Patrick Cawley

Elder Law Attorney

[Patrick Cawley @PatrickSCawley]

@jennyrozelle @grantorino101 We lawyers sure know how to kill a good rags-to-riches story. "Hey kids, let's watch a story about a nice young girl who gets to go to a royal ball. There are no setbacks at all, because she has a well managed trust fund."

[Patrick Cawley @PatrickSCawley]

@ScottPaterno As someone who spent years on the other side of the desk from lobbyists, I would add that they do a great service. Elected officials and staffers need details about how everything works in the field before making law. Otherwise, unintended consequences.

[Patrick Cawley @PatrickSCawley]

@StephenJ_Caruso Does Capitol escalator posting count as engagement farming?

[Patrick Cawley @PatrickSCawley]

@arthurbrooks I'd love for you and @AlexHormozi to have a podcast discussion as the yin and yang of Work.

[Patrick Cawley @PatrickSCawley]

@jennyrozelle I'll remember this as a suggestion the next time someone wants to leave the problem child one dollar.

[Patrick Cawley @PatrickSCawley]

@jennyrozelle Yes, it happens while the person is alive but experiencing cognitive decline, too. And they also have not taken RMDs.

[Patrick Cawley @PatrickSCawley]

@LTCShop @aakashgupta That is excellent. Me too (except the last part, which I will eventually take care of).

[Patrick Cawley @PatrickSCawley]

@jennyrozelle Do you find yourself dwelling on this idea somewhat obsessively? I do. Every day is a constant reminder.

[Patrick Cawley @PatrickSCawley]

@LTCShop I imagine that premium is much higher on unlimited policy. But a Partnership policy can do the job until SNF care is needed and Medicaid pays for it with extra asset protection. Is the Partnership premium any better than unlimited?

[Patrick Cawley @PatrickSCawley]

@KennethKirkPC Yeah, mom should not be paying for grandmother’s care, much less out of mom’s retirement fund. I’m hoping something got lost in translation here. It may not be an actual “nursing home.”

[Patrick Cawley @PatrickSCawley]

@jennyrozelle This has become a more common question from clients, even though my state will be the 50th to allow it. What people don't expect: it won't work with dementia and there's a tiny window with ALS. You have to request it with a clear mind, wait, ask again, and then self-administer.

[Patrick Cawley @PatrickSCawley]

This is fascinating. It reminds me of the movie Awakenings with Robin Williams. I see a lot of dementia. Something like this gives hope that there’s a way to regain function long term.

[Anish Moonka @anishmoonka]

For five years, an 80-year-old woman with Alzheimer's could barely speak and needed help with everything. Her family had accepted she was gone. Then she swallowed a dose of mushrooms, and about 19 hours later, she was talking about her own life.

Before the mushrooms, she answered in single syllables, had lost control of her bladder, leaned on others to walk, and rarely met anyone's eyes. In the weeks after that one dose, a lot of it came back. She dressed herself again, looked people in the eye, held conversations, and remembered who had visited and what they had said.

The doctors who published this case are careful: they are not saying mushrooms cured her Alzheimer's. The disease was still in her brain, still doing damage, and the improvements faded after a few weeks. This is also a single case, the weakest kind of evidence in medicine, and there was no control group, so no one can prove the mushrooms are what did it.

These brief windows are common enough that doctors have a name for them: paradoxical lucidity. Someone who has not known their own kids in years will suddenly come back. They talk, they remember, and for a few minutes or a few days they sound like themselves again. It happens with no drug at all. In one study that tracked 151 people with severe dementia, more than 6 in 10 had at least one of these moments. The same study found ordinary things can set them off, like a familiar song, an anniversary, a moment of stress, or a change in someone's medication.

So the silence of late dementia might not be the full picture. Some of what looks gone for good may just be shut away, and a strong enough nudge to the brain can crack the door for a while. Psilocybin, the active ingredient in the mushrooms, works on the brain's serotonin system, the chemistry tied to mood. In people with depression, it seems to loosen stuck, looping thoughts. In mice, it cooled the inflammation in their brains and grew fresh cells in the part that stores memory. In her case, something like that may have briefly switched the lights back on.

None of this means anyone should go eat mushrooms. Her first day was rough. She overheated, soaked through with sweat, and sank into a sleep so deep she looked like she had passed out. Five grams is a very big dose. There are careful trials testing psilocybin in early Alzheimer's, at Johns Hopkins and other places, but those are about easing depression and anxiety, run by doctors, with everything monitored.

She had a disease with no cure the whole time, and it never stopped getting worse. For a few weeks, though, one dose gave her back to the people who loved her. How that happened is what scientists are now trying to understand.

[Patrick Cawley @PatrickSCawley]

@jennyrozelle Yes, and in that order. Then I have a week where three beneficiaries die during the administration of a family member’s estate and they find out that their situation is not simple.

[Patrick Cawley @PatrickSCawley]

@jennyrozelle Yes! People need to think about what they own, decision-makers, and family needs. But way too often, they think and think and then tell me the spouse is leaving a hospital for a nursing home or a funeral home. With no plan.

[Patrick Cawley @PatrickSCawley]

@jennyrozelle I have met with people whose brain scans and MoCA scores indicate that they cannot function. But they answer open-ended questions and make insightful connections. It makes the ethics of cognitive capacity to sign legal documents pretty complicated.

[Patrick Cawley @PatrickSCawley]

@jennyrozelle Next Up: all the financial firms that refuse to honor a valid POA and, "for convenience," have their own POA that the now-incapacitated person must sign.

[Patrick Cawley @PatrickSCawley]

@Wildlaw406 A constant issue in estate planning. The entity type makes a huge difference, but people love to say they have an S-Corp. That's not helpful.

[Patrick Cawley @PatrickSCawley]

@StephenJ_Caruso Yes. Do I embellish my involvement in the Hellbender March for Dignity and Recognition? Also yes.