Guardianship Quality Initiative Live Program #1: “The Aging Process: What Guardianship Judges and Lawyers Need to Know About the Actual and Perceived Physical and Mental Consequences of Aging”

On Friday, June 19th, 2015, an attentive audience gathered at the Touro College Jacob D. Fuchsberg Law Center for the launch of the Guardianship Quality Initiative (“GQI”). Over 100 individuals, including members of the judiciary, attended Friday’s program titled, “The Aging Process: What Guardianship Judges and Lawyers Need to Know About the Actual and Perceived Physical and Mental Consequences of Aging”.

Honorable A. Gail Prudenti, Chief Administrative Judge, New York State Unified Court System addresses the audience at the launch of the Guardianship Quality Initiative

Following Dean Patricia Salkin’s opening remarks, the Honorable A. Gail Prudenti, Chief Administrative Judge, New York State Unified Court System, offered a thoughtful and insightful take on the Aging Process and provided a wonderful start to the day’s events. Justice Prudenti highlighted the important role the legal system plays in promoting and protecting the rights of vulnerable older persons and offered insight into why judges and lawyers must be aware of the actual and perceived physical and mental consequences of aging.

Ellyn Kravitz, Esq., Partner at Abrams, Fensterman, Fensterman, Eisman, Formato Ferrara & Wolf, LLP, and Dr. Wilbert S. Aronow Professor of Medicine, Westchester Medical Center, New York Medical College addressed the Actual and Perceived Physical and Mental Consequences of Aging. Ellyn reviewed the aging process, including an overview of common chronic conditions and the impact these conditions can have on an individual’s ability to perform activities of daily living. Ellyn offered an interesting and at times very humorous commentary on how to assess “Quality of Life”.

Dr. Aronow discussed health risk factors with an emphasis on heart disease, the leading cause of death in the United States, and hypertension. In his presentation, Dr. Aronow emphasized how these chronic conditions can adversely impact an individual’s overall health and quality of life as well as result in other medical problems.

Sheila Shea, Esq., Director, Mental Hygiene Legal Services, Third Judicial Department, New York State joined Dr. William H. Frishman,  Professor of Medicine, New York Medical College to discuss The Relevance and Consequences of Diminished Mental Capacity. Sheila provided a short statistical overview of the prevalence of diminished mental capacity and addressed the various formulations of capacity under New York Law. Sheila also distinguished dementia from mental illness and addressed the civil rights of individuals with diminished mental capacity. Dr. Frishman identified and discussed risk factors associated with diminished mental capacity.

Following lunch, Dr. Kenneth Cohen, Associate Professor, Touro College of Pharmacy and Robert Cannon, Esq., Coordinator, Aging and Longevity Law Institute, addressed The Positive and Negative Implications of the Significant Use of and Reliance on Prescription Medications and Over the Counter Drugs by Older Persons. Robert discussed provisions within Mental Hygiene Law Article 81 that require individuals in guardianship proceedings to consider medications taken by alleged incapacitated persons. Dr. Cohen outlined the types and number of medications older individuals commonly take and introduced the audience to important terms, including “geriatric pharmacotherapy” and “polypharmacy”. Dr. Cohen also discussed the effect drugs can have on physical and emotional health as well as medication management issues and adverse drug reactions.

In the final presentation, Judges and Lawyers Must Look Beyond a Person’s Age, Diagnosis and Appearance, three experienced and well-respected guardianship attorneys, Joan Robert, Esq., Fern Finkel, Esq., and Ira Salzman, Esq, addressed the audience.

Joan reviewed the applicability of Surrogate’s Court Procedure Act 17-A and Mental Hygiene Law Article 81.

Fern Finkel, Esq. addresses the audience.

Fern Finkel, Esq. addresses the audience.

Joan and Fern emphasized the importance of addressing the physical and/or mental limitations of alleged incapacitated persons and that all participants in a guardianship matter must dedicate the time and resources required to ensure the rights of individuals are protected and respected.

Ira addressed challenges lawyers and judges face when determining if and when medical information should be introduced directly or indirectly in Article 81 Guardianship matters. Ira concluded the day’s events with a summary of the important role medical and pharmacological information can play in guardianship proceedings and urged members of the audience to utilize the information that the medical professionals provided in practice.

