Did you know that this center in here in Chicagoland?
Go to youngparkinsons.org to learn more, register for their newsletter, and much more
Did you know that this center in here in Chicagoland?
Go to youngparkinsons.org to learn more, register for their newsletter, and much more
IDOT Unveils Life-Saving Yellow Dot Program
Program Provides Emergency Responders with Crucial Medical Information to Help Crash Victims
The Illinois Yellow Dot program, a life-saving, traffic safety initiative that provides first responders with critical information to improve emergency care for persons involved in vehicle crashes. IDOT along with the Illinois Department of Public Health (IDPH), Illinois Department of Aging (IDOA) and county health departments across the state are working together to increase awareness of the voluntary, federally funded program, and provide distribution centers and information for interested residents.
“Roadway safety is always a top priority at IDOT, and the Yellow Dot program can help improve roadway safety by providing first responders the crucial medical information they need to treat injuries and save lives, beginning at the scene of a crash,” said Acting Transportation Secretary Ann Schneider. “This important program gives IDOT and our partners another important way to improve our exceptional record on traffic safety. I encourage all motorists to participate in this unique and effective program, which could make the difference between life and death for individuals involved in crashes.”
Because the first hour following an injury is the most crucial, the Yellow Dot program provides essential personal health information to emergency responders in order to promptly care for a crash victim. This ‘Golden Hour’ is critical in the treatment of crash victims, and the medical information provided through the program could be a lifesaver.
When a crash occurs, emergency medical first responders such as police officers, firefighters and emergency medical technicians are immediately dispatched to the scene. These responders usually have basic information such as the location of the crash and the number of victims. Frequently, minimal personal information is available during this early, most critical time period.
“This is a great opportunity for older drivers to update their medical information and have a voice in their emergency treatment in the event of an accident,” said John K. Holton, Ph.D., director of the Illinois Department on Aging. “The Yellow Dot program will serve as a lifeline to alert first responders of crucial medical information which can help the victims who may be unable to communicate at the crash site or may have forgotten to share the information.” Yellow Dot participants are supplied with a simple, bright yellow decal for their car and a corresponding yellow folder. The decal is placed in a conspicuous and consistent place – in the lower left-hand corner of the rear window, driver’s side. The yellow dot signifies there is a folder in the glove compartment containing the following medical information about the motorists: participant’s name, close-up photo, emergency contact information, patient’s physician information, medical conditions, recent surgeries, allergies and a list of current medications. Having access to this information allows first responders to make important decisions regarding emergency treatment and can better prepare emergency hospital staff in the receiving room.
“Time is critical in an emergency situation. If paramedics and emergency medical workers know what medications a person is taking, if the person has allergies or a chronic condition, they can make better decisions about treatment,” said Acting IDPH Director Dr. Craig Conover. “Delaying treatment can mean the difference between life and death in some cases. Something as simple as having your medical information on a yellow card in your glove compartment can potentially make a big difference in the emergency care you receive.”
The Yellow Dot program, funded by the U.S. Department of Transportation, was originally introduced in Connecticut in 2002. For more information on the program and to find a distribution center near you, visit www.yellowdotillinois.org.
By Carolyn M. Clancy, M.D.
December 6, 2011
Finding a high-quality nursing home for a family member is a daunting task.
Many people have not had to make this decision before. And it’s often made under stress, when asking good questions and thinking carefully about your options are harder than usual.
Fortunately, more information is available that can help you learn about nursing home quality and prepare you to make a well-informed decision.
Start this process with an online tool from the Federal Government called Nursing Home Compare. This lets you look up nursing homes in your area by name, city, county, State, or ZIP Code. First unveiled in 2009, Nursing Home Compare has detailed information on every nursing home certified by Medicare or Medicaid.
Nursing homes are rated using a 1- to 5-star scale, with those earning 5 stars being rated the highest. Ratings are based on how many and what type of staff members they have, how well they perform on health inspections, and how they rank on quality measures. Ratings for each measure are given individually and are also combined into an overall rating.
Starting in 2012, Nursing Home Compare will include a new measure that includes input from the nursing home residents. This new information will take the place of the quality measures that currently appear on Nursing Home Compare. Findings will be part of the ratings starting in April 2012.
