William & Mary Elder and Disability Law Clinic

Serving Seniors in the Greater Peninsula Area

Author: wmelderlaw (page 1 of 3)

How Post-Adoption Contact and Access to Records Impact the Grandparents I Have Never Met

By Anonymous, Elder Law Clinic Student, Spring 2016

My mom was adopted by my loving grandparents as an infant and, for most of her life, knew nothing about her birth family. That changed, however, a few months ago. She first obtained her original (redacted) birth certificate along with non-identifying family information from the Chicago church that facilitated her adoption in the early 1960s. Then she petitioned an Illinois Court to appoint her a “confidential intermediary” (CI)—a professional who can retrieve information from sealed records, locate birth parents, and contact them on behalf of adoptees. After verifying that her birth parents are still alive, the CI notified them that my mom wants to make contact. If either rejects or ignores the request, the CI can contact “other blood relatives,” presumably biological siblings or half-siblings. My mom is still waiting to hear back.

Illinois’s CI service became available under recent legislation, backed by an open records movement that is increasingly influential across the U.S. In many states, adoptees have lobbied for and gained substantial access to sealed court records and family medical histories. In Oregon, for example, adoptees can access unaltered birth certificates. Our pervasive digital culture amplifies these policy initiatives, as technology has removed many of the traditional barriers to information. My mom admits that, if the CI route fails, she may turn to a private investigator or trace her genealogy through genetic testing. Some adoptees track down and reunite with birth relatives through social networks like Facebook.

My biological grandparents, however, did not grow up in this information age; in fact, secrecy was the primary goal of adoption law and policy from the 1930s into the 1960s. In that era, privacy helped protect birth parents from social stigma, and it created a sense of permanency in an adoptee’s placement. Releasing records will no doubt upend the expectations of many individuals who put children up for adoption during those years. Working with the Elder Law Clinic has forced me to consider, for the first time, what my biological grandparents—and other senior citizens in their position—stand to gain or lose from open records laws and communication with birth children.

Through my Clinic cases, I better understand how vulnerable seniors are, especially near the end of their lives. The sad reality is that people ingratiate themselves with and take advantage of aging relatives and friends. By no means do I think that adoptees harbor such ill intent. Fears of abuse and exploitation, however, are well-founded for many elderly individuals and their families. In attempts to communicate or reunite, adoptees should recognize the potential complexities of their birth parents’ situations and the threats they might pose with unmediated contact.

Increasing adoptees’ access to personal and genetic information is an important and worthy goal—so much so that many birth parents support laws promoting open access. Nonetheless, the privacy rights and personal choices of birth parents should not be overlooked. And, as I voice my opinions and my mom’s adoption story, I wonder whether my biological grandparents have the same luxury. I wonder whether they could push back against openness in adoption records, even if they were so inclined. It seems unreasonable to expect aging birth parents to be vocal or visible in their opinions, especially if the privacy promised to them years ago is precisely what they would like to maintain.


Anything Can Happen to Anyone at Any Time

By Kate Lennon, Elder Law Clinic Student, Spring 2016

Preparing for the worst case scenario is never fun. What the Elder Law Clinic has taught me is that everyone should plan for the future, regardless of how unlikely, unnecessary, or discomforting this planning may seem. Upon signing up for the Clinic, I envisioned that we would be helping people who have current legal problems, and while we do a significant amount of that, I was surprised to learn that we could do so much for those people who had yet to have any serious problems occur in their lives. If I had to choose one thing I learned from the Clinic to pass on to others, it would be to plan now.

I know some readers will think, “well sure, I know that I am supposed to plan, but how am I supposed to make decisions for such unlikely circumstances,” or  “I have plenty of time to make these choices.” I can relate to that. On the first day of class, our clinic’s supervising attorney told us we should have a power of attorney in place for ourselves, and I thought, like many of you, that I have plenty of time to create a document like that. Truth is, without my clinic experience, I would have likely been saying the same thing at 65 years old as I said at 24 years old: “I have plenty of time.” The reality is, we will always feel like we have plenty of time, until problem strikes, in which case, we will have no time at all to make these decisions.

