Ohio, It was very nice to meet you and THANK YOU for attending the rally and showing your support for me and my family. I just want to thank everyone on the forum who are supporting me, and who are keeping me in thought and prayer. It means more than any of you will ever know!

Welcome Lisa,

You and your family are in my prayers.

Ohio...Thank you, first of all, for attending last night. It was a joy to meet and talk with you.

Thank you for sharing and explaining the information I was seeking. Like I have stated before, this is like a crash course for me, personally. The more I can learn in the few weeks we have before trial, the better.

I look forward to taking you up on your offer, and will be in touch, most likely by the first of the week.

Rick

Dearest Lisa,
Welcome to our forum.
Praying for you and your family.
Peace,
Dani

ttt

I am following this thread with great interest. I think the outcome could have a profound effect on the rest of us home caregivers.

Welcome Lisa,
we're here for you!!

I have just finished reading this discussion and I can not believe this is happening to this family. I have been a RN for many years, and over twenty of those years were in home health and hospice. Many, many of my former patients did die at home under the family care because of their choice to keep their loved ones at home instead of nursing home care. This is a very hard job to provide that total care at home and I always admired those who were able to answer the call to do so. When someone has a terminal illness, it is just that, terminal. The body shuts down and part of that process is not eating with many terminal diseases. When people do not eat, they lose weight, this is a basic fact. When they are without mobility, they are prone to skin breakdown, combine that with no nutrition and you will have breakdown "bed sores". When patients get to end stage they will lose control of urine and bowels. If as a nurse or doctor, you feel that this is making the patient more uncomfortable or difficult for the caregivers to provide care, the nurse or doctor suggests a catheter for the patient. But, if the patient is confused, they pull this out in their confusion and the catheter may cause more damage than helping the matter.
I can not understand why there were complaints on this patient for the weight loss, skin breakdown, urine and fecal incontinence against the family. All these were a natural process of an end stage disease. There is no cure for dementia, Alzheimers, so why did they think these things could be prevented?
Also, if neglect was there as they are stating, why in the world didn't the home health nurses report it to division of aging? Home health is required to hotline any situation that they suspect abuse. Home health nurses are to teach the family how to provide the care that is needed to the patient. If the home health nurse sees that the family can't be taught or is unable to care for the patient, the nurse is to do further intervention. Every home health has a social worker available also for the intervention of that patient in the home. The social worker could have assisted with placement into a nursing home if that was indicated. This is why it does not make any sense how caregivers could be charged with manslaughter. If care was that bad, something would have or should have been done prior.
I can not tell you how many patients I had that passed at home that were under weight, with skin breakdown, and had loss of bowel and bladder. This just happens with many terminal diseases. How can a family be charged with criminal charges with a condition that occurs with a terminal process? I think if the loved one was in a nursing home this would not be an issue and that I just don't understand. As a hospice nurse I visited patients in nursing homes and saw many of them under weight, with "bed sores", and not eating or drinking for many days, sometimes for weeks before they passed.
Families should not be forced to place their loved ones in nursing homes. This needs to be fought to the highest form. This has the potential to instill fear with all caregivers that have made the loving choice to provide home care.
My support and prayers to you, Lisa. I am so sorry you are going through this. It looks like you do have a good legal support system.
My dear husband has frontal temporal dementia and I realize there will come the time when he will refuse to eat, have decrease mobility, and have loss of bowel and bladder. I plan to keep him at home, if I can to the end, and this situation in Ohio scares me. This is government telling us again what to do. I will be following this also with deep concern.
Linda

Hello Linda: I too am an RN and spent over 20 years as Administrator of Patient Case Management and also consulted in QI auditing records re practice patterns for Home Health and Hospice.

I am also confounded by this DA's prosecution; especially so many years AFTER the death. Four years later, what the heck?

I had written a detailed note very similar to yours. This entire scenario makes no sense at all, does it? Completely illogical.

Bet that the pneumonia was aspiration pneumonia. No swallow test EVER done all the years this patient was not eating, even in the early stages. Silent aspiration may also have been an issue as well as the terminal patient just stopping eating.

Home Health out there twice a week; MD appointments ongoing and kept. NO referral to hospice. NO report to APS.

There were the mandated reporters all lined up to go nowhere. If the patient was seen that often, then where did all the action go? The patient did not get to 63 pounds overnight! Why no hospice referral? That one has me entirely perplexed. And if this patient had died under hospice rather than home health, then the DA's office would never have brought this case to prosecution.

