailing consensus of the society. And the fact is that in the face of intractable mentall illness, if the person (I hate to say victim) doesn't want help and doesn't want to be on medication, there is nothing we can do. Tragic as it is. Yes, we can nudge and try to convince. But the disease is too strong.

So, acceptance of the inevitable roller coaster built on a merry-go-round is the only real place to start. Accepting that society can't really respond if the person doesn't want help. And accepting, painful as it is, that they will continue to behave in dysfunctional ways that will weigh heavily on family or caregivers and sometimes end in tragedy.

Then the questions: what is the right reaction? how does one communicate or work with him or her? what is the right level of intervention? what will possibly be healing?

Was placing the man face down on the road and handcuffing him and then steering him from police car to police car and wheeling away with numerous commandos holding onto the van, the right response?

The answers are still out of reach. Our only tools are acceptance, understanding, patience, not judging, and being there, holding our ground. And hoping they will take their medication.

Can't we find better ways?