This brings me to why planning now is so important. While there are likely many reasons why planning proactively is better than trying to make decisions in crisis, I would propose three key reasons that I think will resonate with a lot of readers. First, the unlikely or unfortunate scenarios CAN and DO happen. While it is a bit unsettling, even the healthiest person can face an unfortunate day when they need emergency medical care; when they cannot make decisions for themselves; or when their family is faced with the devastating news of their death. I, like many of you, also find this to be a hard topic to think about, but it is important to remember that it will be even harder to think about these things while they are happening.

That brings me to my second reason: planning now will help your loved ones make decisions in the unfortunate event that something does happen to you. If an unfortunate situation does arise, your loved ones will be in a heightened emotional state. During that time, they will at least find some solace in the fact that you have planned for the situation, leaving them with instructions and guidance on what to do. Having these plans laid out will also decrease the amount of conflict that might arise among your loved ones.

Finally, to my third reason: planning now will give you, and your loved ones, peace of mind as you move forward in life. While beginning to think about unfortunate circumstances is initially unsettling, once you have finished planning, you will find comfort in the fact that if something were to happen, you are as prepared as you can be. In addition, your loved ones will find comfort in the fact that they will have instruction if certain difficult situations were to arise.

So my one suggestion is to plan now, while you have “plenty of time,” rather than waiting until there is no time to make decisions. Implement medical directives, Powers of Attorney, and a Last Will and Testament. While we may not be able to stop bad things from happening, we can plan so that we are ready if they do. As our clinic’s supervising attorney says, “Anything can happen to anyone at any time.”

How to Provide For Your Pet

By Elspeth Berry, Elder Law Clinic Student, Spring 2016

In many modern households, pets are considered to be part of the family. For some, pets are the closest thing they have to children. When a pet is that important to someone, it would make sense that he or she would wish to provide some security for them in a will or other estate planning document. What happens if you become mentally or physically incompetent and cannot take care of your pet for a period of time? What happens to your pet upon your death? Can you leave money specifically for the care and maintenance of your pet? Fortunately, there are estate planning options available to pet owners in these situations that can help set their minds at ease regarding their pets’ futures.

Because pets are considered to be personal property themselves, they cannot inherit anything on their own. The pet owner must therefore provide for his or her pet indirectly. The first thing a pet owner should do is decide to whom they feel comfortable leaving their pet, and then ask that person if they would be willing to assume this responsibility. Once the pet owner makes this decision, and the potential caretaker agrees, he or she may make a specific bequest of the pet in their will to the person they have chosen. The pet owner may also provide for his or her pet during periods of physical or mental incompetency by including a provision in his or her durable power of attorney that names a caretaker for the pet and authorizes funds to be distributed from the estate for the care of the pet. In order to pay the pet’s expenses after the pet owner’s death, he or she may also make a specific bequest of money to the chosen caretaker in his or her will, with the precise instructions that this money be used for the benefit of the pet. Another way to leave money to a pet is by making a trust for them, which a person can do in some states including Virginia. The trustee, or administrator of the trust, has a legal duty to administer trust funds for the sole benefit of the beneficiary, in this case, the pet. A trust can be created for more than one beneficiary, so if a pet owner has more than one pet, he or she may make them all equal beneficiaries. The trust terminates either when the single pet dies or when the last surviving pet dies, if there are multiple pets named as beneficiaries.

While there are no guarantees that a pet owner’s beloved animal will be loved and cared for precisely in the way that he or she would wish, the methods described above can help make sure that the pet is at least looked after by someone chosen and trusted by the pet owner. This can provide some important peace of mind during and after the estate planning process.


Adult Children, Caretaker Parents, and the Scope of a General Power of Attorney

By Charles Lambdin, Elder Law Clinic Student, Spring 2016

As parents age, they often adopt a power of attorney allowing their spouse, child, another relative, or close friend to make decisions for them as an agent in the event they cannot make those decisions for themselves. This power of attorney can be designed to activate only when the individual becomes mentally incapacitated (i.e. unable to handle his own financial affairs). At least one physician must determine that the individual is mentally incapacitated. With these safeguards in place, concerns about the amount of power being handed over decreases. The power of attorney may be broad in scope, but the powers within it are not readily accessible until incapacity.  This is commonly referred to as a “springing” power of attorney.