The unskilled care aide had no education to all re patient care or dementia; she had no POA - the son did. She had no way to understand hospice necessity or dynamics - she had to rely upon the expertise of the professionals as well as acquiescing to the son's POA. Murkier and murkier.

And of course, the patient being that cachectic with absolutely no muscle tissue or protein stores, OF COURSE there are going to be decubs and there are no resources in the body to promote healing.

In the very best of settings, with the very best of care, under these extreme circumstances the body was undergoing, there still would have been skin breakdown issues.

Interesting that the son is also being prosecuted separately from the care aide. It is my understanding that they are trying to offer him a "deal" to roll over and accuse the care aide.

Of course, lets always remember . . . . we have heard the defense side of the matter, we have yet to hear from the prosecution. That will put everything out in the full light of day.

That being said, my gut instinct still tells me something is simply not right here.

By the way, my mother has FTD. Not an easy diagnosis by any stretch of the imagination.

I just thought of something; the defense team found this site and has posted here.

I'll bet you anything that the prosecution is also monitoring this site and NOT posting. Although they have their own professional consultants, this is a good place for them to pick up on public opinion and possible additional defense arguments and then plan strategy to pick the facts apart in their favor.

Maybe, maybe not; but I'll bet they have or are.

Johanna, I made sure they were aware of it several weeks ago.

Hello everyone. I just want to say to the nurses on here your professional medical opinions are right on! Although I don't want to say much but I think I can let you know that hospice was reccomended to my father in law by the M.D. However, the reccomendation came only 6 days prior. By the time they got it set up for them to come in it was too late. It would've been nice to have them here for comfort not only for her, but for me as well to prepare me. I want to let you all know that this is tramatic for me. When you are caring for someone you get used to them being there, and then when they are gone you feel lost. I loved and miss Evelyn so very much and now with all of this, it feels like I'm losing her all over again. As if once wasn't enough! May she rest in peace. I can understand how many people are scared because of my situation because I know I am. I just want to thank everyone again, your kind and encouraging words are greatly appreiciated and your support is helping me to stay strong.

Stay strong, Lisa.

Dear Lisa,

My prayers are with you and your family.

What you are unjustly, [from what I have read here] Going Through--- is a great concern, not only to me, but also for all who wish to care for our LO's at home.

I've been to Medicaid funded NH's. My son and I went on a tour at a NH and there were patients confined to wheelchairs, sitting in their feces/urine, after lunch time, while the aids stood around in their station--- gabbing away. My son said, Out Loud, "PEE-YEW--- it smells like cow poop in here"! The administrator gave 2 excuses for the unpleasant odor: #1 it was just after lunch time and the aids haven't had enough time to change "them" all, and #2 "There must be must be something wrong with the ventilation unit, I will call after you leave to have someone from maintenance to fix it". BS! There were other violations as well. I left in tears! I called APS immediately after I left and the social worker gave me the # for the State Ombudsman. I called to make a complaint to the State Ombudsman. I stated to each agency that, "I wouldn't place my dog there for a minute.... it was Inhumane"!!!

My 22 year old daughter and I are taking care of my mother 24/7. I am my mother's full legal guardian and conservator. I know that I am being held at the utmost scrutiny [through the Probate court] for my mother's care and moreover for the financial decisions that I make. I never wanted to have the responsiblity of guardianship/conservator. However, I had absolutely no choice as my mother is a victim of elder exploitation and abuse. It is an awesome responsiblity to be a full time caregiver. I Do Not want my mom in a nursing home.

Lisa,
My Mimi [grandmother] was a devout Catholic. Mimi had breast cancer. Mimi died in a Catholic hospital [where her sister was the Head Nurse] and when she died, Mimi weighed approx 80lbs. My Mimi who was Pro Life-- stated to my mother just weeks before she died, "I wished someone would give me a little pill that says 3 o'clock...."

My husband's Lutheran Kindergarten teacher, Pro Life advocate and my friend [who was in her 80's] had the most severe case of osteoporosis. She was admitted to a NH due to the fact that she was no longer able to swallow food and she needed a tube inserted in her for her to receive nurishment. She was given the choice whether or not to have the tube unserted and then she would have to remove a certain part of it and clean it out after she ate. She choose Not to have the tube inserted. She said, "If I am not able to clean the tube on my own, then I Do Not want it inserted". She died within the week in a NH.

My great aunt, who was the the Head nurse at the Catholic hospital [Pro Life] was diagnosed with some form of dementia and she was placed into a NH. My great uncle said that her weight started dropping months before she died and that she refused to eat the last few weeks of her life.

I went to the funeral of a former co-worker [she was in her 60's] who succumbed from an autoimmune disease and she weighed no more than 90lbs.

