How to Get Good Hospice Care: Hard-Won Advice from the Pennsylvania Nurse Prosecuted for Aiding Her Father’s Death


In February 2013, Barbara Mancini was arrested in Pottsville, Pennsylvania, and charged with aiding the attempted suicide of her dying 93-year-old father, Joseph Yourshaw. Ms. Mancini, a registered nurse in Philadelphia, had handed him his prescribed morphine at his request. After Mr. Yourshaw took the morphine, his hospice nurse called 911. The hospice nurse and the police ignored Mr. Yourshaw’s written advance directives about the kind of care he wanted at the end of his life, and he was hospitalized and treated in defiance of his wishes.  He died at a hospital four days later.

Ms. Mancini’s prosecution lasted a year, during which the case garnered national attention and was roundly criticized in the media. The charges against Ms. Mancini were finally dismissed when a judge ruled that there was insufficient evidence to send the case to jurors.

In the years since, Ms. Mancini has become a vocal advocate for improved end-of-life care.  She believes that one of the main reasons for the ordeal that her father had to endure in his final days was the failure of his hospice provider to deliver the care he was entitled to.

In a podcast conversation with ElderLawAnswers, Ms. Mancini explains how families can advocate for good hospice care for their loved ones and avoid the nightmare that she and her father endured. As she says in the podcast, “My biggest regret is that I didn’t do more to research hospice care. . . . Hospice is a vital end-of-life care option. The problem is that hospices vary greatly in the quality of care that they provide.”

Medicare’s hospice benefit covers any care that is reasonable and necessary for easing the course of a terminal illness. Among the crucial requirements hospices must follow are that a patient has a right to receive effective pain management and symptom control, and that the hospice must provide care that optimizes comfort and dignity, with the patient’s needs and goals as the top priority.

Many people are satisfied with their hospice care. But information has come to light of problems with some hospice providers. The U.S. Department of Health and Human Services Office of Inspector General (OIG) issued a disturbing 41-page report in 2018, finding that hospices do not always provide needed services to beneficiaries and sometimes provide poor quality care. A more recent OIG report highlights hospice deficiencies that pose risks to Medicare beneficiaries.

These revelations underline the importance of carefully selecting a hospice provider. Ms. Mancini suggests asking for recommendations from friends and family members as well as professionals. But she also strongly advises doing your own research to make sure that you are picking the right provider, and she offers a list of questions to ask when interviewing a hospice:

  •         Is staff available 24 hours a day, 7 days a week? 
  •         How do you ensure that patients obtain their desired level of comfort?
  •         Who will direct the hospice patient’s care? 
  •         What education is provided for the patient and caregivers? 
  •         Will you ever override a patient’s advance directive? Under what circumstances?
  •         How many patient and caregiver complaints were received in the last year? How were they resolved?
  •         How many patients and caregivers have terminated services? What are the reasons?
  •         Is the hospice concerned about opiate addiction in its patients? (“If the answer is yes, run, don’t walk, away from that hospice,” Ms. Mancini counsels.)

The best end-of-life care is based on the individual patient’s values and wishes. For this reason, Ms. Mancini stresses the importance of advance directives, so the patient’s wishes are in writing. She also believes in the importance of individuals being well-informed about the rights of the patient and the responsibilities of hospice providers.

To listen to the full podcast episode, click here (scroll down).  This is Part 2 of a two-part interview with Ms. Mancini.  Scroll down further for Part 1, in which Ms. Mancini recounts the events that led to her prosecution for her father’s death. 

For more on hospice care, click here and here.

For more on end-of-life decision making, click here.

The 2020 Social Security Increase Will Be Smaller than 2019’s

The Social Security Administration has announced a 1.6 percent increase in benefits in 2020, nearly half of last year's change. The small rise has advocates questioning whether the government is using the proper method to calculate the cost of living for older Americans and those with disabilities.

Cost-of-living increases are tied to the consumer price index, and a modest upturn in inflation rates and gas prices means Social Security recipients will get only a small boost in 2020. The 1.6 percent increase is lower than last year’s 2.8 percent rise and the 2 percent increase in 2018. The average monthly benefit of $1,479 in 2019 will go up by $24 a month to $1,503 a month for an individual beneficiary, or $288 yearly. 

The cost-of-living change also affects the maximum amount of earnings subject to the Social Security tax, which will grow from $132,900 to $137,700. 

For 2020, the monthly federal Supplemental Security Income (SSI) payment standard will be $783 for an individual and $1,175 for a couple.

The smaller increase may mean that additional income will be entirely eaten up by higher Medicare Part B premiums. The standard monthly premium for Medicare Part B enrollees is forecast to rise $8.80 a month to $144.30. According to USA Today, advocates are questioning the method used to calculate cost-of-living increases. The Bureau of Labor Statistics uses the Consumer Price Index for Urban Wage Earners and Clerical Workers to set the inflation rate. This method looks at prices for gasoline, electronics, and other items that younger workers rely on. The advocates suggest using a different index (the Consumer Price Index for Elderly) that puts greater emphasis on medical and housing expenses. 

Most beneficiaries will be able to find out their cost-of-living adjustment online by logging on to my Social Security in December 2019. While you will still receive your increase notice by mail, in the future you will be able to choose whether to receive your notice online instead of on paper.

For more on the 2020 Social Security benefit levels, click here.

Powers of Attorney: A problem or a solution?