But what happens when an adult child needs some assistance immediately even though he still has the mental capacity to make most of his own decisions? This is where the strengths and weaknesses of having a caretaker parent become more obvious. Caretaker parents often provide many benefits to disabled adult children; they may take them to appointments, manage their affairs, sort their prescription medications, and provide a loving atmosphere free from the guilt that one might feel from relying on a caretaker. There is a downside, however. Parents are used to making decisions on behalf of their children whether by opening up a savings account at the bank or filing their taxes during those college years when many children are barely aware that they are paying taxes. Adult children with caretaker parents walk the fine line between being an independent adult and a dependent child. They may need their parents to help manage some of their affairs but do not want to give up full control.

This is where a “split” power of attorney can help. A power of attorney can be designed to come into effect immediately. This gives the agent the ability to exercise the powers as soon as the document is signed. A mildly-incapacitated adult child might find this very useful. It would allow the caretaker parent to speak with creditors, talk to doctors, and manage the adult child’s finances whenever it was necessary for the parent to step in. The risk, however, is that the caretaker parent might take things too far. This may include selling or transferring assets without the adult child’s consent or making large purchases that the child may need but should also be involved in.  However, a power of attorney that is limited in scope could protect the adult child’s relationship with the caretaker parent by narrowing the powers given to the caretaker parent. The powers could be limited to only paying bills and picking up medications, for example. Any day-to-day task that the adult child needs help with can be included. The broader scope of powers that one usually finds in a power of attorney would then exist in a “springing” power of attorney. The springing powers would only come into effect if the adult child becomes mentally incapacitated. Thus, by narrowing the scope of the powers that are immediately available, the adult child and the caretaker parent avoid the risk of overstepping boundaries and are protected by the second springing power of attorney that gives the caretaker parent full power to manage the adult child’s affairs should he become mentally incapacitated.

Medicaid – A Complex Solution to a Complex Problem

By Darius Rohani-Shukla, Elder Law Clinic Student, Spring 2016

In many walks of life, when someone is confronted with legal complexities, an obvious solution is to consult a lawyer.  However, indigent elderly people often cannot afford a lawyer, and at this intersection, the Elder Law Clinic is able to fill an important need to the Williamsburg community. The life span of an average person has lengthened over time due to medical advances, so as the “baby boomer” generation ages, there are significantly more elderly citizens than ever before who will need help taking care of themselves.  Elder Law as a whole is a field that is becoming increasingly important and relevant to society; it incorporates a wide range of issues that affect the elderly, such as estate planning, creating trusts, guardianships, powers of attorney, veterans benefits, and Medicaid.

Medicaid is a welfare health care program;  the eligibility rules are confusing and thus qualifying for benefits can be very overwhelming.  There is a litany of options available to them in order to achieve both the financial and non-financial determinations of eligibility.  Financially, there are limits on assets and income, and there are several ways of “spending down” the assets to become eligible. Some examples are putting  money into different types of trusts, annuities, personal property, renovations to a personal residence, burial plots, cars, houses, and specific types of life insurance.  Each of these options can have specific costs and benefits unique to it, and depending on the individual, may be more effective or less.  Making a mistake in these areas by transferring assets in a way that does not comply with the Medicaid rules can cause a penalty period, where for a certain length of time the individual will not be eligible for Medicaid.  If this occurs, the individual will have to either pay for care out of pocket, be taken care of by family, or if already living in a facility, become the financial responsibility of the facility until the penalty period expires.  For this reason, it is of the utmost importance that when a person expects to use Medicaid to pay for long-term care expenses, he is careful in making any transfers of assets and consults a lawyer for legal advice on the eligibility and transfer rules. Mistakes made can have significant affects on the person, both financially and personally, and potentially for the rest of his life.

Alzheimer’s and Elder Law: What Do You Need to Know?

By Ambria Armstrong, Elder Law Clinic Student, Fall 2015

Today, there are over five million Americans living with Alzheimer’s, and it is the sixth leading cause of death in the U.S. No one wants to consider the possibility that their loved one may be showing signs of Alzheimer’s disease, but recognizing the early signs is important – for proper care, and for legal purposes.  It may be harder than you think to determine if your loved one is competent to make his own decisions, and it may be uncomfortable to bring up the possibility.  Some signs of Alzheimer’s or dementia might appear to you like simple signs of old age. The Alzheimer’s Association provides ten symptoms to watch for:

