Who makes medical decisions?

When can Family Members Make Medical Decisions?

Before the pandemic, it wasn’t easy for people to get serious about the healthcare decision making portion of their estate plan. Today, there is greater awareness that incapacity from disease or injury is not a hypothetical. It’s reality, and there are tasks that must be done, as explained in a recent article entitled “Now Is the Time to Protect Your Health Care Decision-Making Rights” from Kiplinger.

You may have a fundamental right to make your own decisions regarding healthcare, but without planning and documenting your wishes, your right may evaporate in a heartbeat. Failing to have your healthcare wishes documented properly also leaves your family in the terrible position of having to guess what you want, and even go to court to settle a dispute between family members.

An estate planning attorney works with clients to plan how their assets will be distributed after they die (using a will and trusts, among other tools). However, they also help clients prepare for incapacity. Both are equally important. There are three basic solutions used in most states, although each state has its own specific rules, so you will want to work with an estate planning attorney from your geographic area.

A Living Will addresses what you want to happen, if you are in an end-stage medical condition or permanently unconscious with no hope of becoming conscious. The living will can serve as an advance written directive for the type of treatment you want to have, or what treatments you do not want to have. If you are unable to communicate your wishes, this document conveys them in a clear and enforceable manner.

A Health Care Durable Power of Attorney works differently than a Living Will. This covers health care decision making in all situations, when you cannot convey your own wishes. You appoint one or more agents to make health care decisions for you. They use their personal knowledge of you and what you would want to occur, if you were able to speak for yourself. They act on your behalf.

If you have not signed a Health Care Durable Power of Attorney or a Living Will before becoming incapacitated, there are Health Care Representative Laws that authorize certain family members to step forward to act as your health care representative and make health care decisions for you. This is the last and worst option. It is much better for you and your family to have a plan and the proper documents. First, the state decides who will make healthcare decisions on your behalf, based on the law. If more than one person is named and the family cannot come to an agreement as to what your care should be, they may end up in court. If you have an even number of children, they could come to a tie. If you have an odd number of children, they could end up estranged because of different opinions for your care, or withdrawal of care.

Create a plan for your healthcare when you are creating or updating your estate plan. It will give you the peace of mind that, even in the worst of situations, your loved ones will know what you wanted to occur clearly and be able to go forward in following your wishes.

Reference: Kiplinger (April 29, 2021) “Now Is the Time to Protect Your Health Care Decision-Making Rights”

 

If I Move to a New State, Do I Need to Update My Estate Plan?

Friends asked me this week, do you need to update your estate plan if you move to a new state. So that conversation that inspired this blog. The U.S. Constitution requires states to give “full faith and credit” to the laws of other states. As a result, your will, trust, power of attorney, and health care proxy executed in one state should be honored in every other state.

Although that’s the way it should work, the practical realities are different and depend on the document, says Wealth Advisor’s recent article entitled “Moving to a New State? Be Sure to Update Your Estate Plan.”

Your last will should still be legally valid in the new state. However, the new state may have different probate laws that make certain provisions of the will invalid. This can also happen with revocable trusts, but less frequently.

However, it’s not as common with powers of attorney and health care directives. These estate planning documents should be honored from state to state, but sometimes banks, medical professionals, and financial and health care institutions will refuse to accept the documents and forms. They may have their own, as is the case frequently with banks.

You should also know that the execution requirements of your estate planning documents may be different, depending on the state.

For example, there are some states that require witnesses on durable powers of attorney, and others that do not. A state that requires witnesses may not allow a power of attorney without witnesses to be used to convey real estate, even though the document is perfectly valid in the state where it was drafted and signed.

With health care proxies, other states may use different terms for the document, such as “durable power of attorney for health care” or “advance directive.”

When you move to a different state, it’s also a smart move to consult with an experienced estate planning attorney to make certain that your estate plan in general is up to date. There are also other changes in circumstances—like a change in income or marital status—that can also have an impact on your estate plan. Moreover, there may be practical changes you may want to make. For example, you may want to change your trustee or agent under a power of attorney based on which family members will be closer in proximity.

For all these reasons, when you move out of state it’s wise to have an experienced estate planning attorney in your new home state review your estate planning documents.