A durable power of attorney is one of the most important estate planning documents you can have.  It allows someone who you appoint (your agent) to make decisions on your behalf in the event you become incapacitated. If you have not appointed an agent then your friends and family may not have the authority to make decisions on your behalf. In that case, a judge may have to appoint someone for this task, which can require a court process that is expensive and tedious. 

While a durable power of attorney (POA) is one of the most common estate planning documents, it is also one of the most misunderstood. This article will break down some of the common misconceptions regarding POAs and help you understand what you need to create a valid POA.

Misconception:Technology is so great now, there is no need to speak with an attorney, I can just create my own POA online. 

Truth: POAs are not one-size-fits-all. Each person’s situation is unique.  If you use a cookie cutter program it may not cover specific transactions.  In order to conduct many financial transactions specific language must be used to grant proper authority.  Elder law attorneys create these documents regularly which gives them valuable experience in unique situations and can make sure you have all your bases covered. 

Misconception:POAs are one-and-done documents. Once I create it I will never have to touch it again.

Truth: POAs are documents that should be updated regularly. Laws change and if you have not regularly updated your documents you may find out too late that your POA is not valid. Further, some financial institutions may not accept a POA that was not updated in the last few years for fear of a lawsuit. 

Misconception: I shouldn’t make my POA active until I become incompetent (a “springing” POA).

Truth: While the timing of granting agency through a POA is a matter of personal preference an immediately effective POA should be considered.  A springing POA usually requires a finding of incompetency by at least one doctor and sometimes two.  However, there may be an emergency where a doctor will not sign off that you are incompetent. Making your POA effective immediately removes the need for a doctor to declare you incompetent.  

Misconception: I don’t need a POA, I’m young and healthy, plus I don’t have many assets.

Truth: Every single person over the age of 18 should have a POA. You never know when something catastrophic may happen.  You need to have a plan in place to take care of you in the event you become incapacitated unexpectedly.  If you do not have these documents in place then you have no control who will be making decisions on your behalf.  It can be expensive and time consuming for your loved ones to go through the court to have one of them appointed by a judge.  

POAs are absolutely essential documents that everyone should have. It is important to consult an elder law attorney who can examine your unique situation to create your POA and to keep it updated. Please do not hesitate to contact our office if you would like to speak with an attorney about creating your own POA. 

Life Settlements: Are they a good idea?

Older Americans with a life insurance policy that they no longer need have the option to sell the policy to investors. These transactions, called “life settlements,” can bring in needed cash, but are they a good idea? 

If your children are grown and your mortgage paid off, you may decide that there is no longer a reason to be paying premiums every month for a life insurance policy, or you may reach a time when you can no longer afford to keep up with the premiums (as may be the case if you need in-home or long term care). If this happens, you may be tempted to let the policy lapse and get nothing from it or to surrender the policy for its cash value, which usually is a fraction of its death benefit. Another option is a life settlement. This allows you to sell your policy to an investor for an amount that is greater than the cash value, but less than the death benefit. The buyer pays all future premiums and receives the death benefit when you die. 

Life settlements offer seniors a way to get cash to supplement retirement income and help pay for living expenses, health care, or other needed items. They can be a good alternative to surrendering a policy or letting it lapse. But as with any financial transaction, you need to exercise caution. 

The amount you receive from a life settlement depends on your age, your health, and the terms and conditions of the policy. It is hard to determine if you are getting a fair price for the policy because there are no standard guidelines for life settlements. Before selling you should shop around to several life settlement companies. You should also note that the amount you receive will be reduced by transaction fees, which can eat up a good chunk of the proceeds of the sale. In addition, you may have to pay taxes on the lump sum you receive. Finally, the beneficiaries of your policy may not be pleased with the sale, which is why some life settlement companies require beneficiaries to sign off on the transaction.

Before choosing a life settlement, you should consider other options. If you need cash right away, you can borrow against your policy. If the premiums are too much, you may be able to stop premiums and receive a smaller death benefit. In some cases of terminal illness, you can receive an accelerated death benefit (this allows you to receive a portion of your death benefit while you are still alive). If you don’t need the cash but no longer want the policy, another possibility is to donate the policy to charity and get a tax write-off. 

To find out the right solution for you, talk to elder law attorney Richard Schulze of Reno, Nevada. He can reached here. 

For more information from the Financial Industry Regulatory Authority on the pros and cons of life settlements and questions to ask to protect yourself in a sale, click here.

Richard (Rich) P. Schulze, JD, MBA – Reno, NV

  • Richard (Rich) Schulze, Reno, Nevada

Richard Schulze is an accredited VA attorney with over 25 years of Elder law experience.  Rich Schulze’z private law practice emphasizes creating effective estate plans for his clients utilizing a variety of tools and techniques, including revocable and irrevocable trusts and specialized Eldercare Wills.  Rich is highly skilled in assisting clients in qualifying for and receiving Medicaid and the Veterans’ Aid & Attendance benefit.

Richard received his bachelor of arts degree from Reed College in Portland, Oregon.  He received his Doctor of Jurisprudence from Willamette University College of Law in Salem, Oregon and his Master of Business Administration for the Atkinson Graduate School of Management.  

Richard has a broad professional background ranging from working as general counsel for a financial services firm to work in some of thelargest law firms in the State of Nevada.  A widely acclaimed speaker, Richard is a frequent lecturer to the public and professionals on estate, Medicaid, asset protection and tax planning matters. 

Rich lives in Carson City with his two teenage daughters.  In his free time, he enjoys hiking in the desert with Rosie, his Labrador-German Shorthair mix.