  1. Memory loss that disrupts daily life. However, a typical age-related change would be to sometimes forget names or appointments, but remembering them later.
  2. Challenges in planning or solving problems. Making occasional errors when balancing a checkbook is nothing to be concerned about, but having trouble following a familiar recipe might be a sign of Alzheimer’s.
  3. Difficulty completing familiar tasks at home or work. Needing help driving to a familiar location or remembering the rules to a favorite game may be signs of Alzheimer’s, but you shouldn’t be worried about helping your loved one to use technology, for example.
  4. Confusion with time or place. People with Alzheimer’s can lose track of dates, seasons, and the passage of time, or trouble understanding something if it is happening in the future.
  5. Trouble understanding visual images and spatial relationship. Vision changes related to cataracts or old age are nothing to be concerned about, but you may want to consider all of these factors if your loved one has trouble judging distance or determining color.
  6. New problems with words in speaking or writing. People with Alzheimer’s may have trouble holding a conversation; they may repeat themselves, struggle with vocabulary, or call things by the wrong name.
  7. Misplacing things and losing the ability to retrace steps.
  8. Decreased or poor judgment. They may, for example, give large amounts of money to telemarketers, or pay less attention to their cleanliness.
  9. Withdrawal from work or social activities. People with Alzheimer’s may have trouble keeping up with their favorite sports team or remembering how to do their favorite hobbies. They may also avoid being social because some of these other changes they have been experiencing.
  10. Changes in mood and personality. A person with Alzheimer’s may frequently become confused, suspicious, depressed, fearful, or anxious.

If you notice these signs in yourself or your loved one, you should make an appointment with your doctor. Do not ignore them.  With early detection, you can get some treatments which may help with some of the symptoms, and you can plan for future care, living arrangements, and legal options for your estate.

Just a few weeks ago, there was a Walk to End Alzheimer’s here in Williamsburg. So what kinds of research are medical professionals doing to work towards the end of Alzheimer’s?  Out of the top ten leading causes of death, Alzheimer’s is the only one that cannot be prevented, cured, or slowed. There are medications for some of the symptoms of Alzheimer’s, such as medications for memory loss and confusion, irritability, anxiety, depression, or sleep changes. Researchers are working to understand brain functioning to determine what causes the changes in the brain with Alzheimer’s disease.

If your loved one is not competent to make his or her own decisions, it’s important to make sure they are properly cared for.  If your loved one has a full durable power of attorney, that will be sufficient to allow their directed agent to make decisions regarding care of the elderly person. However, if no durable power of attorney exists, a friend or family member can petition the court to obtain guardianship or conservatorship.  This is another way to make sure that someone with Alzheimer’s receives the care and living arrangements they need.  It is important to recognize the signs and symptoms of Alzheimer’s early, so that the elderly person’s wishes can be known and carried out in their best interest.  For more information on Alzheimer’s disease, please visit the Alzheimer’s Association website.

Assisted Suicide or Elder Abuse

By Shaina Salman, Elder Law Clinic Student, Fall 2015

In 2014, Time Magazine reported that five states currently have death with dignity laws. Those states—Oregon, Washington, Vermont, New Mexico and Montana—each have a variation of a statute or legal precedent that permits euthanasia. Essentially, terminally ill patients, in consultation with their doctors, can request a prescription for doses of lethal medications that will allow them to end their own lives. Proponents of the law argue that assisted suicide is a practice that places the decision of dying within the hands of the patient, giving them autonomy to decide on their own terms when and how they want to die. However, opponents argue fiercely that patients might be pressured to take their own lives by family members and others who wish to save money or end the burden of caring for someone with a debilitating illness. Time Magazines’ data shows that the average age of those dying from taking assisted suicide medications is 71 years old in Oregon. This demonstrates that the majority of those taking the drugs are the elderly. Since 1998, the state reports that 1, 173 people have had assisted suicide prescriptions written while 752 of that number actually died from taking the medications.

The sheer number of cases alone may not be very alarming, but the median age of those who are dying from the drug should be. The Oregon Stateman Journal published an article in 2014 that cited a 10% increase in allegations for elder abuse While the study does not distinguish between financial and physical abuse, advocates for the elderly are sure that this is no coincidence. A columnist for the New York Times points out a gaping hole in the law. “Neither [Washington’s or Oregon’s] act requires witnesses at the death. Without disinterested witnesses, the opportunity is created for an heir, or someone else who will benefit from the patient’s death, to administer the lethal dose to the patient without his consent. Even if he struggled, who would know?”