Reference: Wealth Advisor (Jan. 26, 2021) “Moving to a New State? Be Sure to Update Your Estate Plan”

Estate hassles start here

‘Real Housewives’ Ex under Temporary Conservatorship

Tom Girardi’s brother, Robert, has been named to take care of the daily and personal activities of the reality star’s estranged husband. The news comes a month after Robert filed a petition to be in control of Tom’s estate and ongoing legal battles.

A conservatorship is when a judge appoints someone to manage an incapacitated person’s financial and personal affairs. The conservator’s duties include overseeing finances, establishing and monitoring the physical care of the ward and managing living arrangements. Conservatorships and guardianships are often necessary when powers of attorney and trusts are not in place or are poorly drafted.

Screen Rant’s article entitled “RHOBH: Erika’s Ex Tom Girardi Now Under Temporary Conservatorship Due to Illness” reports that Tom and Erika have been entangled in some legal drama since she filed for divorce in November of last year.

Despite the May-December romance (more than 30 years’ difference), they always appeared to be happy together. However, as they battle in divorce, their relationship has turned ugly. Tom refused to pay spousal support, but he has her involved in another legal issue: the couple is being sued by Tom’s former clients for embezzling over $2 million. The plaintiffs say that Tom and Erika stole the money to maintain their lavish lifestyle.

According to Us Weekly, the 81-year-old’s attorney Rudy Cosio said that Tom wouldn’t be able to attend the hearing because he suffered a medical emergency over the weekend. His brother filed a petition in January to control Tom’s estate and legal battle because he’s not currently well enough to handle this on his own. The petition was approved by the judge. Robert was given temporary conservatorship of his brother’s estate, as well as his daily activities and personal matters until the end of March. Another hearing is set for mid-March when the judge will decide whether to grant Robert’s other requests. These include granting him approval to place Tom in facility that treats patients with neurocognitive disorders like dementia.

Robert’s attorney released a statement to Us Weekly on the conservatorship and its urgent nature.

“There was an urgent need for Bob Girardi to have the power to engage counsel in the bankruptcy proceeding on his brother’s behalf, and Tom’s court-appointed counsel clearly agreed, as did the court today,” the statement read.

According to court filings, Robert admitted Tom’s health has been declining since Erika filed for divorce and the embezzlement lawsuit last year. Tom is currently unable to understand the ramifications of the bankruptcy filings pending against him and needs Robert to help him.

In December, it was reported that Tom was secretly hospitalized due to a serious illness. While Tom’s illness is not yet known, many are worried about his mental capabilities.

Reference: Screen Rant (Feb. 2, 2021) “RHOBH: Erika’s Ex Tom Girardi Now Under Temporary Conservatorship Due To Illness”

 

COVID worries older Americans

Elder Financial Abuse on the Rise during Pandemic

The same isolation that is keeping seniors safe during the pandemic is also making them easier targets for scammers, reports WKYC in a news report “Northeast Ohio family warns of elder financial exploitation during the pandemic.” While this report concerns a family in Ohio, seniors and families across the country are facing the same challenges.

Two brothers enjoyed spending their time together throughout their lives. However, for the last three years, one of them, Michael Pekar, has been trying to undo a neighbor’s theft of his brother Ronnie’s estate. A few months before Ronnie died from cancer, a neighbor got involved with his finances, gained Power of Attorney and began stealing Ronnie’s life savings.

The money, more than a million dollars, had been saved for the sons by their mother. Pekar went to see an attorney, who helped uncover a sum of about $1.6 million that had been transferred from Ronnie into other accounts. A civil complaint was filed against the woman and $700,000 was eventually recovered, but nearly $1 million will never be recovered.

How can you prevent this from happening to your loved ones, especially those who are isolated during the COVID-19 pandemic?

An elderly person who is isolated is vulnerable. Long stretches of time without family contact make them eager for human connection. If someone new suddenly inserts themselves into your loved one’s life, consider it a red flag. Are new people taking over tasks of bill paying, or driving them to a bank, lawyer, or financial professional’s office? It might start out as a genuine offer of help but may not end that way, elder lawyers say.

The possible financial abuser does not have to be a stranger. In most cases, family members, like nieces, nephews or other relatives, prey on the isolated elderly person. The red flag is a sudden interest that was never there before.

Changes to legal or financial documents are a warning sign, especially if those documents have gone missing. Unexpected trips to attorneys you don’t know or switching financial advisors without discussing changes with children are another sign that something is happening. So are changes to email addresses and phone numbers. If your elderly aunt who calls every Thursday at 3 pm stops calling, or you can’t reach her, someone may be controlling her communications.

