Posts Tagged ‘osteoporosis’

Americans With Disabilities Act Overrides Local Zoning Rules

NOVEMBER 5, 2001 VOLUME 9, NUMBER 19

George and Astrid Dadian live in the Village of Wilmette, Illinois. The Dadians both have medical problems—she suffers from osteoporosis and asthma, and he from orthopedic problems. That is why they wanted their reconstructed home to have a garage that could be reached from the front curb.

The Dadians have lived in Wilmette for forty two years. Their home, like most in the Village, has a garage that is accessible only from the back of the lot. They plan an extensive reconstruction, however, and they hope to move the new garage entrance around to the front of the house. This would shorten the distance Mrs. Dadian has to back up to get out their garage, and her doctors agree that the change would be better for her, since she would not have to twist and turn for as long when backing out.

Neighbors of the Dadians are concerned about the safety of small children if Ms. Dadian has trouble turning around long enough to back up to the residential street. The Village suggested that the Dadians look into putting in a back-yard turnabout to limit Mrs. Dadian’s backup distance, but the couple rejected that approach because it would cost them most of their back yard.

Under the federal Americans with Disabilities Act (the ADA), the Dadians’ zoning problems became a legal issue. They argued before a federal judge and jury in Illinois that the Village’s refusal to permit the front access amounted to discrimination against them based on their disabilities.

The Village objected, arguing that the Dadians are not disabled within the meaning of the ADA, and that the law does not require the Village to approve this curb cut even if it does apply. After a jury trial, the Village was ordered to approve the front access to the Dadians’ garage, and the Village appealed.

The ADA prevents governmental or private discrimination against the disabled, and defines disability very broadly. According to the federal Court of Appeals Mrs. Dadian fits within the law’s definition because she suffers physical impairments that substantially limit a major life activity. Mr. Dadian’s disability status is less clear, but the ADA applies even if only one spouse is disabled.

Once Mrs. Dadian’s disability is established, the ADA requires local governments to provide make accommodations for her disabilities. The appeals court agreed that the front-access curb cut was reasonable, especially since six of the sixteen homes on the Dadians’ block already have similar front or side access. Dadian v. Village of Wilmette, October 18, 2001.

The ADA (and the related Fair Housing Act Amendments of 1988) can overrule local zoning restrictions. Based on those laws, local governments and private businesses can be forced to show that rules and decisions reasonably accommodate the needs of the disabled.

Diet, Exercise Aid Elderly

JULY 11, 1994 VOLUME 2, NUMBER 2

Two recent studies suggest ways to combat frailty and immobility in elderly patients. Both were reported in the June 23 issue of The New England Journal of Medicine, and both promise relatively simple ways to gain substantial health advantages.

Bicarb for Bones

In the first study, 18 post-menopausal women were given daily supplements of potassium bicarbonate for 18 days. After that period, the bicarb supplements were stopped and the women monitored for an additional 12 days.

Researcher Anthony Sebastian, of the University of California in San Francisco, reasoned that bone calcium might be used by the body to neutralize excess acids formed during digestion. Since little bone formation takes place after menopause, he then deduced that excess digestive acids might actually imperil bone calcium reserves, and that the bicarbonate might help slow or reverse that calcium loss.

Study results showed that, though women continued to lose calcium during the potassium bicarbonate trials, the loss was significantly slower than after the supplements were stopped. Loss of bone itself was halted or even reversed during the bicarbonate supplement period.

The reduction in calcium loss was dramatic despite the fact that no calcium was supplied in the supplements. Apparently, Sebastian’s theory was correct.

Pumping Iron

The second study sought to determine whether weight training, vitamin supplements or a combination of both might assist elderly patients to overcome physical frailty. 100 patients (with a mean age of 87) were randomly assigned to one of four groups. Group one underwent intensive resistance training for thigh and hip muscles three times each week. Groups two and three received vitamin-fortified, 360 calorie drinks daily; group three also went through the weight-training regimen. Group four participants received neither therapy.

The results of the study clearly showed that weight training benefits the frail elderly. In fact, four of the weight-training participants exchanged their walkers for canes by the end of the study.

Overall, exercise more than doubled the muscle of study subjects. Among the non-exercising participants, muscle mass decreased 3.9% during the study. Gait velocity and stair-climbing power both showed dramatic improvement among the exercising participants, as well. Interestingly, the gains were not dependent on age, sex, medical condition or initial frailty of the participants.

This recent study, conducted by Maria A. Fiatarone of the U.S. Human Nutrition Center on Aging in Boston, confirms the results of a 1990 study involving weight training. That earlier study was notable for another finding; after the researchers concluded their involvement, virtually none of the elderly participants continued the exercise regimen. The failure to continue the program was most ironic, but still prevalent, among those who had realized substantial gains in mobility during the study.

Recent Court Cases

APRIL 18, 1994 VOLUME 1, NUMBER 21

Some recent court cases of note to those caring for or working with elders:

Fraudulent Medigap Sale

An Alabama insurance salesman persuaded Mattie Foster to purchase a Medicare supplemental insurance policy. Ms. Foster was 70 years old and illiterate. Although she told the agent that she was covered by Medicare, she was actually receiving Medicaid. The agent left brochures explaining the policy, but did not tell Ms. Foster that without Medicare coverage the policy would be worthless.

Three years later, Ms. Foster filed a claim for reimbursement from the insurance company. She was told that the claim was being “investigated,” but no payment was made. A year later Ms. Foster learned from her doctor’s office that the policy was worthless; the doctor’s office also spoke with someone from the insurance company, who promised to “look into the matter” but never did.

Ms. Foster canceled her policy (after having paid a total of $2,468.600 in premiums) and filed suit. The jury awarded her a total of $1 million in punitive damages and $250,000 in actual damages for reimbursement, mental anguish and distress. The trial court reduced the punitive damages to $250,000.

The Alabama Supreme Court reinstated the $1 million punitive award. The actual damages were reduced to $50,000, based on the court’s reasoning that the evidence of distress was “scant.” Foster v. Life Insurance Co. of Georgia, Alabama Supreme Court, January 14, 1994.

Nursing Home Did Not “Dump” Patient

Catherine Fields, a patient at a Florida nursing home, was transferred to the hospital due to respiratory failure. After hospital treatment, the nursing home refused to readmit her because of its “inability to deliver proper patient care.” The hospital filed suit, seeking payment for five days of non-acute care provided while it looked for alternative placement.

The hospital argued that the nursing home’s actions constituted “patient dumping” as defined in federal statutes prohibiting hospitals from transferring patients to other facilities based on the inability to pay. The Federal Court in Florida disagreed, holding that the “patient dumping” prohibition applies only to hospitals, not nursing homes. Even if the federal rules applied to this transfer it was motivated by the need for emergency care and not by the nursing home’s desire to shift the burden of uncompensated medical care to another facility. In re: Senior Care Properties, Inc., Florida Federal District Court, Northern District, November 24, 1993.

Reducing Fractures

A recent study shows that flouride and calcium, taken in combination, may help reduce the risk of bone fractures in elderly women. An interim report of the study relates that 48 women with osteoporosis have taken an experimental slow-release fluoride, along with calcium citrate, for the past 2½ years. During that time, only 10 new fractures have been reported, compared to 26 new fractures in the control group of 51 women receiving a placebo.

Tests also show that there may be some bone rebuilding in the women taking fluoride. The interim results are reported in the current Annals of Internal Medicine.

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