The narrative looks like this: an elderly patient is diagnosed with a terminal disease. Out of fear of losing autonomy or being a burden, the patient asks his doctor to prescribe him a lethal drug that will allow him to die when he is ready. The fear is that this patient, may change his mind and become a victim of an interested party forcing the pill down the throat of the patient to hasten death and attain his inheritance. This narrative is not so far-fetched as proponents suggest. Elder abuse is a prevalent issue in this country. The National Center on Elder Abuse reports an upward trend in the problem with anywhere from 7.6-10% of the elder population being abused. These numbers indicate that this may become a larger issue in the future.

With the growing size of the elder population, and the growing popularity of assisted suicide laws, legislators should be concerned with the consequences of such laws for this vulnerable segment of the population. Ultimately, assisted suicide and elder abuse are not –so-strange bedfellows because one appears to certainly be implicating the other. As others have said, assisted suicide appears to be ripe for elder abuse. The laws make the tools for abuse much more readily available and leave the elder much more at risk. Ultimately, with the growing popularity of these laws nationwide (this month alone, California’s governor signed a bill into law allowing for assisted suicide), proponents and naysayers should both be looking at this issue through the lens of the most vulnerable and taking affirmative steps to protect the elderly.

Cooler Heads Prevail

By Mitch Smithpeter, Elder Law Clinic Student, Fall 2015

“I’ve been thinking about what you told me to do, and I have a problem.” Though our client was trying to remain calm, I could sense the frustration and distress in her voice. Our client, a woman in her seventies, had come to the Clinic to find out if her Power of Attorney, which had been set up for her by her son while she was temporarily incapacitated, was still in her best interest. After some consideration, we at the Clinic agreed that it was not and subsequently set our minds to creating a new Power of Attorney for her. Now, a new problem had arisen: she could not find anyone willing to serve as the agent for the new Power of Attorney. Her relationships with both of her children were sour, and she had no other living relatives that she could assign. She had a few friends, but they were her age and were not willing to assume the added responsibility to act as the agent. She indeed had a problem.

While listening to her, admittedly, I was not as immediately concerned as I probably should have been, mostly owing to my lack of experience. I figured that there had to be some organization out there that would act as agent. After all, several organizations act as guardians for people who have no one else, so why not as an agent? I was brought back down to earth soon after; there really was not an organization that would act as agent. I was surprised, and frustrated. I felt righteously indignant that this woman needed help and there was no one willing or able to offer that help.

In a team meeting a few days later, I explained the situation to our supervising attorney. As clients sometimes do, I came to the meeting secretly harboring a hope that our supervising attorney could point out an obvious option we had missed, pull a rabbit out of her hat, or work a small miracle. I have been told that I have a terrible poker face, and as we discussed the situation I am certain our supervising attorney could detect my frustration with the suboptimal choices. As we talked, she offered our group counsel. “You have to remember that this is the client’s problem.” Upon hearing this I thought, “Well, yeah, but she came to us, and so now it’s our problem.” The full force of what she meant did not hit me just then. It finally did when we met with the client to explain what options she had. In that meeting, I realized that my job as a student attorney was to objectively find and present the available options to the client. My job was to represent the client zealously, but “zealously” did not mean that I needed to pull a rabbit out of a hat or part the Red Sea. While I could empathize, I did not need to feel frustrated; I had done my job.

While it may sound callous at first, this realization brought me immediate relief. Not because I was glad the problem was hers and not mine. Rather, I realized that an attorney must be careful not to let the client’s problem become his or her own so the attorney can do the best job possible. If we let the problem become our own, we may be more apt to start giving subjective advice, not objective counsel. Just because the available options are not what we want does not mean there is no hope, or that we are not doing our job. I realized that to maintain a clear, objective view of the situation I had to refrain from becoming engrossed in the situation. Empathy, to an extent, was acceptable, even advisable, but not to the point where it clouded my judgment. By allowing the problem to remain the client’s problem, I could remain clearheaded. True, we must look at the evidence in the light most favorable to the client, but we can still do that from an objective standpoint. As is the case with many problems, cooler heads will prevail. While empathy helped me be human, objectivity helped me be an attorney.