Staffing and health inspection data add important information and will continue to be a factor in each nursing home’s overall rating. The staffing measure tells you the average staffing levels—such as the number of registered nurses, licensed practical nurses, and certified nursing assistants—for each resident each day. This is a good benchmark, but it has limits. It does not show the number of nursing staff present at any given time or describe the amount of care give to any one resident. The health inspection measure looks at many major aspects of care in a nursing home. This includes how medicines are managed, whether food is prepared safely, and whether residents are protected from inadequate care. Inspections take place about once a year, but they may be done more often if the nursing home has several problems to correct.
Even with so much good information, the Nursing Home Compare tool and rating system won’t answer all of your questions. For example, the ratings won’t tell you if the nursing home has improved, or gotten worse, in certain areas since it was rated. That’s why it’s important to visit any facility you are considering. Be sure to ask questions of the staff, especially people who provide care to residents. It’s also a good idea to visit a nursing home a second time on a different day of the week and another time of day. You may get a better idea of changes in staff, activities, and other factors that could make a difference in your choice.
An excellent list of questions to ask during such visits is available from a nursing home checklist (PDF File; PDF Help) by the Centers for Medicare and Medicaid Services (CMS). And a new handbook (PDF File; PDF Help) from CMS explains how to pay for nursing home care, describes residents’ rights, and gives alternatives to nursing home care. Another good resource is your State ombudsman; select to find yours.
click here to read more.
The Illinois Department of Insurance published a helpful medicare supplement comparison guide.
Click here to learn more.
Blood thinners and diabetes drugs cause most emergency hospital visits for drug reactions among people over 65 in the United States, a new study shows.
Just four medications or medication groups — used alone or together — were responsible for two-thirds of emergency hospitalizations among older Americans, according to the report. At the top of the list was warfarin, also known as Coumadin, a blood thinner. It accounted for 33 percent of emergency hospital visits. Insulin injections were next on the list, accounting for 14 percent of emergency visits.
Aspirin, clopidogrel and other antiplatelet drugs that help prevent blood clotting were involved in 13 percent of emergency visits. And just behind them were diabetes drugs taken by mouth, called oral hypoglycemic agents, which were implicated in 11 percent of hospitalizations.
All these drugs are commonly prescribed to older adults, and they can be hard to use correctly. One problem they share is a narrow therapeutic index, meaning the line between an effective dose and a hazardous one is thin. The sheer extent to which they are involved in hospitalizations among older people, though, was not expected, said Dr. Dan Budnitz, an author of the study and director of the Medication Safety Program at the Centers for Disease Control and Prevention.
“We weren’t so surprised at the particular drugs that were involved,” Dr. Budnitz said. “But we were surprised how many of the emergency hospitalizations were due to such a relatively small number of these drugs.”
Every year, about 100,000 people in the United States over age 65 are taken to hospitals for adverse reactions to medications. About two-thirds end up there because of accidental overdoses, or because the amount of medication prescribed for them had a more powerful effect than intended.
As Americans live longer and take more medications — 40 percent of people over 65 take five to nine medications — hospitalizations for accidental overdoses and adverse side effects are likely to increase, experts say.
In the latest study, published in The New England Journal of Medicine, Dr. Budnitz and his colleagues combed through data collected from 2007 to 2009 at 58 hospitals around the country. The hospitals were all participating in a surveillance project run by the C.D.C. that looks at adverse drug events.
A common denominator among the drugs topping the list is that they can be difficult to use. Some require blood testing to adjust their doses, and a small dose can have a powerful effect. Blood sugar can be notoriously hard to control in people with diabetes, for example, and taking a slightly larger dose of insulin than needed can send a person into shock. Warfarin, meanwhile, is the classic example of a drug with a narrow margin between therapeutic and toxic doses, requiring regular blood monitoring, and it can interact with many other drugs and foods.
“These are medicines that are critical,” Dr. Budnitz said, “but because they cause so many of these harms, it’s important that they’re managed appropriately.”
One thing that stood out in the data, the researchers noted, was that none of the four drugs identified as frequent culprits are typically among the types of drugs labeled “high risk” for older adults by major health care groups. The medications that are usually designated high risk or “potentially inappropriate” are commonly used over-the-counter drugs like Benadryl, as well as Demerol and other powerful narcotic painkillers. And yet those drugs accounted for only about 8 percent of emergency hospitalizations among the elderly.