According to the CDC, about one in ten adults over age 60 are abused, neglected, or financially exploited.

Be sure to check in more frequently on elderly family members during the pandemic because increased isolation can lead them to rely on others, making them vulnerable to abuse.

Reference: WKYC (Nov. 19, 2020) “Northeast Ohio family warns of elder financial exploitation during the pandemic.”

 

The New Orleans woman who fought the longest court battle in US history

In an 1850 pamphlet summarizing the ongoing estate litigation of a New Orleans woman, Myra Clark Gaines, journalist Alexander Walker wrote, “The wildest romance ever written, could not contain a greater variety of strange incidents, more affecting details, more strongly marked characters, a more constant succession of stirring events, and stronger exhibitions of folly, intrigue, deception and crime.” If we ever needed a reminder that it is best to keep your estate out of probate and the courts, a story from NOLA’s The New Orleans Collection in 2020 was it.

Walker’s report was published less than a third of the way through the marathon case, a 57-year estate battle involving hidden paternity, a destroyed will, and a multimillion-dollar fortune. The case touched all levels of the judicial system and appeared before the United States Supreme Court a total of 17 times. It remains the longest continuous litigation in the history of the country. The legal fight was covered extensively over the decades, granting Gaines a public platform that she used to advocate for women’s rights and suffrage.

The Gaines case is a real-life American equivalent of Jarndyce v Jarndyce, a fictional court case in Charles Dickens’ Bleak House (1852–53), which progressed at a wounded snail’s pace in the English Court of Chancery. The case is a central plot device in the novel and has become a byword for seemingly interminable legal proceedings.

Make it a New Year’s resolution to protect your family from “interminable legal proceedings” by updating your estate plan, and talk with an estate planning attorney about ways you can do just that, especially with a revocable living trust.

Happy 2020. And to read about the unfortunate, if ultimately successful Mrs. Gaines, check out the NOLA historical tale here:

https://www.hnoc.org/publications/first-draft/new-orleans-woman-who-fought-longest-court-battle-us-history?button&utm_source=wordfly&utm_medium=email&utm_campaign=FirstDraft2020EOYRound-Up&utm_content=version_A&promo=

How will President-Elect Biden Help Seniors with COVID-19?

Before you object, take note. This is not a political “post”.  Whenever there’s a change of Administration, it makes sense to look to the winning candidate’s platform and policy aspirations to predict how new leadership may impact things we care about. And I care about care for seniors. Home Healthcare News’s recent article entitled “‘Our Work Begins with Getting COVID Under Control’: What a Biden Administration Means for Home-Based Care” says that long-term care and protecting America’s senior population will need to be at the very center of President-Elect Biden’s response.

“Our work begins with getting COVID under control,” Biden said during his victory speech. “We cannot repair the economy, restore our vitality or relish life’s most precious moments — hugging a grandchild, birthdays, weddings, graduations, all the moments that matter most to us — until we get this virus under control.”

As the U.S. nears the mark of 18 million total coronavirus cases, the Biden administration’s response to the ongoing pandemic will need to be wide-ranging and thorough, impacting everything from vaccine development and distribution, to additional rounds of relief for health care providers.

“I will spare no effort — or commitment — to turn this pandemic around,” Biden continued.

The 78-year-old Biden has commented that he has a deep appreciation of home-based care. In July, he outlined a $775 billion plan to overhaul the nation’s caregiving infrastructure, which primarily consists of women and people of color. Biden said he wants to create upwards of three million new caregiving and education jobs over the 10 years and provide pathways for former caregivers to re-enter the workforce. That plan also called for a $450 million increase in funding for senior care. Some of those funds would be earmarked to improve wages and labor conditions for in-home care workers.

“Home health workers do God’s work, but aren’t paid much,” the then presidential candidate said on social media. “They have few benefits, and 40% are still on SNAP or Medicaid. It’s unacceptable. I’ll give caregivers and early childhood educators a much-needed raise.”

Biden has repeatedly brought attention to very specific, innovative programs that typically only industry insiders know about. This includes making specific references to CAPABLE, the program from the Johns Hopkins School of Nursing aimed at supporting aging in place, by coordinating nursing, therapy and handyman services in the home.

