Legal Services & Resources

Legal Services:
The Memory Center is based in Hyannis, MA and comprised of psychologists, psychiatrists, psychiatric nurse practitioners and Licensed Clinical Social Workers all offering direct mental health services through a group practice known as Lewis Bay Associates. Dr. Elovitz and his colleagues provide the following services to attorneys and the courts:

• Evaluation of capacity specific to the legal area in question
• Prepare Medical Certificates for guardianship
• Prepare Medical Certificates for conservatorship
• Testimony and preparation of affidavits
• Pre-evaluation for Long Term Care insurance qualification
• Clinical Team Reports for intellectually disability
• Rogers (Monitor) guardianships
• Consultation and advice to the legal profession
• Pre-employment psychological assessment for public safety officers; e.g., police, fire fighters, state corrections workers.


Additional Notes:
All evaluations result in a carefully prepared (and typed) 5+ page report, usually within a few days of the evaluation. As the evaluation precedes any request for a Medical Certificate (MC) if standards are not met for limited or general guardianship/conservatorship, then the MC is not completed and there is no charge for it. If the evaluation yields good evidence supporting need for a MC, then the evaluation report can be attached to the MC and submitted to the court as substantial evidence of the “tests” given and the process used.

MCs are completed within days of the report, and Dr. Elovitz is sensitive to the fact that a patient must be seen/evaluated within 30 days of the hearing. Given most MC’s result in a temporary guardianship/conservatorship he plans to re-see the patient within the next 90 days if a hearing for permanent status is planned. MC’s are typed and proof-read extensively; i.e., there is no scribbled handwriting. They reflect a dozen or more tests/procedures used and contacts/interviews with multiple people involved.


The Mini-Mental State Exam (MMSE):
The Mini-Mental State Exam (MMSE), especially when used without available normative data (as it almost always is), does not meet criteria as a “test.” The MMSE is nearly completely insensitive to diagnosing Mild Cognitive Impairment (MCI) and it is very weak at diagnosing first stage (early) dementia. It is a fair-to-good predictor of moderate and late dementia, but that degree of mental impairment is usually obvious to all. Any MC evaluation can reference it, but should not depend on it.


Resources:
Few mental health professionals seem aware that there are specific Instructions to Clinicians for Completing the Massachusetts Medical Certificate. These are periodically reviewed and always followed by Dr. Elovitz and his colleagues at The Memory Center. Moreover, there are also professional handbooks on the subject published by the American Psychological Association (APA) for psychologists.

Additionally there are guides for attorneys; e.g., Assessment of Older Adults with Diminished Capacity: A Handbook for Lawyers published in 2003 by the American Bar Association (ABA) in collaboration with the APA. There is also a guide for judges; Judicial Determination of Capacity of Older Adults in Guardianship Proceedings, published in 2006 by the National College of Probate Judges in collaboration with the APA and ABA. Dr. Elovitz and his team use and work within the guidelines put forth in these resources to provide the best service he can to his clients and their attorneys. See the section on Resources for more information on these guides and books.

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