Dr. Budnitz said that the new findings should provide an opportunity to reduce the number of emergency hospitalizations in older adults by focusing on improving the safety of this small group of blood thinners and diabetes medications, rather than by trying to stop the use of drugs typically thought of as risky for this group.
“I think the bottom line for patients is that they should tell all their doctors that they’re on these medications,” he said, “and they should work with their physicians and pharmacies to make sure they get appropriate testing and are taking the appropriate doses.”
The American Automobile Association (AAA)emphasizes the importance of communication to help keep senior drivers safe and mobile:
This is a wonderful organization dedicated to advocacy, support, education, and resources to stroke survivors and their families.
To read the December newsletter, please click here.
Dutton & Casey, PC (Elder and Disability Law)
Advocates for Elders, Persons with Disabilities, and their Loved Ones.
The law firm of Dutton & Casey, P.C., is committed to serving our clients with the comprehensive and personally tailored service they need and deserve. With 50 years of combined legal experience, we have acquired the depth and breadth of knowledge necessary to address the full scope of elder law and disability issues.
Our Areas of Concentration:
* Full Time Social Worker/Certified Care Manager On Staff
Arlington Heights, Chicago, Skokie, and Vernon Hills, Illinois.
Phone / Video Conferencing Appointments are also Available.
Telephone: 312-899-0950 or 847-261-3584
-please click here for a flyer on the law firm.
In Illinois, Medicaid is changing because the Deficit Reduction Act is being implemented.
Click here to read more.
Did you know that the NIA publishes easy-to-read booklets on numerous aging-related health topics?
Click here to learn more about the resources available from NIA.
The Centers for Medicare and Medicaid released the rates for 2012.
For more information, please click here.
The Association has a program, The American Brain Tumor Association Connections Support Community, the connects patients, families, friends and caregivers for support and inspiration.
Please click here to read more.
Medicare has published the 2012 guide.
Click here to obtain the booklet.
Driving demands quick reaction time and fast decision making — because of this, a person with Alzheimer’s will eventually become unable to drive. Making decisions about when it’s time to stop driving can be difficult, but dealing with the issue early on can help ease the transition. Learn more at our online Dementia and Driving Resource Center, where you can watch how four families deal with different issues related to dementia and driving.
Click here to read the entire article, from the Alzheimers Association.
Register Now for the Free Webcast on Oct. 22, Live from
Can’t make it to Rhode Island? Watch the live webcast of the key speakers from the comfort of your home. Register now for the free, live webcast and learn about the following topics:
This event is brought to you by the National Parkinson Foundation and the American Parkinson Disease Association. Thank you to our generous sponsors: Teva Neuroscience, Ipsen and Medtronic.
For more information, please call NPF’s Helpline at 1-800-4PD-INFO (473-4636).
This free resource from the National Eye Institute includes medical, emotional, and practical (vision rehab therapy etc.) information related to Age-Related Macular Degeneration.
Attorney Kathryn C. Casey was a guest on “Disabled Radio” on Wednesday, August 31, 2011.
In a recent article in Reuters Magazine, Alzheimer’s: Early Planning Critical to Financial Health, working with a certified elder law attorney is an important step in planning for the future.
Janna Dutton, founder of Dutton & Casey, is one of only 8 certified elder law attorneys in Illinois.
Click here to read the article.
For additional information on how Dutton & Casey can assist you, or someone who you care about, please go our website.
An admission to, and a discharge from, the hospital can be scary for the patient, and the family. The National Family Caregiver Alliance published a guide on the hospital discharge process. It is vital to pay attention, and be involved, in the plans being for when your relative leaves the hospital.
read the entire article.
The law firm of Dutton & Casey concentrates in assisting older adults, people with disabilities, and their families. Many times, plans following a hospital stay also include the need for legal planning. With over 50 years in expertise and offices in Chicago, Skokie, Arlington Heights, and Vernon Hills, the advocates at Dutton & Casey are available to assist. Please click here to read more about how we can assist you or those you care about.
Training Tips for the Caregiving Marathon, Speaker: Daniel Kuhn, LCSW
May 18, 2011 7:00-8:30 p.m.