My Grandma, my mom's mother died at home from breast cancer with the aid of hospice and she was no more than 90lbs.

Every person that I have gone to a funeral for who had a long term illness was gravely underweight!!!

No one can prove in court what a dying person's soul, subconscience-will is. However, I believe that even people with Dementia are able to lose their will to live.

My mother is at stage 7 and when she is upset or depressed she tells me she's not hungry. My mom is very strong willed and if it is God's will for her to suffer this illness to the dreaded end--- I know that she will have her way and give up her will to live and stop eating--one way or another!!!
God help us all!

I think that it is human nature to want all suffering to come to an end-- whether the suffering is in the body or the mind. Even Jesus prayed and asked, "My Father, if it is possible, may this cup be taken from me"...

Lisa,
I cannot imagine how very difficult this must be for you! Please know that there are people who Believe in You! Please do Not lose Faith and Hope. There is Hope and His name is Jesus. All the women that I have known who have suffered with terminal illnesses Never lost their Faith.

I've petitioned the Lord to grant you peace and the strength that you and your family need to help you through this difficult time. May He guard your hearts and minds.

I pray that when you feel alone, that the Holy Spirit will remind you that the Lord is with you always and He keeps His promises.

Never will I leave you,
Never will I forsake you.

Lisa, my family went through a very difficult trial with my mother. It is important that you believe and have faith that God will work this all out for the good.

May God bless you and keep you all in His grace.

Marcie

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The Parable of the Persistent Widow
Luke 18:1-7

Then Jesus told his disciples a parable to show them that they should always pray and not give up. He said: "In a certain town there was a judge who neither feared God nor cared about men. And there was a widow in that town who kept coming to him with the plea, 'Grant me justice against my adversary.'

"For some time he refused. But finally he said to himself, 'Even though I don't fear God or care about men, yet because this widow keeps bothering me, I will see that she gets justice, so that she won't eventually wear me out with her coming!' "

And the Lord said, "Listen to what the unjust judge says. And will not God bring about justice for his chosen ones, who cry out to him day and night? Will he keep putting them off? I tell you, he will see that they get justice, and quickly. However, when the Son of Man comes, will he find faith on the earth?"

[quote]Start by doing what's necessary; then do what's possible; and suddenly you are doing the impossible.
St. Francis of Assisi[/quote]

Marcie, thank you so much! I love the quote! That is the truth!!!!

We are under the assumption the prosecutors are aware of and monitoring this forum. We are not trying to suppress the truth nor embellish facts in order to have a guilty caregiver walk away from a homicide conviction.

We are not seeking to have this case tried on this Forum.

We want a bright light on this case before Lisa has to go to trial. The only thing we fear is continued ignorance on the part of the prosecutor and ultimately, the jury.

We are working with very limited resources and have to network for professional and educated opinions on this very misunderstood topic.

Dear Mr. Koffel: It must be extremely frustrating to deal with this, especially compounded by lack of funding. This is not only a very important issue for Lisa, it is also a very important case in the history of your career.

I don't think the prosecutor's office is as dense as they appear to be.

By now, they must have a full understanding regarding the facts of terminal dementia and the wasting and skin breakdown which can occur in the best of care. At least one would think so. And if they DO have the knowledge, then there is another motive for hanging onto this case and that is NOT going to do much for the prosecutor's reputation nor for what is perceived to be his intelligence and ethics.

The autopsy - that's another thing. I do hope you have an expert to refute some of what the coroner's office was assuming. I think that he may well have missed the actual "facts" that were staring him in the face. OR, heaven forbid, could he be tailoring his findings to fit the prosecutor's demands? Sure hope that is not the case. Yes, something may be present on findings; BUT the causative factors may well have been far from his assumptions.

Ignorance, willfully wanting to "make" something out of what is not there, to twist the facts to force them to point to something that isn't, this all points out to me the possibiliity of a noxious approach by some very, very less than ethical people - because if this is so, then it becomes about THEM. It is not about Mrs. Cox, it's not about the actual truth, and it definitely is NOT about justice, it then becomes self-serving.

So, it appears it may be all about a person who NEEDS this to be something for HIS benefit - at all costs. Pretty odd to pin one's professional coattails to something which may well make one look like the village idiot and a simpering fool or worse. It just doesn't make sense. And four years after the fact? Very murky indeed.

This may well turn around and take a bite out of the posterior of someone's future credibility and even one's career.

What is the "temperature" of the people down there? What is public opinion in your area? Do you have a "feel" for this? Have there been any media interviews with either the defense or prosecution regarding this upcoming trial?