A special thank you to all of our speakers for taking the time to participate in the event and for contributing their skill and expertise to this exciting and rewarding program. If you would like to view the comprehensive materials that accompanied Friday’s program, please click here.

For your review, please find below a link to our “Guardianship Quality Initiative Brochure”, which features an overview of the GQI, an outline of the online weekly CLE programs, an outline of the live CLE programs, GQI content, and information regarding the cost of and how to register for this unique initiative.

Please click here for access to the Guardianship Quality Initiative brochure.

Please click here to go directly to the Guardianship Quality Initiative Registration Page.

If you have questions or wish further information, please feel free to write to me at or call me (631-761-7190).

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Touro Law Center’s Aging and Longevity Law Institute Hosts the Inaugural Live Guardianship Quality Initiative (“GQI”) Continuing Legal Education Program on The Aging Process

On Friday, June 19, Touro College Jacob D. Fuchsberg Law Center, in collaboration with New York Medical College and Touro College of Pharmacy, will host the inaugural live Guardianship Quality Initiative (“GQI”) continuing legal education program. Friday’s live program is the first of many live and online programs in the GQI.

Friday’s program, “The Aging Process: What Guardianship Judges and Lawyers Need to Know About the Actual and Perceived Physical and Mental Consequences of Aging”, will take place at Touro Law Center, 225 Eastview Drive, Central Islip, New York 11722 from 9:00 a.m. to 3:00 p.m. Registration will begin at 8:30 a.m. and breakfast will be served.

5.0 MCLE credits are being offered and admission is free.

The program will highlight the need for judges and lawyers involved in the guardianship process to work with and learn from colleagues in the medical profession. World class faculty will discuss key facets of the aging process and address the challenges of ensuring older individuals and individuals with diminished mental capacity are treated with the utmost respect and sensitivity. Speakers will demonstrate how knowledge, patience, and collaboration can promote individual rights and ensure the integrity of the guardianship process.

After Dean Patricia Salkin’s welcome and program introduction, the Honorable A. Gail Prudenti, Chief Administrative Judge, New York State Unified Court System, will provide the keynote address.

The June 19th program is divided into four subject areas. The four subject areas and the speakers are as follows:

  • The Actual and Perceived Physical and Mental Consequence of Aging
    • Wilbert S. Aronow, MD, FACC, FAHA, FACP, FCCP, AGSF, FGSA Professor of Medicine, Westchester Medical Center, New York Medical College
    • Ellyn S. Kravitz, J.D., LL.M., CELA Abrams, Fensterman, Fensterman, Eisman, Formato Ferrara & Wolf, LLP
  • The Relevance and Consequences of Diminished Mental Capacity
    • William H. Frishman, MD, MACP Chairman and Professor of Medicine New York Medical College
    • Sheila Shea, Esq., Director, Mental Hygiene Legal Services, Third Judicial Department, New York State
  • The Positive and Negative Implications of the Significant Use of and Reliance on Prescription Medication and Over-the-Counter Drugs by Older Persons
    • Robert Cannon, Esq., Coordinator, Aging and Longevity Institute (ALLI), Touro Law Center
    • Kenneth Cohen, PharmD, Ph.D., MS Associate Professor, Touro College of Pharmacy
  • Judges and Lawyers Must Look Beyond a Person’s Age, Diagnosis and Appearance
    • Fern Finkel, Esq., Law Offices of Fern Finkel, Esq.
    • Joan Lensky Robert, Esq. Kassoff, Robert & Lerner, LLP
    • Ira Salzman, Esq., Goldfarb Abrandt Salzman & Kutzin, LLP

Please click here to access the full June 19th Agenda.

If you are interested in attending, please contact Robert Cannon, Aging and Longevity Law Institute Coordinator, or (631) 761-7190.

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Aging and Longevity Law Institute Launches Guardianship Quality Initiative (“GQI”)

Millions of Americans are victims of Alzheimer’s disease or other diseases or conditions that cause diminished mental capacity. The Alzheimer’s Association predicts that by the year 2050, the number of people 65 years of age and older with Alzheimer’s disease will triple, from 5.1 million to 13.8 million. In addition, tens of thousands of older New Yorkers will suffer with other physical or mental health, personal or financial challenges which will require legal assistance, including, for some, the protection of the Guardianship Courts.