Arlington Heights Senior Center, 1801 Central Road, Arlington Heights, IL
Please call Kathy Peck at (847) 253-5500 ext. 375 to reserve your seat
For assistance with the legal planning that is involved with being a family caregiver, please contact the law office of Dutton & Casey. Kathryn Casey is an experienced elder law attorney who sees clients in our Arlington Heights office. For more information or to schedule an appointment, please go to www.duttonelderlaw.comor email us at email@example.com
The April, 2011 issue of the newsletter from the Law Firm of Dutton & Casey was published today.
Please take a few minutes to read the newsletter… it contains many helpful articles and resources focusing on older adults, adults who have a disability, and the people who care about them, including family members and professionals.
Should there be any questions on the newsletter, to learn more about the many resources that the attorneys and staff can provide, or/and to schedule an appointment with a firm attorney, please go to https://www.duttonelderlaw.com/
Since we published last month’s Proposed Chages in Medicaid article, outlining a few ways in which Illinois is attempting to change its rules on Medicaid eligibility, you may wonder what hasn’t changed about qualifying for Medicaid benefits in Illinois. One method of Medicaid eligibility that Illinois has contemplated eliminating entirely, but still currently allows, is the special needs pooled trust for disabled people over the age of 65.
Ordinarily and generally speaking, to qualify for Medicaid, a person cannot own more than $2,000.00 in assets, a home, a car and a prepaid funeral. Medicaid is intended to provide healthcare coverage for the indigent blind, disabled and aged. However, one shortfall of this policy is that the indigent disabled usually have special needs and those needs are not met through Medicaid coverage. To correct for this shortfall in policy, the federal government allows disabled people to qualify for Medicaid even though they have more than $2,000.00 in assets as long as they place those excess assets into a special needs trust. That special needs trust can then be used to pay for the disabled person’s special needs which are not covered by Medicaid. Special needs can include special medical and dental equipment, therapies, treatments, pharmaceuticals, custodial and companion care, clothing, personal products and transportation. For a disabled person living in either the community or a long term care facility, a special needs pooled trust can increase quality of life enormously.
While the federal government allows disabled people to hold their excess assets in a special needs trust and to use those assets to pay for their special needs, the government does impose some limitations. For instance, the funds in the special needs trust can only be used for the benefit of the disabled person and any funds remaining in the trust at the end of the disabled person’s lifetime must be used to pay back the bill Medicaid has incurred providing benefits for the disabled person. Those limitations are minor considering the benefit a disabled person receives from being able to preserve and use their own funds during their lifetime while still qualifying for Medicaid coverage. The special needs trust is an exceptional tool to prevent the complete impoverishment of the disabled and it is very fortunate that Illinois has not yet attempted to eliminate this important option for disabled people over the age of 65.
For more information on how to prepare a special needs pooled trust, or for other questions you may have in the face of the proposed changes to Medicaid eligibility, contact the experienced elder law attorneys at Dutton & Casey, P.C. at www.duttonelderlaw.com or (312)899-0950.
There are a lot of pieces to the health care puzzle, and you are not alone in wishing that information regarding affordable health care coverage was located in a centralized location. In fact, enough people seemed to be interested in the same thing, because at the beginning of July, the U.S. Department of Health and Human Services unveilied an innovative new on-line tool that will help consumers take control of their health care by connecting them to new information and resources that will help them access quality, affordable health care coverage. Called for by the Affordable Care Act, HealthCare.gov is the first website to provide consumers with both public and private health coverage options tailored specifically for their needs in a single, easy-to-use tool.
“HealthCare.gov helps consumers take control of their health care and make the choices that are right for them, by putting the power of information at their fingertips,” said HHS Secretary Kathleen Sebelius. “For too long, the insurance market has been confusing and hard to navigate. HealthCare.gov makes it easy for consumers and small businesses to compare health insurance plans in both the public and the private sector and find other important health care information.”
HealthCare.gov is the first central database of health coverage options, combining information about public programs, from Medicare to the new Pre-Existing Conditions Insurance Plan, with information from more than 1,000 private insurance plans. Consumers can receive information about options specific to their life situation and local community.
In addition, the website will be a one-stop-shop for information about the implementation of the Affordable Care Act as well as other health care resources. The website will connect consumers to quality rankings for local health care providers as well as preventive services.
“This website is unlike any government website you have ever seen or used before,” said HHS Chief Technology Officer Todd Park. “It was developed with significant consumer input and is remarkably easy to navigate. This is despite the sheer volume of content it offers consumers: billions of health care choices through the insurance finder and more than 500 pages of new content, all of which is designed to grow with ongoing consumer feedback and as our health care system improves.”