Biden and his Administration will likely try to get more resources for home-based care providers and other long-term care operators. In its official policy plan for nursing home regulations, for instance, the Biden team stated it would invoke the Defense Production Act to increase the overall supply of PPE. Right now, “protecting older Americans” is one of the main priorities featured on the Biden-Harris Transition website, which hasn’t been overlooked by those in aging services.

“Dealing with the coronavirus pandemic is one of the most important battles our administration will face, and I will be informed by science and by experts,” President-Elect Biden said recently.

Regardless of how you voted, I hope you’ll join me in wishing the new team success in that fight.

Reference: Home Healthcare News (Nov. 9, 2020) “‘Our Work Begins with Getting COVID Under Control’: What a Biden Administration Means for Home-Based Care”

Who makes medical decisions?

What are Young People Doing to Help Seniors in Isolation?

With the pandemic continuing to be a part of our world, family caregivers are increasingly concerned about loved ones’ isolation at home or in facilities. What can others do to help?

Many older adults and their family caregivers have little human interaction in “normal” times, and the pandemic makes it even worse.

Research shows that isolation and loneliness are as detrimental to health as smoking 15 cigarettes a day, says AARP’s recent article entitled “Teens Reach Out to Isolated Older Americans Through Online Programs.”

However, some new programs and approaches that have come about in the coronavirus quarantine can have a positive impact far beyond the pandemic. Let’s look at three virtual intergenerational programs that bring hope for the future.

Music and Games to Brighten Spirits. Fifteen-year-old Maya Joshi and her twin sister, Riya, started daily video calls with their grandparents when the pandemic took hold. Seeing how much their grandparents enjoyed it, Maya decided to do something to help other isolated older adults. She launched Lifting Hearts with the Arts in April. The intergenerational program involves teen volunteers connecting online with residents in 17 Illinois nursing homes and assisted living facilities. They present musical performances, games and 1:1 video chats.

These virtual activities are making a significant impact and are improving the residents’ moods, said the director of programming at a nursing home in Springfield, Illinois. After one resident grew more comfortable with the technology, she began initiating video calls with her friends and family. These seniors now have something to look forward to and they like seeing young smiles on the screen.

Meals and conversation To Eliminate Loneliness. The Los Angeles-based Youth Movement Against Alzheimer’s (YMAA) YouthCare program, in partnership with the University of Southern California, has been training students to provide in-home nonmedical respite and cognitively stimulating activities for people living with dementia.

The program was suspended when the COVID-19 lockdown began. As a rapid response to the pandemic, YMAA reached out to their chapters in high schools and college campuses across the country to create Meals Together. It’s a program where students have virtual visits during mealtime with those in early stages of dementia and their caregivers.

In only three months, 39 YMAA chapters are participating in the expanding program. They now serve 175 users. They partner with nonprofits, like Meals on Wheels and assisted living facilities, to identify older participants. Seniors can also sign up on their own.

Natashia Townsend, YMAA’s director of caregiving programs, says they describe the program to participants in early stages of dementia as a way to help the students as they prepare for their careers. “It makes them feel empowered to help someone else,” Townsend explains. The youth volunteers also find it rewarding. “It’s just a great way to connect, and a lot of our seniors are feeling lonely at this time; they just want to feel like they have a friend,” she says.

Reference: AARP (July 27, 2020) “Teens Reach Out to Isolated Older Americans Through Online Programs”

 

Medical Advice by Teleconference

How Did Country Star Hal Ketchum Die?

Country music star Hal Ketchum, who found fame in the ’1990s with the critically acclaimed album “Past The Point of Rescue,” passed away at home, according to a report in The New York Post entitled “Country singer Hal Ketchum dead at 67 after battle with dementia.”  His death was hard enough on his family. The high medical bills and expenses associated with his dementia are still with them.

Ketchum’s wife Andrea shared the news on his Facebook page, writing: “With great sadness and grief, we announce that Hal passed away peacefully last night at home due to complications of dementia. “May his music live on forever in your hearts and bring you peace. Andrea.”

Ketchum was diagnosed with acute transverse myelitis, an ailment of the spinal column, which forced him to relearn basic tasks, such as how to walk and play the guitar.

However, he continued to record and would often hit the Billboard Hot Country Songs charts. Ketchum sold more than five million records in his career. His two most famous songs were “Small Town Saturday Night” and “Hearts Are Gonna Roll.”