The Guardianship Quality Initiative (“GQI”) was created by Robert “Bob” Abrams, co-founder of Touro Law Center’s Aging and Longevity Law Institute (“ALLI”). GQI’s goal is to assess and address the legal needs of these vulnerable individuals as well as to inform and educate the legal community about the medical, societal, personal, legal, and non-legal issues that affect individuals with diminished mental capacity, their loved ones, and their communities. In cooperation with the New York State Office of Court Administration, prominent judges, experienced practitioners, government representatives, healthcare professionals, and members of academia, ALLI has created a comprehensive program that includes valuable and practical resources for New York judges, lawyers, court personnel, and all guardianship stakeholders.

GQI is an historic initiative that will not only improve the quality and delivery of legal services to older New Yorkers, but also serve as a national example as to how the legal community can partner with legal educators to leverage collective expertise, available technology, and unwavering collegial commitment to ensure our community is better equipped to address an important societal issue. The GQI endeavors to provide lawyers, judges, and court personnel with the information, tools, and resources necessary to meet the needs of individuals with diminished mental capacity and their families. A series of online continuing legal education (“CLE”) programs and numerous live CLE programs will address How to Humanely and Competently Assess, Litigate, and Adjudicate Matters Involving Individuals with Diminished Mental Capacity.

The objective of the CLE programs is to provide lawyers, judges, and court personnel with substantive information and resources in a collegial environment.

Weekly CLE Programs

Each online CLE program will provide CLE credit for “experienced” NYS attorneys who comply with the applicable requirements of the NYS Office of Court Administration (OCA). Beginning on Monday, June 29, 2015, CLE programs will be released and available to view on a weekly basis for 50 weeks.

Live CLE Programs

Over the course of the GQI, live CLE programs will be offered, which registered participants can attend at no extra charge. Live program faculty will consist of lawyers, judges, experts, and individuals from academia. All live CLE Programs will be recorded and uploaded onto the GQI website and made available for registered participants to view online

The first live Program titled, The Aging Process: What Guardianship Judges and Lawyers Need to Know About the Actual and Perceived Physical and Mental Consequences of Aging, is being held at the Touro Law Center on Friday, June 19, 2015. Attendance is by invitation only and this program is being offered at no charge. Please click here to view the agenda for the first live program. If you are interested in attending, please contact me.

For your review, please find below a link to our “Guardianship Quality Initiative Brochure” which features an overview of the GQI, an outline of the online weekly CLE programs, an outline of the live CLE programs, GQI content, and information regarding the cost and how to register for this unique initiative.

Please click here for access to the Guardianship Quality Initiative brochure.

Please click here to go directly to the Guardianship Quality Initiative Registration Page.

If you have questions or wish further information, please feel free to write to me at or call me (631-761-7190).

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Aging in Place – A Stakeholder’s Conference on Care, Healthcare, Finance, and Law: Session Two

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On Thursday September 18, Touro College Jacob D. Fuschberg Law Center in collaboration with Touro College of Health Sciences and with New York Medical College’s Center for Long Term Care Research and Policy will welcome an array of professionals from the fields of social work, law, government, and academia to participate in the second session of the Touro College and University System Conference on Aging in Place.

Thursday’s conference is a follow up to the inaugural session of the aging in place conference which took place on Friday, June 20. On June 20th, a diverse and attentive audience listened to presentations from a variety of speakers including Carol Levine, Director, Families and Health Care Project, United Hospital Fund, Eric Sokol, Vice President of Public Policy at the Alzheimer’s Foundation, Jean Accius Ph.D., Director, Health & Long-Term Services and Supports, AARP, and Greg Olsen, Executive Deputy Director, New York State Office for the Aging.

Shortly after the inaugural session, the conference organizing committee set about shaping Thursday’s conference. The committee agreed that in order to improve the lives of older individuals, innovative models and proposals for regulatory and policy changes that will promote aging in place are required. To further this goal, the organzing committee established four facilitated workings groups to address specific aspects of aging in place. Each of the four groups (outlined below) will be facilitated by a professor from the Touro Community. The group facilitators drafted the following descriptions of their working groups and each took the time to provide suggested reading materials.