As the health care market transforms, so will HealthCare.gov. In October, 2010, price estimates for health insurance plans will be available online. In the weeks and months ahead, new information on preventing disease and illness and improving the quality of health care for all Americans will also be posted. The website also includes a series of opportunities where users can indicate whether pages were helpful to them and we will continue to seek user feedback to grow and strengthen the site.
“People need to see what choices are offered, what options cost, and how coverage works in practice,” said Karen Pollitz, Deputy Director for Consumer Support, Office of Consumer Information and Insurance Oversight. “Today HealthCare.gov takes an important first step in that direction. In the coming months and years, we will add pricing and plan performance information so that consumers can see and understand and make meaningful choices about their health coverage.”
For information on how you can plan ahead to finance long-term care for yourself or your loved one, contact the experienced elder law attorneys at Dutton & Casey, P.C. at www.duttonelderlaw.com or (312)899-0950.
A trip to the hospital can leave family members and caregivers feeling more reactive than proactive. For some of us, the medical jargon can be so over our heads and the stress and worry levels so high, that it seems best to stay on the sidelines when it comes to caring for a patient. For instance, have you ever found yourself thinking- “this doctor/nurse deals with these situations all the time, so they know how to handle it much better than I do…” Or how about when a sibling asks why your mom received a certain kind of medication or what the side effects are and you say, “I’m not sure, the doctor told me we should do it.” There are incredibly caring and knowledgeable health care professionals in the world that are experts at what they do, but as a family member you are an expert in that particular patient, and that counts for something, too! No matter how great the health care professionals involved with your family may be, advocacy for your patient in the fast-paced health care environment is critical.
But how do you know what to do or what to ask? This is a start. Here is a recent blog from the New York Times that poses “Six Questions to Protect Elderly Patients.” Her blog noted that “About a third of patients over age 70 experience hospital delirium, and the consequences can be serious, delaying a patient’s recovery and even leading to placement in a nursing home.” So, to play a more proactive role in the care of your family member or loved one, Pam Belluck of the NYT, suggests asking the following 6 questions when it comes to older patients:
1. Do the nurses and doctors routinely screen for delirium or identify high-risk patients?
2. How does the hospital deal with agitation or delirium in patients if it develops?
3. What does the hospital do to keep patients from becoming disoriented?
4. What policies are in place to make sure patients get adequate sleep?
5. If my family member needs a urinary catheter or other bedside interventions, how does the hospital decide when to remove them?
6. Will the physicians and pharmacy staff review my family member’s medications to identify medications that increase delirium risk?
Read the complete blog here.
The Alzheimer’s Association-Greater Illinois Chapter is pleased offer a free online resource, Encouraging Comfort Care: A Guide for Families of People with Dementia Living in Care Facilities. This 21-page booklet provides useful information to families and staff of long-term care facilities about Alzheimer’s disease and related dementias, particularly care issues related to the late and final stages.
For families, this guide will enable them to make informed choices about a variety of medical decisions they may face on behalf of loved ones with dementia living in nursing homes, assisted living facilities, and other types of care facilities. It will also equip families to ask good questions aimed at obtaining the best care for their loved ones, including a handy checklist of comfort care measures to be discussed with staff members of care facilities.
To view and download the free guide, click here: http://www.alzheimers-illinois.org/pti/comfort_care_guide.asp
For more resources or to read about the elder law firm of Dutton & Casey P.C.’s areas of concentration, visit www.duttonelderlaw.com or call (312)899-0950.
Have you been counted? Complete and return your census form… it seems like such a simple item, but as estimated 48 million households have not sent their’s back this year. Why do it? Well, the information the census collects helps to determine how more than $400 billion dollars of federal funding each year is spent on infrastructure and services like:
If you haven’t recieved a census form, received one and can’t find it, or thought your information didn’t count and threw the form away, please call 1-866-872-6868 or go to 2010.census.gov to complete the census today. It only takes about 5-10 minutes, but could help your community get the funding it needs.
Late into the day on Wednesday, November 18th, Senate Majority Leader Harry Reid ( Dem.- NV) unveiled the proposed health care reform bill senate leaders plan to bring to a floor debate at the end of November. The bill, named the Patient Protection and Affordable Care Act, is a combination of the health bill approved by the HELP (Health, Education, Labor and Pensions) Committee and the Senate Finance Committee bill.
Key elder issues:
According to the NCCNHR, there’s no word yet on whether Senator Reid has enough votes to pass the bill, but he is expected to call for a procedural vote by this weekend.
Keeping up with all the recent health care reforms and bills can be quite a task. Luckily, Senate leaders prepared an overview and section-by-section analysis of the Patient Protection and Affordable Care Act. Click here to view it.
For more information on how these proposals will affect-term care planning for yourself or a loved one, contact the attorneys at Janna Dutton & Associates.
11/23 UPDATE: On November 21st, the U.S. Senate Democrats got a “fililbuster proof 60 votes that will allow them to bring their version of health care reform to the Senate floor for debate.” While the vote is considered historic, the passage of this bill is in no way a sure thing. Read here for complete details from the Examiner.com.
Caring for an elderly parent or loved one can be a full-time job. Even when a family can agree on a care plan, which is not always the case, the plethora of decisions that need to be made and the never-ending pile of documents that need to be filled out is overwhelming. In addition to that, you have your own life to live and yourself to take care of.
It’s tempting to want to handle everything yourself, but sometimes outside help can actually allow you to provide the best possible care for your loved one, not to mention allow you to take better care of yourself. In September, the New York Times published an article on geriatric care managers, or what they also refer to as the equivalent of a case worker. Aptly named, these care managers do just that–manage the care of your family member. They have both the time and the expertise that family members often do not, which can greatly improve your elder’s quality of life. (See complete article for costs)
A good care manager will thoroughly assess the individual and use that assessment to determine a care plan that will meet the individual’s needs. Amongst a variety of other changes, this could mean that home care is recommended, or that sleeping and eating times must be adjusted. Plus, using someone outside of the immediate family can help in a few ways. One family member explained that he couldn’t get his mom to listen to him, but she would always listen to the care manager. It also provides the family with the option to be the “good cop” while the care manager is the “bad cop.” Persuading an older person not to drive anymore is a good example of when the good cop/bad cop routine might come in handy (and be more effective).
Click here to see the article in full. It provides some examples of how geriatric care managers have assisted families in finding and maintaining the right kind of care, costs involved and ways to find the right care manager for your family.
For legal advice on long-term care planning for yourself or a loved one, contact the attorneys at Janna Dutton & Associates.
When thinking about the effects of dementia, most people view it as a disease that solely affects the mind– a debilitating illness that strips an individual of his/her memories, but appears to leave the rest of the body untouched. However, a recent article in the New York Times reminds us that the body undergoes a physical attack as well as a mental attack. The illness is progressive and as it weakens the brain it also shuts down the body. Doctors advise that these often-overlooked physical tolls must be understood and taken into consideration when considering the future care of your loved ones.
The article explains that the lack of understanding about the physical effects of dementia means that many patients near the end of life are subjected to aggressive treatments, many of which cannot possibly help them, or can even increase symptoms such as confusion and anxiety. Researchers in a recent Harvard study found there were stark differences in treatment decisions depending on what family members knew about dementia. Dr. Susan L. Mitchell, the study’s lead author, explained, “When family members understood the clinical course of dementia and the poor prognosis, the patients were far less likely to undergo these distressing interventions.” She concluded that, “Dementia is a terminal illness and needs to be recognized as such so these patients receive better palliative care.”
For the full article, click here.
For more information on long-term care planning for yourself or a loved one, contact the attorneys at Janna Dutton & Associates.
The New York Times posted a very interesting article about medical residents who spent a short time living in a nursing home to find out what it’s like to be a nursing home resident. One of the goals of the program is to generate interest in geriatric medicine, which continues to be one of the most underrepresented fields in medicine. Additionally, participants found that their experience offered invaluable insight into how to be better physicians.
For legal assistance, contact the experienced elder law attorneys at Janna Dutton & Associates.
This web site is designed for general information only and should not be construed to be formal legal advice nor the formation of an attorney/client relationship. You should consult an attorney for advice regarding your individual situation. We invite you to contact us and welcome your calls, letters, and electronic mail. However, contacting us does not create an attorney/client relationship, so please do not send any confidential information to us until such time as a relationship has been established.