He has had his songs recorded by many artists, including Trisha Yearwood and Neal Diamond. Ketchum earned five million-air awards from BMI, acknowledging those songs that have been broadcast over one million times.

In 2019 his wife announced he was suffering from early on-set senile dementia and would no longer be touring.

“Dementia is an exhausting and confusing illness and now it’s time for Hal to stay home with loved ones,” she shared, saying that he was glad to be at home with friends and family.

Dementia is more frequently found in people over the age of 65. However, it can also affect younger people. Early onset of the disease can start when people are in their 30s, 40s, or 50s. Treatment and early diagnosis can slow the progression of the disease and maintain mental function.

Ketchum’s family organized a benefit concert in January 2020 to help with medical bills and raised over $20,000.

“Hal has sung his last tune for us on this earthly plane of existence,” read the description of the concert, according to The Sun.

“He can no longer tour or make records to support his family. Now it’s time for us to step up and help with the almost insurmountable medical bills and living expenses that are piling up.”

Ketchum became an addict at 15 after losing his mom to MS. He started with alcohol and moved on to drugs, including cocaine. However, he became sober in 1997, after spending a month at the Betty Ford Clinic. He married his wife Andrea in 2014.

Reference: New York Post (Nov. 24, 2020) “Country singer Hal Ketchum dead at 67 after battle with dementia”

 

generations

What’s the Difference Between Nursing Homes and Assisted Living?

My parents had the best experience in the dozen or so years at the end of their lives, at a continuing care community in the Richmond area. But there are many choices for senior living.  US News & World Report’s recent article entitled “Nursing Homes vs. Assisted Living” explains that a big question is determining what type of facility is the best fit, a nursing home, assisted living or another senior community. According to the National Institute on Aging (NIA), long-term care residences include:

  • Assisted Living Facilities
  • Nursing Homes
  • Board and Care Homes; and
  • Continuing Care Retirement Communities.

We will look at the major differences among these options.

Assisted Living. Assisted living and nursing home facilities are different in many ways. One big difference is in how to pay for them. Some assisted living facilities do not accept Medicaid and are private pay only. Medicaid does cover nursing home care because states must do so under federal law. That’s the only way some can cover the cost in many instances.

Otherwise, the primary difference is in the level of care each can provide. Assisted living is for those who need some help with daily care, but not as much as what a nursing home has to offer. These facilities are for those who can still take care of themselves, but could use a bit of help with daily activities such as:

  • Housecleaning and laundry
  • Household chores and cooking
  • Bathing
  • Medication management; and/or
  • Transportation to medical appointments or stores.

The residents use any or all of the services offered and pay for the level of care they are receive. However, the more care, the higher the cost. Assisted living residents typically have their own private apartments and share common areas, like the dining room and community rooms. Most offer three meals a day for those who don’t want to cook, 24-hour supervision and security and socializing and recreational events with other residents. Many assisted living communities even permit pets.

Nursing Homes. Nursing homes are also called “skilled nursing facilities” and provide a higher level of daily care—especially medical care that assisted living facilities aren’t equipped to handle. Along with the same help for daily living that assisted living communities provide, a nursing home can offer:

  • Nursing care
  • Rehabilitation services, such as physical, occupational and speech therapy
  • Help getting dressed or in and out of bed
  • Frequent or daily medical management for chronic conditions; and
  • Some facilities specialize in memory care for patients suffering from Alzheimer’s disease or other forms of dementia.

Board and Care Homes. Also called “residential care facilities” or “group homes,” these are small homes of 20 or fewer residents living in private or shared rooms. Similar to assisted living facilities, these places can provide personal care and meals but no nursing or medical care.

Continuing Care Retirement Communities. Also called “life care communities,” they offer different levels of service in one location, like independent housing, assisted living, and a skilled nursing facility all in one place. Residents can begin at one level of care and transition into higher care, as needed.

How to pay for care is another common misunderstanding, because unless you have long-term care insurance, assisted living is paid out of pocket. For a skilled nursing facility, if you are hospitalized and discharged to a care facility, Medicare will pay a set amount for a certain time. The responsibility for payment then goes back to the resident.

Only when a senior is legally destitute, can you use Medicaid. Talk to an elder law attorney about the details.

Reference: US News & World Report (November 52, 2020) “Nursing Homes vs. Assisted Living”

 

surgical risks

What are Riskiest Surgeries for Seniors?

Are you considering the risk of surgery for yourself or an older family member as her healthcare agent? Consider this:  a team of researchers recently compiled a list of 277 risky procedures for older adults. They hope it’s useful in preparing for the potential of unwanted outcomes. The study was published in JAMA Surgery and was generated by using admissions data of patients 65 years and older.

Considerable’s recent article entitled “These 10 surgeries are considered “uniquely high risk” for older adults” says that scientists found 10 surgeries to be especially problematic for older patients.

  1. Adrenal Gland Removal (Adrenalectomy). This is the removal of one or both of the adrenal glands which produce hormones necessary in carrying out daily bodily functions. A tumor can form on the glands and causes increased hormone production. When this happens, the gland(s) needs to be removed. The typical recovery time after this surgery is two to six weeks. The risks include blood clots, infections and high blood pressure.
  2. Plaque Buildup Removal from the Carotid Arteries (Carotid Endarterectomy). This is a procedure that removes plaque buildup from inside a carotid artery in the neck. It is performed to restore blood flow to the brain when there are symptoms of reduced blood flow. A carotid endarterectomy is typically preventative of a stroke and removes blockages that might trigger one. The risks include clotting, stroke, or death, but taking anti-clotting medicines before and after can reduce these risks.
  3. Arm Blood-Vessel Replacement (Peripheral Vascular Bypass Surgery). Blood vessel replacement in the arm improves blood flow when one or more of the arteries become narrowed or blocked. A blood vessel from another part of the body or a synthetic blood vessel is used to replace the damaged blood vessel. Risks include irregular heartbeat, infection and death.
  4. Resection or Replacement of Abdominal Veins. When a blood vessel causes tissue injury in the abdomen, some of the tissue might need to be removed or replaced. Risks can include pulmonary embolism, infection and excess bleeding.
  5. Varicose Vein Removal. These veins form in the legs, when the valves in the veins aren’t functioning properly. This can cause pain, blood clots, or bleeding. A doctor might recommend varicose vein removal, which has risks that include nerve injury, heavy bleeding and infection.
  6. High Gastric Bypass. Weight loss surgery changes how the stomach and small intestine handle the food a person eats. There are several criteria that must be met to receive this procedure. High Gastric Bypass can pose major risks and complications, such as malnutrition, perforation of stomach or intestines and dumping syndrome (when food gets “dumped” directly from the stomach pouch into the small intestine without being digested).
  7. Proctopexy (Rectal Prolapse Surgery). This procedure is performed to correct stool leakage, inability to control bowel movements (fecal incontinence), or obstructed bowel movements. This procedure helps put the rectum back in place. The risks can include damage to nearby nerves and organs, narrowing (stricture) of the anal opening and development of new or worsened constipation.
  8. Bile Duct Excision. If a tumor is blocking the flow of bile to the bile ducts, a surgeon may remove them. Nausea, jaundice, or a high temperature (over 101) are potential risks.
  9. Urinary Reconstruction. Sometimes a person’s urinary bladder is removed because of cancer, a non-working bladder, or another medical reason. This procedure creates a new way for urine to exit the body when a bladder is not present. A risk of this procedure is urine backing up into the kidneys, causing infections, stone formation, or organ damage over time.
  10. Ureter Repair. When the ureter is injured (i.e., scar tissue forms after an accident or surgery), more surgery might be required to repair it. Complications include chest pain, blood clots and trouble urinating.

Before any planned procedures, be sure your Medical Directive and powers of attorney are up to date. Review any needed updates with an estate planning attorney.

A note on dental exams. Dental examinations should be considered before any surgery—but they’re especially important for certain heart surgeries, along with joint replacements that use implanted devices. With both joint replacement and cardiovascular valve replacement surgery, the risk of the bacteria from the mouth traveling systemically to the surgical site is very high. During a dental procedure, the gum tissue can be broken and that lets bacteria from the mouth to enter the bloodstream. The bacteria can go to any foreign material in the body and attach, frequently developing a biofilm. This makes it very difficult to treat with antibiotics alone. As a result, surgical removal may be required for complete eradication.

Reference: Considerable (Nov. 4, 2020) “These 10 surgeries are considered “uniquely high risk” for older adults”

 

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