Financing & Long Term Care Policy (Facilitator: Kenneth A. Knapp, PhD, Assistant Professor, Center for Long Term Care Research & Policy SHSP, New York Medical College):

The ability of older adults to satisfy their desire to age in place, whether in their current homes or in non-institutional settings within their current communities, depends on their financial resources as well as their long term care needs. In this context, we seek to identify both the most successful financial and long term care policies as well as those whose adoption would further help promote aging in place. Resources include:

Workforce & Workforce Training Needs (Facilitator: Nathan Boucher, PA-C, MS, MPA, CPHQ, Assistant Professor & Director of Graduate Education, Touro College, School of Health Sciences, Manhattan Physician Assistant Program):

The working group will discuss the current state of professional preparation and areas for training improvement in the aging-related workforce caring for, or otherwise providing services to, our aging populations. We will discuss how Long Island communities can benefit from a multidisciplinary approach to aging-related professionals’ education. We will also discuss how the communities themselves can help shape the preparation of these professionals through collaborative engagement between learning institutions and key community-based organizations and/or knowledgeable informants. Resources include:

  • A Reminder from the CDC website“aging in place” -The ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level.
  • “Retooling for an Aging America” Institute of Medicine Report, 2008:
    • Recommendation 5-1: States and the federal government should increase minimum training standards for all direct-care workers. Federal requirements for the minimum training of certified nursing assistants (CNAs) and home health aides should be raised to at least 120 hours and should include demonstration of competence in the care of older adults as a criterion for certification. States should also establish minimum training requirements for personal-care aides.
    • Recommendation 5-2: State Medicaid programs should increase pay and fringe benefits for direct-care workers through such measures as wage pass-throughs, setting wage floors, establishing minimum percentages of service rates directed to direct-care labor costs, and other means.
    • Recommendation 4-3: Public and private payers should provide financial incentives to increase the number of geriatric specialists in all health professions.

Livable Communities & Land Use (Facilitators: Sarah J. Adams-Schoen, Professor & Director, Touro Law Center, Land Use & Sustainable Development Law Institute, and Joan Foley, Professor, Touro Law Center):

The working group will discuss policies and rules on the use of land and on building codes that effect aging in place. We discuss how Long Island communities can use best practices to become more age-friendly by assessing and making improvements to outdoor spaces and structures, housing, transportation, and community services. We will address fostering the use of universal design. Resources include:

Ethics (Facilitator: Marianne Artusio, Professor & Director, Touro Law Center, Aging and Longevity Law Institute):

The working group will discuss the laws and policies in place to ensure professionals have a working knowledge of the important ethical issues facing society’s aging population. We will discuss how Long Island’s professional communities can adopt and utilize different ethical standards across disciplines to ensure a more well-rounded understanding. Further, we will discuss how we can raise community awareness of the age-related ethical obligations facing Long Island’s professionals. Resources include:

Please click here to access the Conference Agenda.

For additional information about the Conference, please contact the Conference Administrator, Robert Cannon by telephone at (631) 761-7190 or by email at (2)

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Newly-Insured Face Hurdles as They Navigate Health Insurance Benefits

Posted by Professor Marianne Artusio

Sunday’s New York Times brings the discouraging news that many people, newly-insured under the Affordable Care Act, are having difficulty figuring out how to use this new benefit. Although eight million people have now enrolled, government and communities now must assist them to be smart consumers of health services and to use their medical coverage wisely. Many, insured for the first time, are perplexed by the complications of co-pays, premiums, and the task of choosing a primary care doctor. It is such a new world for many who are thankful to have insurance, but uncertain how to use it. Just as medical providers are struggling to adjust to the changes wrought by the Affordable Care Act, enrollees are grappling with such mysteries as the differences between coverage for urgent care clinics, emergency rooms and retail clinics. Even the task of understanding the information on an insurance card can be baffling. Fortunately, the Centers for Medicare and Medicaid Services (CMS) has rolled out an extensive program and easy-to-understand materials to help community groups teach “health insurance literacy.” These efforts are vitally important if the promise of expanded coverage is to be realized. It would be tragic if unfamiliarity with the ordinary processes of handling health insurance defeated newly-insured enrollees, jettisoning them into the ranks of the uninsured again. The problem is particularly acute among enrollees with limited English language proficiency and older enrollees. CMS is producing printed materials and videos in Spanish and many other languages.

However, the confusion for older enrollees may warrant even greater efforts. Many, who are nearing the Medicare eligibility age of 65, are not computer-literate. When they signed up for health insurance initially, they were not able to study the available plans offered on the online marketplace.  Relying on friends, family or community services, many did not fully understand the choices available or their responsibilities and must now contend with new and bewildering obligations. For example, the schedule for making premium payments may be confusing; an enrollee who does not pay the premium will eventually find the policy has been cancelled with no chance to reenroll until the next enrollment period.  I spoke with Rebecca Cashman, who was featured in the Times article and whom I have known since she was born.  She is the program coordinator for Resources for Human Development, a non-profit agency in Philadelphia, offering educational programs and assistance for new enrollees and she has spent her career working for better health outcomes for at-risk populations.  “People who are not familiar with computers find the need to engage with technology daunting,” she said.  “Setting up an email account for their coverage can be unsettling. They will need more in-person explanations and help to understand their coverage.”

The recession ended the working lives of many older adults, many of whom never had health insurance. Surely, their health needs cannot wait until they qualify for Medicare. Preserving the health of those on the brink of their senior years requires fully utilizing all health care coverage, so “health insurance literacy” programs should be presented to senior centers and caregiver programs too. Medical providers and insurers have a role here too, participating in educational programs and operating telephone information lines, staffed with patient, unflappable and knowledgeable employees.

Click here to read the New York Times article.

Click here to read the Centers for Medicare and Medicaid Services  “From Coverage to Care” materials.

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Elderly Are Hit by a Surge in the Price of Generic Drugs

By Professor Marianne Artusio

Last week the New York Times reported a startling trend: a sudden increase in the price of commonly-usedpill picture generic drugs.  Because older persons take more prescription medication and many rely on the cost-savings expected from generic drugs, this is a worrisome development.  In fact nearly 80% of all medicines prescribed in the United States are generic drugs. For example the price of digoxin, a commonly used generic heart medicine has nearly tripled since last October, so elderly patients may be forced to choose between life-saving medicine and other critical needs.  For most seniors, selecting a prescription plan under Medicare Part D often depends on the cost of the needed medicine available under the plan.  Unexpected price hikes play havoc with the choice made, usually after careful computation of expected out-of-pocket costs. Many seniors spend countless hours studying the available Medicare Part D plans with family or counselors, seeking the best deal.  Because the Medicare Prescription plans cannot be changed until the next enrollment period, seniors who expected to pay reasonable co-pays for generic drugs can find themselves in serious trouble.  According to the Times article the Federal Trade Commission has been looking into anticompetitive practices of the generic drug manufacturers. The alarming rise may be partially the result of fewer generic manufacturers; when generics are cheap manufacturers find producing them not so profitable and cease production, leaving few remaining manufacturers who face little competition.  Last year the National Community Pharmacists Association revealed that the price of some essential generic drugs have soared 600% – 1000% over the last few years, resulting in staggering co-pays for some patients.  And the response of insurance companies?  The Times reports that some insurers are requiring doctors to complete multiple page forms to justify renewing a higher cost generic in an effort to discourage physicians from prescribing it for their patients or putting the drug in a higher co-pay group.  Most insurance plans available to seniors require the doctor to prescribe a generic drug when it is available, but when the cost of generic drugs climbs, the potential savings diminishes, inevitably resulting in higher co-pays or higher insurance premiums.  When market forces are allowed to whipsaw the prices of what are supposed to be the cheaper drugs for seniors, their financial stability can be shaken and their health compromised.  Is there a legislative solution?  Some states (Arkansas, Kentucky and North Dakota) have passed generic drug pricing transparency laws requiring disclosure by pharmacy benefit managers (PBMs) of the maximum allowable costs (MAC) for generic drug reimbursement.  Because PBMs often have multiple MAC lists, they can charge the insurance plan a higher MAC, but pay the pharmacy a lower MAC, keeping the difference.  By requiring this disclosure, pharmacies are better able to negotiate reimbursement rates and these 3 states have taken a positive step to prevent price gouging for generic drugs.  Click here to read the Times article.

Click here to read the report of the National Community Pharmacists Association.


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As LGBT Rights Advance, So Do Housing Options for LGBT Elders

Posted by: Professor Marianne Artusio

It seems that advances in the law for the LBGT community come with increasing rapidity and as they do, the prospects for comfortable and respectful aging for LBGT seniors advances comparably.  Last week the 10th Circuit Court of Appeals in Kitchen v. Herbert held that Utah’s 2004 constitutional amendment and other statutes banning same-sex marriage violated the equal protection and due process guarantees of the 14th Amendment.LGBT Blog Post. 2 On July 1, 2014, a federal district court also struck down as violating the guarantee of equal protection Kentucky’s constitutional and statutory bans on same-sex marriage.  While the struggle for marriage equality is certainly not over, these decisions are but two more examples of the nation’s progress toward full respect for LGBT rights and relationships.  Regrettably this respect has been only recently gained and many older LGBT couples enter their senior years with a personal history of discrimination, fear and secrecy.  This is why it is so heartening to see the opening of senior housing complexes specially intended for the LGBT community.

As greater numbers of LGBT seniors live openly, whether in couples or as singles, the need for housing that is supportive and welcoming correspondingly grows. Gay seniors are much less likely to have children or grandchildren to support or assist them according to a National Gay and Lesbian Task Force Policy Institute study.   A lifetime of discrimination both in employment, education, health care and in lawful family relationships has left LGBT seniors with poorer economic and health outcomes.  Discrimination that has prevented members of LGBT couples from benefitting from a partner’s health insurance coverage, spousal protections in governmental benefits, private pensions and the other financial benefits of marriage has led to devastating health disparities and economic insecurity in old age.  Click here to read the Task Force Report. As these seniors age, many without adequate family and social supports, their need for safe housing in accepting communities becomes urgent.  Older generations, raised in times that were less tolerant, may not welcome their LGBT neighbors, making the choice of a suitable home in later life a thorny task.  

Thankfully an array of housing choices for LGBT seniors is beginning to emerge. Stonewall Gardens, an assisted-living complex is slated to open soon in Palm Springs, California.  Although also open to straight residents, the facility, whose name evokes the 1969 Stonewall Riots that is often cited as the spark of the gay rights movement, intends to offer a comfortable and accommodating environment for LGBT residents.  In 2007, Triangle Square, an affordable rental complex catering to LGBT seniors, opened in Los Angeles.  When it opened it was one of only a small number of housing options for LGBT elders, but now its operator, Gay and Lesbian Elder Housing, is starting to fill the Argyle, another Los Angeles affordable housing complex with a special mission to serve this population. True to the ideal of equality inherent in the LBGT rights movement, the Argyle will be open to non-LGBT tenants. However, the distinctive focus on housing LGBT seniors will assure steady stream of LGBT applicants for these apartments. In January 2014, Philadelphia opened the John C. Anderson Apartments, hailed as gay-friendly, affordable senior housing, intended to provide housing for the generation whose activism, pride and openness cost them the economic opportunities and family supports others have achieved.

As the Courts undermine the legal barriers to LGBT relationships, hopefully financial hardships, discrimination and social isolation will plummet as well.  In that future, gay-friendly senior housing will be a choice, but one selected for the delight in the variety of human experience and not to avoid intolerance and misunderstanding.  As the Court in Kitchen v. Herbert said last week:

A generation ago, recognition of the fundamental right to marry as applying to persons of the same sex might have been unimaginable. A generation ago, the declaration by gay and lesbian couples of what may have been in their hearts would have had to remain unspoken. Not until contemporary times have laws stigmatizing or even criminalizing gay men and women been felled, allowing their relationships to surface to an open society. As the district court eloquently explained, “it is not the Constitution that has changed, but the knowledge of what it means to be gay or lesbian.”

Click here to read the full opinion.

Click here to read the Kentucky district court opinion, Love v. Beshear,

In the same spirit, President Obama declared June 2014 as Lesbian, Gay, Bisexual and Transgender Pride Month. As I watched the events of the New York 2014 Gay Pride March on June 29, I was reminded of the older generation who braved discrimination, ridicule and violence to demand recognition and respect.  They certainly deserve a dignified later life.  Click here to read the President’s proclamation.

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