Advising, Not Choosing

By Catherine Brown, Elder Law Clinic Student, Fall 2015

Watching the people we love begin to slow down is hard.  The health problems may be physical or mental, occurring as part of the natural aging process or being exacerbated by a specific diagnosis.  Either way, the question often arises: can this loved one continue to live at home, or does he or she need institutional care?

At the risk of sounding heartless, I am a big advocate for institutional facilities.  Three of my grandparents have received or are receiving institutional care: two were in Alzheimer’s/dementia wings for the final years of their lives, and one currently lives in an assisted living facility.  Personally, my family has had positive experiences with the facilities and the staff who work there.  I have peace of mind knowing that Grandpa – who was widowed twenty years ago, can no longer drive, and doesn’t pay attention to medical details – can socialize with people his age just by walking down the hall, and gets the correct doses of medication each day with the help of the nurse on call.  Similarly, it was a relief when my other grandfather started receiving institutional care: if he had another fall, a worker would help him; telemarketers wouldn’t trick him into buying another state-of-the-art sound system or collectable DVDs; and he’d have someone to ensure that he bathed regularly and wore clean, unstained clothes.

Not everyone views facilities as favorably, however.  People have well-founded concerns about institutions, and argue that the facilities provide impersonal or loveless care, limit residents’ autonomy, and simply don’t have the charm that a home with decades of memories can bring.  When I expressed a pro-nursing-home view to one client, she incredulously asked me, “Why do you feel this way?”  To her, keeping her mother at home for as long as possible with in-home caregivers is the top priority.  This arrangement is causing her – and us at the Elder Law Clinic – a lot of extra work and concern that would be mitigated if her mother was receiving institutional care instead.  However, it is important to remember that it is not our job as attorneys or law students to make personal decisions for the clients based on our individual preferences.  Instead, we have a duty to outline all of the available legal options, let the client choose what is best for herself and her family, and work rigorously to help the client achieve her chosen goal.

When a loved one slows down, there is no easy, “one size fits all” solution to their care.  In my family alone, my grandfathers got to their respective facilities very differently: one voluntarily stopped driving and checked himself into assisted living, while the other one refused to admit that he had become incapacitated and nearly sued his power of attorney for acting on his behalf.  Therefore, when counseling clients, it is important to remember to listen to their goals and tailor your advice to fit those objectives, rather than simply projecting your personal views onto their unique situations.

Adults with Developmental Disabilities: Unique Aging Challenges

By Sarah Pitts, Elder Law Clinic Student, Fall 2015

Before I came to law school, I worked as direct care staff and day program staff for adults with developmental disabilities. It was one of the most challenging and rewarding jobs I have ever had. I learned to live and work with people who had various talents, interests, and abilities. I met one lady who lacked most of her fine motor skills but could tell me in a matter of seconds the day of the week that corresponded with any date past or future with perfect accuracy from memory. I took many trips to Logan Airport with another woman who enjoyed watching the planes take off and wonder where they were going. One of my clients loved to imitate the Three Stooges and had the most contagious laugh. I became very close to some of my clients, and I grew to care deeply about issues that concerned the folks I worked with.

Aging is an issue that affects us all, but it affects adults with developmental disabilities in distinct ways. The normal aging process is often compounded by reduced mobility, poorer general health, medications, surgeries, and other concerns. Those with developmental disabilities are at a higher risk of developing chronic health conditions at younger ages than other adults, owing to biological factors related to syndromes and associated disabilities. They may also have difficulty accessing adequate healthcare because of environmental and communication challenges. Additionally, as their close family members grow older, it may become harder to provide much needed care and support, either at home or in community living situations. The needs of adults with developmental disabilities tend to be unique to each person, and long-term care facilities are often ill-equipped to handle individual needs.

There is hope, however. People with developmental disabilities are living longer than ever before and have better access to health care than had past generations. Doctors and caregivers are learning more and more about how aging specifically effects this population, and they are increasingly aware of how medications interact. Because many individuals already qualify for Medicare and Medicaid, finances are usually not a problem for long term care.

Some pre-planning will further ease the aging process for individuals with developmental disabilities and their families and caregivers, including: (1) effective guardianship and a plan for what will occur when a guardian is unable to support their loved one; (2) preparing long-term care facilities for caring for adults with developmental disabilities; and (3) training families and caregivers regarding unique challenges facing the aging developmental disability population.

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