How is the media slanted on this one? Have there been any news bits or programs regarding terminal states, care giving, etc.?

So much hinges on this trial. It will effect this person, her husband and her child literally for as long as they live. If found not guilty, what recourse does this young woman have to receive some sort of recompense for what may be a malicious prosecution?

And of course, the most important of all . . . the jury. You will be having to educate each and every person there - ALOT! Overcoming the photos and the prosecutions "facts", seems to me to be mind-boggling. What the prosecutor will be presenting, and probably with pictures, will be shocking and instantly make jurors want to blast the defendant right out of the room. So, that blatant sensationalism will be a huge part of your challenge. May your experts be up to this task.

If you have the opposition witness list, will either of you be calling Mr. Cox to the stand? Have they offered him a "deal"?

I wish you well, and do so hope that true justice is achieved.

They concerned eyes of caregivers across the nation are upon this case; and thus far, the majority are not feeling anything positive regarding the prosecutor and his minions.

We ALL know how this goes for many loved ones at the end; the not eating, the not drinking, the wasting away with skin issues, and so much more. Even when there area valiant interventions, dedicated care and the same outcome STILL happens for many. So many of us have been there - personally and professionally.

And, lastly; IF this patient had issues, why in the world have the healthcare professionals who were surely in the driver's seat to have this patient removed from the home NOT being held to answer? They were the ones with the expertise, they were the ones with primary responsibility, was this just a stupid oversight or was it in exchange for damaging testimony?

It is not making any sense.

Once again, I wish you well. I am not certain of the trial date, but we are certainly watching. In fact, several of the folks on this forum that live close enough to the court plan to be present. They will be reporting back to us.

We are all available for any questions, etc.

Brad,

Johanna expresses so well the sentiments at the forefront of many professional caregiving-experienced minds. Professional does not only mean licensed, in a work setting. It also means the hands on, self taught, down in the trenches, been there, done that, 24/7 at home caregivers. We're a pretty big caregiving population out here.

My opinion, why I feel defensive of caregivers in general, is because the prosecutor and coroner imply abuse by citing conditions we see happen in the most loving and caring environments. We know what happens, and I find their statements an insult to our intelligence, and down right offensive .

In seeking to prosecute a landmark case, Johanna makes a good case for why the prosecution can unjustly swayed a jury of laypersons by using gruesome photos of wasting and decubs. My prayer is that the jury be comprised at least in part, of medical professionals, homecare workers, and family caregivers. There needs to be someone who is able to decipher between sensationalism and end stage reality in the deliberation room. Brad, I assume you do have as much a hand in jury selection as the prosecution. The testimony of unbiased experts only goes so far.

It would seem more credible if people on the prosecution side had no "special interest" such as owning or operating a Hospice, forming new commissions on Elder Abuses, and career notoriety. These ambitions involve a great deal of taxpayer money. And they require a "basis" for grants and funding. Interesting how these ambitions coincide with the resurrection of case of Evelyn's dying process.

Hopefully all individuals will reassess their motivations. Then IF, if they find they've been thinking in a "tunnel" they will do the right thing and back down. Saving their community loads of money from an over ambitious prosecution, will go over far better with the public than wasting money trying to prosecute Lisa.

This whole case confounds me. Going after the family member is clearly barking up the wrong tree. There are far too many first line responders, mandated reporters, licensed people involved here. The order of things here just DO NOT COMPUTE.

If this case turns out to be the farce and abuse of power that it is smelling like, I have three wishes:
One, that the accused are freed with public apologies from their accusers on all news channels and newspapers.
Two, that they sue the DA, et al for false arrest, mental CRUELTY and SUFFERING, and for allowing jackasses to roam at large inside city owned buildings; and that the plaintiffs are awarded a BUNDLE by a jury of their peers (that would be US). Plaintiffs to buy the beer afterward.
Three, that those who brought the charges will be handcuffed, ducttaped and sent into "the field" with a different home caregiver every day for a few years. THEN they can at least say they have had SOME experience on the subject.

Extra bonus:
Whomever invented the weenie "adult diapers" should have to accompany the above parties handcuffed, ducttaped and wearing one of their virtually useless inventions 24/7. At the end of their sentence, I am SURE they will have thought of ways to improve their product.

I am TRYING not to prejudge until all the facts come out, but my mind wanders...

ttt

"Update on Lisa's case, Jury trial to begin on 6/02/08 @ 9:00 am."

A whole 'nother month to wait.

Tick. Tock
Tick. Tock

Who here from the Forum will be able to attend the trial on behalf of the Forum members?

Can you go, Ohio?