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HomeMy WebLinkAboutAffidavit of Dr Lorn MillerAffidavit of Lorn S. Miller, MD STATE OF ALABAMA COUNTY OF W4kl K.&I The undersigned, Lorn S. Miller, MD, being duly sworn, hereby deposes and says: 1. 1 am over the age of 18 years and am a resident of the State of Florida. I have personal knowledge of the facts herein, and, if called as a witness, could testify competently thereto 2_ 1 am board certified neurologist with over 35 years of experience in the medical field. I attended medial school at the University of South Alabama. I served in the United States Air Force as a staff' neurologist before transitioning into the private sector. I have been in the private neurology practice from 2002 to present. 1 hold active Alabama, Alaska and Florida medical licenses. Past and current academic affiliations include but are not limited to serving on the board of examiners for the American College of Functional Neurology, associated professor of neurology at the Carrick Institute for Graduated Studies, Adjunct Instructor. Drake University College of Pharmacy 2002 and Midwestern University College of Pharmacy 2002 and Assistant Professor of Clinical Sciences, Neurology, Medical College of London, LTD. 3. 1 have been asked to provide my medical opinion on whether assisted living residents with Alzheimer's and other dementias are capable of self- preservation and can be appropriately placed in an Assisted Living Memory Cane home, or whether their condition mandates placement in an institutional -grade facility. 4. When talking about memory care residents, we are specifically talking about seniors who are forgetful for a variety of reasons. Of these, 60-80 per cent will likely have Alzheimer's type dementia. Clinically. Alzheimer's disease is a highly variable progressive neurodegenerative diseases of the cerebral cortex that results in progressive decline in cognitive function' therefore, Alzheimer's diseases is staged (I-VII) to understand the patient's level of function and level of dependency. Stage I-V is very suitable for assisted living memory care. Depending on the resident's' behavior and comorbidity, by stage VI many residents will require nursing care beyond what home health can provide, at which time, the resident's medical needs preclude their remaining in any assisted living facility and they must be moved to a nursing home. The following is a brief description of the Alzheimer stages. a. Stage I- No appreciable cognitive impairment b. Stage II- Mild decline: mayor may not be evident on neuropsychiatric testing. c. Stage III - Mild decline: misplacing items, wording finding and naming difficulties. d. Stage IV- Moderate decline: poor awareness of current events: withdrawn and moody, decreased executive functions poor memory of personal history. e. Stage V- Moderate decline: moderately severe cognitive impairment: needs assistance with activities of daily living and daily activities: confused and disoriented: knows self and family but not address or phone number. f. Stage VI - Severe decline: unable to perform ADL's: behavior changes, disruption of circadian rhythms, hallucinations, delusions, paranoia, incontinent of bladder and bowel. Most patients will require nursing home placement at some point in Stage Vl. g. Stage Vil Bed bound and requires full nursing care. S. Most seniors with memory issues will required assisted living memory care placement at late Stage IV or early Stage V. Depending on the individual, their dementia etiology, presentation and progression: they may remain suitable to reside in an assisted living setting for several years. 6. It is my professional medical opinion that seniors who do not require medical care, only personal care and safety supervision, are suitable for assisted living memory care in residential grade facilities and do not require institutional grade facilities, as these residents are fully mobile and capable of self preservation. Once a memory care resident is incapable of self-preservation, then they cannot lawfully reside in an assisted living facility and must be transferred to a nursing home or long term convalescent care facility. 7. Seniors placed in assisted living memory care homes are typically very mobile and simply need supervisory protection and containment so they do not wonder off and get lost or hurt_ Therefore, the necessity of egress control doors that automatically unlock when the fire alarm is activated, or during power loss. In general, memory care residents have greater physical capacity of self-preservation than other assisted living residents. 8. For this reason, it is my further opinion that mandating code conditions that restrict the supply of memory care homes is detrimental to people with dementia and their families, and others who truly need institutional placement. 9. Assisted living facilities are an essential part of caring for our aging population, as many spouses are too infirm to care for their partner and most adult children do not have time, capacity or appropriated accommodations for the care and treatment of elderly parents who require frequent assistance, monitoring and supervision. 10. If barriers exist to seniors being placed in assisted living memory care homes, then they will be at increased risk of neglect, subsequent injury and harm resulting in increased morbidity and mortality causing increased expense and loss. 11, A lack of appropriate assisted living memory care homes can cause hardship to family caregivers. These negative effects can include: resentment, frustration, anger, possible abuse, guilt and remorse. Additionally, family members may have to leave the work force, no longer paying Federal or Indiana State income tax and may rely on the State of Indiana for financial assistance, thus increased burden on society. 12. Premature placement in higher -level medical facility due to limited lower level care availability increases long term care costs to individual and or family as well as Medicare and Medicaid; thereby diverting funds form other essential medical services and increasing the tax burden. 13. To deny our seniors access to assisted living memory care homes (where they received personal care and assistance with activities of daily living, are provided a social environment with physical and mental activities and exercises while being kept safe) will result in increased risk of injury, illness or death of the senior, causing devastating family dynamic shifts, hardship and others in need of nursing care and financial burden on the individual, family and society. I declare that, to the best of my knowledge, medical training, and professional experience, the information herein is true, correct and complete. Executed this day of November 2019. ' � • wit ). Lorn S. Miller, MD NOTARY ACKNOWLEDGEMENT SPATE OF A AMA COUNTY OF�/� fn- The foregoing document was acknowledged before me day of November, 2019 by Lorn S. Miller, MD. Signature of Notarial Officer Nam y Commission Expires: