Increase in SSI Benefits

Americans with disabilities who receive Social Security benefits, specifically Supplemental Security Income, will see an increase in their monthly benefits in 2013.

On Tuesday, the Social Security Administration stated that all beneficiaries will get a 1.7% increase to compensate for a higher cost-of-living. The automatic payment adjustment, also know as COLA, occurs whenever inflation rises.

This increase will go into effect on 12/31/12 for over 8 million SSI recipients.

The maximum federal benefit for an individual receiving SSI will increase from $698 per month to $710. Also, payments to couples on SSI will increase to $1066 from $1048 monthly.

Source: disabilityscoop.com

Medicare Part D Open Enrollment

Medicare Part D Open Enrollment is from October 15^th to December 7^th

What does this mean?

·          Anyone enrolled in a prescription drug plan can switch to another plan for the following year

·          Those who missed the original deadline for Part D can join the program

·          Your medication needs may have changed in the last year – a different plan may provide better coverage

·          Many plans change their coverage and cost from one year to another

How do I get help evaluating my options?

·          Did you know…  Your local Walgreens pharmacist can provide No Cost face to face consultation to evaluate all your plan options.  Families can call to set up an appointment or just stop in to request help anytime.  Walgreens creates a personalized report showing the cost and coverage of each plan

·         Families can also call Medicare:  (800) 633-4227

State of Kansas and Missouri Board on Aging and Long Term Care Ombudsman Program

Did you know the word Ombudsman is Scandinavian?  In the US, the word has come to mean an advocate or helper.  An Ombudsman protects and promotes the rights of long-term care consumers, working with residents and families to achieve quality care and quality of life.  The program is required by both federal and state law. 

If families have questions or concerns about resident rights, they can call 

(877) 662-8362 Kansas

(800) 309-3282 Missouri

State of Kansas and Missouri Board on Aging and Long Term Care Ombudsman Program

Your Digital Legacy as Part of Estate Planning

Reports that Hollywood star Bruce Willis is considering legal action against Apple so that he can leave his vast iTunes music library to his children when he dies show that more and more people need to think about their digital assets as they plan for the future.

The actor, best known for action roles in films including the Die Hard series, is said to be thinking about launching a challenge over iTunes rules which technically mean that he does not own the songs that he has downloaded from the service.

Apple’s terms and conditions for the music service state that users are borrowing tracks under licence and do not have the right to pass on the music they have purchased to others, which means Willis is unable to leave his collection to daughters Rumer, Scout and Tallaluh.

It is reported that Willis is considering whether he can create family trusts which will allow his daughters to gain legal access to the collection, while he could also choose to support legal action in five US states aimed at improving the rights that people who download music have.

The story is one of the latest in recent months to shine a light on the issue of digital legacies and how people are slowing realising that they need to consider their online assets when writing a Will or putting plans in place for the future.

Chris Walton, a specialist solicitor in Irwin Mitchell’s Will, Trust and Estate Disputes team, said: “In terms of this issue, lots of people will be surprised to learn that all of those tracks from iTunes – as well as eBooks bought from Amazon for use on Kindles  - do not actually belong to them. It is only natural that you would want to pass them on to a loved one.

“The law will catch up, but ideally Apple and the like will update their policies and work out the best solution for their customers.”

“However, this story also points to a wider issue. People are increasing living their lives online, yet many still fail to recognise the need for them to consider how they would like their various internet accounts and interests to be looked after following their death.

“The grand majority of people have social media accounts on sites like Twitter and Facebook, while others may also have accounts with gambling and gaming sites which could in fact have significant monetary value.

“These assets should not be forgotten about and we would urge anyone preparing for the future to ensure that they consider leaving log-in details and clear instructions on how they would like such accounts to be handled upon their death in their Will or a Letter of Wishes.”

Chris added that it is very likely that online assets will become a bigger part of estate disputes between friends and loved ones in the future if such steps are not taken.

He outlined: “We see a number of cases arise as a result of a person failing to leave clear and comprehensive instructions about a range of matters to their loved ones about their estate, which often means that families face long and emotionally draining legal battles as a result.

“It is vital that people do not allow online accounts to become a new battleground for friends and families.

“By taking simple steps to address the issue of digital legacy in a valid Will created with the help of expert solicitors, people could save those who mean the most to them a lot of heartache in the future.”

Source: www.irwinmitchell.com

Write Your Way to Wellness: The Best (free!) Website & Blog Creators for Caregivers

Article of interest - Click on this link to learn how caregivers can benefit from blogging.

Write Your Way to Wellness: The Best (free!) Website & Blog Creators for Caregivers

Medicare CLAIM Training in Kansas City

Do you want to better serve Medicare beneficiaries and their families?

Have you ever needed help with Medicare or would you be willing to help someone that needs help with their Medicare?  

If so, CLAIM training is available here in the Northland to become a certified CLAIM Volunteer Counselor.

Volunteers are trained by the Missouri Department of Insurance to answer questions and to provide health insurance counseling and assistance to Medicare beneficiaries and their families.

Dates & Times:

Session 1:  September 10 & 11 from 9:00 am - 4:00 pm
Session 2:  September 17 & 18 from 9:00 am - 4:00 pm 

Location:

Clay County Public Health Center
800 Haines Drive
Liberty, MO  64068

If you are interested, please contact:

Christine (at Shepherd Center Northland)
816.452.4536

August 7, 2012

FOR IMMEDIATE RELEASE
For more information, contact:
Angela de Rocha
Director of Communications
Kansas Department for Aging and Disability Services 785-250-8113

Phone: (785) 296-4986 Fax: (785) 296-0256 wwwmail@kdads.ks.gov www.kdads.ks.gov

TOPEKA -- The Kansas Department for Aging and Disability Services’ Senior Medicare Patrol would like to alert Medicare beneficiaries of a potentially harmful phone call.
Right now, scam artists in Kansas and Missouri are trying to trick seniors into giving them information that can be used to raid their bank accounts.

Callers are being told that Medicare will be issuing them a new Medicare card, and that in order to complete the process and get their new card, they need to provide the caller with their confidential banking information. This is not a Medicare call; this is attempted fraud and theft. If you are a Medicare member, do not fall for it.

According to the federal Centers for Medicare and Medicaid Services (CMS), Medicare does not make cold calls and would never solicit confidential banking information.

To find out more, please contact the Kansas Department for Aging and Disability Services, Senior Medicare Patrol to learn more. 785-296-0377. 

In Preventing Alzheimer’s, Mutation May Aid Drug Quest

By GINA KOLATA

Published: July 11, 2012

A study of a rare gene mutation that protects people against Alzheimer’s disease provides the strongest evidence yet that excessive levels of a normal brain substance, beta amyloid, are a driving force in the disease — bolstering hopes that anti-amyloid drugs already under development might alter the disease’s course or even prevent it.

DeCode Genetics stored blood samples from its research on genomes and Alzheimer’s disease.

So far, the drugs have not succeeded. But scientists not connected with the new study said it suggested that the drug companies’ big bets on anti-amyloid treatments could yet pay off.

The implication for drug development “is hugely important,” said Dr. David Altshuler, a genomics expert at Harvard Medical School and the Broad Institute of Harvard and M.I.T. 

And Dr. Samuel Gandy, an Alzheimer’s researcher who directs the Mount Sinai Center for Cognitive Health, called the finding the most significant in the field in two decades, since researchers first reported a mutation that leads to the disease. 

The protective mutation, whose discovery was reported online Wednesday in the journal Nature, is highly uncommon — it is not the reason most people do not develop Alzheimer’s. But what intrigues researchers is how it protects the brain. 

Mutations that cause Alzheimer’s lead to excessive amounts of beta amyloid in the brain; by contrast, the protective mutation slows beta amyloid production, so people make much less.

“This paper provides strong evidence that it would work in the general population if you did it right,” Dr. Altshuler said. 

Scientists at the drug companies agreed. “We are thrilled,” said Ryan Watts, one of the authors of the new paper and head of the neurodegeneration labs at Genentech, which is developing two drugs to reduce brain amyloid levels. 

Dr. Richard Mohs, leader of neuroscience early clinical development at Eli Lilly, said the company was “very encouraged by these study results.” They show, he said, that despite an initial failure, the strategy of focusing on drugs to reduce beta amyloid levels is “a logical path for the development of effective therapies that may slow disease progression.” 

Many questions remain, of course. Most people do not have the protective gene mutation, but as common as Alzheimer’s is, most people do not get it. It is not clear why. And most who develop Alzheimer’s do not have one of the rare gene mutations that cause it. The reasons for their disease are unclear. 

The discovery of the protective gene mutation, a product of the revolution that has taken place in genetics, arose when researchers scanned the entire DNA of 1,795 Icelanders. 

About 1 in 100 had a mutation in the gene for a large protein that is sliced to form beta amyloid. Then the investigators studied people who had been given an Alzheimer’s diagnosis, and a group of people 85 and older. Those with the mutation appeared to be protected from Alzheimer’s disease.

The investigators, led by Dr. Kari Stefansson, chief executive at DeCode Genetics, an Icelandic company, looked at genomes of North Americans and found the gene mutation in only about 1 in 10,000 people. That indicates, Dr. Stefansson said, that the mutation arose relatively recently in Scandinavia. 

The protective gene even appears to override a very strong risk factor for Alzheimer’s disease in old age — two copies of a gene known as ApoE4. Ninety percent of people with two ApoE4 genes get Alzheimer’s by age 80. But Dr. Stefansson says there are 25 people in his study with two copies of ApoE4. None have Alzheimer’s disease. 

The research “is obviously right,” said John Hardy, an Alzheimer’s researcher at University College London and a discoverer of the first gene mutation found to cause the disease. “The statistics and the finding are pretty secure.” 

The discovery is part of a continuing story that implicates beta amyloid as a central and crucial player in this destructive brain disease. The idea began two decades ago with the discovery of very rare gene mutations that always cause Alzheimer’s in those who inherit them, usually by middle age. The mutations were different in different families, but all had the same effect: They increased the amount of beta amyloid in the brain. That meant that a buildup of amyloid was sufficient to cause the disease.

Elderly people with Alzheimer’s — who typically do not have these gene mutations — also had excess amyloid in the brain. So researchers reasoned that might mean that excess amyloid was causing the disease in them, too. 

Additional evidence of the role of beta amyloid was reported on Wednesday in The New England Journal of Medicine. Using spinal taps and brain scans to track the protein, investigators found that people with one of the Alzheimer’s-causing mutations start making too much beta amyloid as long as 20 years before they have symptoms of the disease. 

Researchers and drug companies focused on the amyloid hypothesis to the extent that almost every experimental drug being tested to slow or halt Alzheimer’s disease is designed to reduce the amount of amyloid in the brain. Most of those drugs are still being tested in clinical trials, but a Lilly drug that failed spectacularly in 2010, semagacestat, actually made people with Alzheimer’s worse and gave rise to soul-searching in the field. 

It emphasized a crucial question that hung over the endeavor. Was amyloid really causing Alzheimer’s in elderly people? Might the protein instead be a bystander, accumulating, for example, as part of the brain’s response to damage? 

The discovery of the protective gene mutation provides strong clues. People with the mutation make substantially less beta amyloid, but other than that they are no different from anyone else. And they do not get Alzheimer’s. 

People could be tested to see if they have the protective mutation, Dr. Stefansson said, but he added, “The benefits of doing so are not obvious to me.” He explained that since the gene is so rare, chances that a person being tested would have it — especially if that person is not Scandinavian — are extremely low. Almost everyone would end up with the same uncertainty they have now. There is as yet no way to prevent Alzheimer’s and, outside of families with one of the rare disease-causing gene mutations, no way to know who is going to get it. 

Still, Dr. Hardy noted, as provocative as the discovery of the protective gene mutation is, the strategy of reducing amyloid levels — the ultimate test of the amyloid hypothesis — still must be evaluated in typical Alzheimer’s disease. For example, perhaps people need to have lower levels of beta amyloid from birth to really be protected. 

Researchers and companies explain away the failure of the first few experimental drugs to reduce beta amyloid levels or to block the protein by saying they were not powerful enough and were studied in people who already had the disease and clear symptoms of mental decline. By then it might be too late to make any difference. When brain cells have died, nothing can bring them back.

The strategy now is to use new brain scans and other methods to find and treat people before they have symptoms of mental decline. 

“The idea is that treatment has to start early to make a difference,” Dr. Watts said.

Of course, people with the newly discovered mutation have lower levels of beta amyloid for their entire lives. 

“You couldn’t start earlier than that,” Dr. Watts said.

Women and Finance

Money Matters | Women just don’t get it

By SANDI WEAVER

The topic assigned for today was women’s issues. Since I’ve intensely enjoyed financial planning for 30 years, I felt my perspective may be skewed even though I’m female. So I sent a survey. Twenty women revealed a stunning (to me) “state of the sexes”. When asked what women should do better in planning their finances, the overwhelming response was to quit ducking it and be an active participant.

One woman lost her husband at age 49, and emailed a heartfelt message to “learn now while your partner is here and … wants to help you.” She felt that handling finances side-by-side with her husband would have helped her understand why budgeting was important, to “own some of the worry” when times were tight, how to teach their two college boys to handle money better during school, and to avoid the massive anxiety she has faced when dealing with finances since his death.

How do women get in this spot? It’s easy. For couples, a division of labor makes life easier. I’ll do the wash if you’ll do the lawn. I’ll cook, if you’ll handle the money. Both sides become comfortable in the roles.

Do you see yourself in these other comments?

Some don’t get involved because “they perceive themselves to be too stupid – a mistake.”

Some women in their 60’s “don’t know even how to pay the bills. They should start small … and learn the process.”

“Women need to know where all their assets are, and make sure they’re jointly titled or not, depending on circumstances. Are they in a second marriage?”

Even “professional women cannot turn finances over to their husbands without keeping close tabs. We think we’re too busy with work to pay attention to it.”

That’s the No. 1 tip for women and money. Based on my 30 years in this field, here’s my list along with the survey’s other comments, to round out the top 10.

Increase your earning capacity with education and savvy career transitions. Women typically have lower income due to less education, plus they earn less than men for the same positions.

Many women don’t like numbers, or are big spenders. Don’t manage your cashflow blindly. Use software such as Quicken, or online services like Mint. One woman who wanted to curb spending recently made a deal with herself that she could not get her hair cut until she paid off her credit card. That worked!

Don’t give money you need to your adult children unless they’ve promised to house you in your retirement years. You’re responsible for your financial needs. Help by teaching them to be responsible for theirs. One woman said friends agonized over decisions on whether to help a child.

You make 77% of what a man does, so start saving early. Women generally are more concerned about the present: money issues surrounding their children, home, and parents, but fail to be concerned about their retirement.

Save smart. To get the biggest bang for your buck, first save that 3% or 6% of salary to snare your employer’s company match in the pension, then contribute to a Roth, then go back and maximize savings into your pension. If you can’t qualify to use a Roth, then use a deductible IRA if possible, otherwise save in a non-deductible IRA. If you need to save more, next consider a low-cost annuity if your marginal tax rate is high, or save in a plain vanilla taxable brokerage account.

When investing, don’t be too conservative. Two women wrote “I feel that women, through years of practice, are already good at finding bargains and savings on household expenditures. We need more practice on investing and "growing the money.” “….women could do a better job of taking calculated risks so that their money could grow sufficiently to provide for their future needs.”

Get powers of attorney for financial decisions and for healthcare decisions in case you’re incapacitated. Women live long, but those years may be fraught with difficulties.

Long-term care insurance is a needed safety net for most women, unless you’re in the low income or upper income strata.

When age 62, research if you can use your work record to start social security and later switch to 50% of your husband’s, or a divorced spouse’s, work record if it yields a higher benefit. Otherwise, it’s usually more beneficial to wait until full retirement age or later, if you expect a normal life span.

I’ve paraphrased another woman’s conclusion. Women often taken time off to care take - whether it's children or parents, to be underemployed, to work part time, to be underpaid compared to males counterparts. All of those decisions we make, which we usually don't regret, can have a huge impact on what's available for retirement whether it's a 401k or social security income.

Life is such a balancing act for women, but if we use a smart approach, we can have it all.

Senate Legislation Introduced to Impose a 36-Month VA Look-Back

Senate Legislation Introduced to Impose a 36-Month VA Look-Back:

NAELA’s Public Policy Committee has taken the lead in communicating NAELA’s response to Senate legislation that addresses some of the concerns identified in the Government Accountability Office (GAO) report on veteran pension benefits. NAELA supports steps to protect veterans from being taken advantage of by representatives from organizations who persuade veterans to purchase unsuitable financial products to qualify for VA Pensions. NAELA also supports steps to protect veterans from being given inappropriate advice on long-term care planning and asset transfers that may preclude or delay both VA and Medicaid eligibility.

NAELA supports steps to resolve these concerns in a way that expedites the VA catching up with its large backlog of unprocessed claims, and that does not burden veterans seeking to receive the benefits they have been promised by law. See NAELA's press release. Among the matters that could be cleared up by legislation or rule-making is a more precise definition of exempt versus countable assets for VA purposes and a clear asset standard. It also would be helpful to consider the extent to which any VA transfer-of-asset provisions should model themselves on the transfer-of-asset, spousal impoverishment, and special needs trust provisions of Medicaid.

In addition to contacting me, you may obtain current information by contacting NAELA’s Public Policy Consultant, Brian Lindberg, or NAELA’s Public Policy Chair, H. Amos Goodall. You can also visit the NAELA website for information.

Missouri Medicaid Allowances Increase Effective July 1st, 2012

Missouri Medicaid has announces that it will be increasing allowances starting on July 1st of this year. The monthly minimum maintenance allowance (MMNA), which is the amount of money allocated to the community spouse, has increased from $1,839 to $1,892. The shelter allowance, the money allocated for rent, and utilities will also increase from $552 too $568. These increases are low but much welcomed.

Cohousing - What is it? Where is it?

Boredom and isolation are hardships for seniors who want to age at home. Especially for those living in rural and remote areas, staying at home can mean going days without interacting with another person. Fortunately, there is a growing movement known as cohousing that offers seniors the opportunity to age in a tight-knit community of individuals who all contribute to the greater good of the neighborhood.

Cohousing is a community that is designed and organized by its residents. Residents get to decide what they want the community to be and then manage it themselves. Each member has a role within the community and feels a sense of accomplishment. Residents are required to participate in meetings to reach community-wide agreements, make plans and listen to each other. When new residents join the community, they receive training about what it takes to be a part of a cohousing community.

Cohousing communities are not designed to replace assisted living or nursing homes. Generally, people move into these communities in their 50s and 60s, planning for the future, rather than when living at home is no longer a viable option. In fact, cohousing as a concept was not created specifically with seniors in mind and most of these communities are multigenerational. However, Silver Sage in Boulder, Colo.; Glacier Circle in Davis, Calif.; ElderSpirit in Abingdon, Va. and Wolf Creek Lodge in Grass Valley, Calif. are some of the cohousing communities now prospering which were specifically designed for senior residents. These living arrangements allow seniors to maintain their independence by living in a house, condominium or apartment of their own while also remaining social and connected through planned social activities and communal areas. In addition, the residents make decisions about community policies, building projects and community organization.

Cohousing communities include libraries, guest rooms, community gardens, laundry faculties, dining rooms where the entire community gathers for a potluck dinner twice a week and community kitchens. They also include a variety of housing options for a diverse population. In fact, ElderSpirit has 42 residents, all aged between 60 and 86 years. Some of these residents own a two-bedroom house for which they paid roughly $165,000 while others rent and pay anywhere between $315 and $500 a month. Not only does cohousing provide these tangible benefits, but it also offers friendship, community and support. Many members of a cohousing community opt to return to their homes after a hospital visit rather than going to rehab facilities. They are able to do this because their community members help them to complete household tasks while they are physically unable.

This movement began in Denmark in 1985 and that country now has 250 of these innovative housing communities. The architect Charles Durrett introduced this concept to the American market with his book The Senior Cohousing Handbook. Durrett maintains that helping seniors live independently lessens the wear on social services and that by living together, they can not only live longer, but also happier and healthier lives.

These communities offer seniors security and fulfill their social needs. They also allow seniors to feel empowered and provide a sense of accomplishment for what they each bring to the community as a whole. In addition, many communities focus on sustainability and economic diversity. Seniors from all walks of life are provided various housing options to meet their needs, all of which are designed to be as green as possible. Many communities also grow their own food, which helps to make the community more environmentally sustainable while also providing a social activity to perform together.

To read more about cohousing and to find cohousing communities in your area, please visit:

http://www.midatlanticcohousing.org/?p=841

file:///Users/acarrubba/Desktop/Shepherd%20Elder%20Law/Cohousing%20Directory%20%7C%20The%20Cohousing%20Association%20of%20the%20United%20States.webarchive

Source: Taken from an article from Kevin Knapp

MO Seniors' Legal Helpline

The Missouri Seniors’ Legal HelpLine was developed with a grant from the U.S. Administration on Aging. The goals of the HelpLine project are to coordinate access and enhance existing legal services for Missourians 60 and over.  The Area Agency on Aging’s Information and Assistance network responds to phone and email contacts to provide legal information and screen referrals for legal advice.  The website has Missouri-specific information on senior legal issues such as benefits, financial and estate planning, consumer protection, guardianship and a glossary of common legal terms. The HelpLine can be contacted at 800-235-5503 (toll-free) and at www.moaging.com/legalhelp. 

Attorneys can register on the HelpLine site to provide pro bono and reduced fee services to seniors needing brief legal advice or assistance. Attorneys may also register by selecting the HelpLine on The Missouri Bar website pro bono affiliate “volunteer opportunity” list.  Referred seniors are screened for economic or social need. Legal issues are limited to civil matters (no criminal or traffic violations). Referrals are made to volunteer attorneys via fax. The attorney’s name is not given to the senior until the attorney accepts the referral. The site also allows sign up to offer (and to access) mediation, mentoring and community education. A volunteer attorney has the option to take a temporary leave, choosing the dates and length of time to be removed from the list.

HelpLine stakeholders are planning professional training (CLE courses) to reward current volunteers and recruit other attorneys. Proposed topics are assessing mental capacity of your elderly client and identifying undue influence or financial exploitation; civil remedies for financial exploitation; and when seniors divorce – the effects on estate planning and benefits and on dependents with disabilities.

Project staff applied for grants to underwrite the costs of CLE courses on collaboration of legal services and aging network professionals on elder abuse at the Aging Summit pre-conference on August 22, 2012 at Capital Plaza, Jefferson City.

For more information contact Marta Fontaine at 573.526.3246 or marta.fontaine@health.mo.gov or Cindy Deegan at 573.356.6496 or cindy.deegan@health.mo.gov

MONAELA OUTSTANDING MEMBER OF THE YEAR: SAMANTHA SHEPHERD OF KANSAS CITY!

From the Missouri chapter of NAELA, kudos go to Samantha Shepherd, current MoNAELA Chapter Treasurer, for being elected MoNAELA Outstanding Member of the Year! Samantha will receive her award at the Seattle NAELA Annual Conference in April.

Among her many contributions to the Chapter:
Successful establishment of our websites, http://www.monaela.com and its identical twin,
http://www.monaela.org. For several years the Board discussed and brain-stormed about creating and maintaining a MoNAELA Chapter website. But the person who actually got it done (at significantly less cost than “market rates”) was Samantha. The site is maintained, updated and monitored by our staff assistant Diane Carey (who replaced retiring Ann Bickel). If you have suggestions for adding to the website, feel free to contact the Chair of the Publications Committee (currently Christine Gilsinan, cag@solaw.com)Samantha and Mike Weeks (a former recipient of the MoNAELA Member of the Year) are co-chairs of the annual NAELA Conference which will take place in Seattle April 25 -28, 2012. This is a HUGE undertaking which anyone who has attended a national NAELA event can attest to.

Working to promote this year’s National Health Care Decision Day, Samantha has organized attorney volunteers, staffed senior centers, independent and assisted living facilities in the Kansas City, Missouri area, spoken on a radio show, blogged and sent out a newsletter highlighting the importance of completing your health care directives.

Congratulations (and thank you) Samantha!

5th Annual National Healthcare Decisions Day - April 16, 2012

Federal Patient Self-Determination Act

The Federal Patient Self-Determination Act requires that all Medicare-participating healthcare facilities inquire about and provide information to patients on Advance Directives; it also requires these facilities to provide community education on Advance Directives. See 42 C.F.R. § 489.102. All healthcare facilities are required to: 

• Provide information about health care decision-making rights.
• Ask all patients if they have an advance directive.
• Educate their staff and community about advance directives.
• Not discriminate against patients based on an advance directive status.

AHRQ

The U.S. Agency for Healthcare Research and Quality, in a 2003 article, “Advance Care Planning: Preferences for Care at the End of Life,” found the following:

• Less than 50 percent of the severely or terminally ill patients studied had an advance directive in their medical record.
• Only 12 percent of patients with an advance directive had received input from their physician in its development.
• Between 65 and 76 percent of physicians whose patients had an advance directive were not aware that it existed.

Pew Research

"More Americans Discussing – and Planning – End-of-Life Treatment. The Pew Research Center, January 2006.

• 42% of Americans have had a friend or relative suffer from a terminal illness or coma in the last five years and for a majority of these people and 23% of the general public, the issue of withholding life sustaining treatment came up.
• An overwhelming majority of the public supports laws that give patients the right to decide whether they want to be kept alive through medical treatment.
• By more than eight-to-one (84%-10%), the public approves of laws that let terminally ill patients make decisions about whether to be kept alive through medical treatment.
• One of the most striking changes between 1990 and 2005 is the growth in the number of people who say they have a living will – up 17 points, from 12% in 1990 to 29% now.

Annals of Internal Medicine

Brief Communication: The Relationship between Having a Living Will and Dying in Place. Howard B Degenholtz, PhD, YonJoo Rhee, MPH, PhD; and Robert Arnold, MD. Annals of Internal Medicine. 2004; 141:113-117.

• Having a living will was associated with lower probability of dying in a hospital for nursing home residents and people living in the community.
• During advance care planning, physicians should discuss patients’ preferences for locations of death.

Appropriate Use of Artificial Nutrition and Hydration – Fundamental Principles and Recommendations. David Casarett, MD, Jennifer Kapo, MD and Arthur Caplan, PhD. New England Journal of Medicine. 353; 24.

• Patients and families are often not fully informed of the relevant risks and potential benefits of artificial nutrition and hydration (ANH). In addition, financial incentives and regulatory concerns promote the use of ANH in a manner that may be inconsistent with medical evidence and with the preferences of patients and their families.
• Because ANH is associated with uncertain benefits and substantial risks, it is essential to ensure that decisions about its use are consistent with the patient’s medical condition, prognosis, and goals for care. Therefore, decisions about ANH require careful consideration of its risks and potential benefits.

The Older Americans Act Should Be Reauthorized by Congress This Year

Pass This Mom, Grandmom, and Apple Pie Bill
By Craig Reaves, CELA, CAP

Halfway through the 112th Congress, it appears unlikely that it will be remembered as the “MVP” of legislative sessions. With Americans frustrated with Congress’ inability to coalesce around almost anything, why not spend a little time on reauthorizing one of the most successful community-based service programs in our nation's history? The Older American Act (OAA) authorizations expired in September 2011. The services and programs funded by the OAA keep older adults in their homes and communities by providing home-delivered and congregate meals, home care, transportation, information and referral/assistance, case management, adult day care, legal services, senior centers, senior employment, caregiver support, elder abuse prevention, and many other services. For those who live in nursing homes or assisted living facilities, the OAA provides help to ensure their quality of care by investigating and resolving resident complaints. The OAA programs protect and improve the health and security of older adults, while reducing the strain on Medicare and Medicaid resources.

These programs require a relatively modest level of assistance (about .02 percent of federal discretionary spending), but often make the difference between living with dignity in the comfort of one’s home and community, and needing costly assisted living, nursing home placements, or expensive hospital stays.

Here are some quick facts about a few of the programs based on data from the Congressional Research Service and the Department of Health and Human Services.

Bipartisan Support

The OAA has always enjoyed bipartisan support because of its overarching goals and success at the local level. Rep. Fred Upton (R-MI), Chair of the House Energy and Commerce Committee, said in August 2011, "I know the importance and value of folks staying at home with quality care. I believe we can save taxpayers' money and give them a better quality of life. I look forward to supporting it again."

The OAA has intergenerational support because it helps families take care of aging parents without having to quit their jobs. It makes political sense too. In January, public approval for Congress was at 13 percent, up from 11 percent in December – record lows. One would think that showing support for the OAA might win over some voters who consider this a “do-nothing Congress.”

Congress Should Make the OAA and Its Critical Services a Priority

So one might ask: Why can't this Congress do what others have and reauthorize this successful program and use this opportunity to make the improvements that aging experts have recommended? The National Academy of Elder Law Attorneys and other Leadership Council of Aging Organizations (LCAO) developed a consensus document to help Congress and the Obama Administration reauthorize the OAA. The Assistant Secretary for Aging, Kathy Greenlee, who runs the Administration on Aging and disburses the funds to the aging network, traveled across the country conducting listening sessions on how to improve the OAA…that was in the summer of 2010.

Unlike previous bipartisan reauthorizations, the House of Representatives has not held any committee hearings concerning the OAA. The Senate is moving forward with reauthorization, under the leadership of Sen. Bernie Sanders (I-VT), Chairman of the Subcommittee on Primary Health and Aging in the Senate Health, Education, Labor and Pensions (HELP) Committee. The HELP committee began the reauthorization dialogue by inviting stakeholders to share reauthorization priorities with both Democratic and Republican congressional staff members during listening sessions this past summer. This work led to the January 26, 2012, introduction of Sen. Sanders’ bill, S. 2037, to reauthorize the Older Americans Act.

In his bill, Sen. Sanders identifies his priorities and calls for a 50 percent increase in funding for the four core programs:

• Meals;
• Supportive services;
• Jobs; and
• Health promotion.

The bill also:

• Strengthens the long-term care ombudsman program;
• Strengthens legal services and resources centers;
• Modernizes senior centers; and

·         Requires better data collection and program evaluation.

Others who have stepped up with OAA ideas:

• Sen. Robert Casey (D-PA) S.1982
• Sen. Al Franken (D-MN) S.1750
• Sen. Amy Klobuchar (D-MN) S.1744
• Sen. Herb Kohl (D-WI) S.1819
• Rep. Laura Richardson (D-CA) H.R. 3749

·         Rep. Debbie Wasserman Schultz (D-FL) H.R. 2786

Get the OAA Back Into Law

Now that Sen. Sander’s bill has been introduced, it’s time to get the process moving forward with input from both sides of the aisle, negotiations on the final bill’s content, and passage by the HELP Committee and the full Senate. The Senate certainly has a good chance to complete its work on the reauthorization this spring. The House needs to start its work in earnest, or the two bodies will never have a chance to come together in a conference committee.

Elder Law attorneys often connect their clients with the "aging network" for services. Some serve on Area Agency on Aging boards (these are the agencies funded by the OAA and states to be the focal point for aging services in each area), work as volunteer ombudsmen, handle referrals from the local service providers to provide help with advance directives, living wills, Medicaid and Medicare eligibility questions or cases, and some are legal services providers funded by the OAA. Elder Law attorneys know the value of these programs and urge Congress to act now to reauthorize the Older Americans Act. If you agree, tell Congress to pass the OAA this year.

Contact the House and Senate. 

Craig Reaves, CELA, CAP, is an Elder Law attorney practicing in Kansas City, Mo. He is a Certified Elder Law Attorney (CELA) and former president of NAELA.

Read the OAA Reauthorization Bill.

See a video of Sen. Sanders’ introductory remarks.

This publication is written for policy makers, consumers, aging and special needs network professionals, lawmakers, and members of the media. We welcome your comments.

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New Poverty Guidelines Announced

2012 Poverty Guidelines: How Poverty Levels Affect Eligibility for Many Federal Public Benefit Programs

Federal poverty level (FPL) guidelines for 2012 were published in the Federal Register on January 26, 2012.[1]  The guidelines provide the baseline for eligibility levels for many public benefits, including health benefits for older people and people with disabilities.

The published poverty levels merely state a dollar figure for different-sized family units.  They do not address issues of what income is included, what deductions from income are allowed, who is included in a family unit or other use issues.  These questions are addressed by the individual programs relying on the poverty guidelines.  The amounts given below apply to the 48 contiguous states and Washington, DC.  Rates for Alaska and Hawaii are slightly higher.  A complete list of FPLs is available at http://aspe.hhs.gov/poverty/12poverty.shtml

Federal Health Programs Affecting Older People and People with Disabilities that Rely on Federal Poverty Guidelines:

1. People with Full Medicaid:

Poverty Level Aged and Disabled (PLAD):  States can choose to provide full Medicaid benefits to aged and disabled individuals with incomes up to 100% of the federal poverty level (FPL).  For states choosing 100% FPL as their ceiling, eligibility levels for 2012 will be $930.83/month ($11,170/year) for an individual; to $1260.83/month ($15,130/year) for a couple.

Amounts protected for the at-home spouse of a Medicaid nursing facility resident:  Medicaid law allows for certain levels of income and resources to be protected for the community spouse of a nursing facility resident whose care is paid for by Medicaid and who otherwise would have to pay most of her/his income to the facility.  The minimum amount of income protected is 150% FPL for two people ($1,891.25/month), effective July 1.  Until that time, the amount is $1,838.75. Other protected amounts for 2012, not linked to FPL, are maximum monthly protected income,$2,841; minimum resource allowance, $22,728; and maximum resource allowance, $113,640.

2. People in Medicare Savings Programs:

Qualified Medicare Beneficiaries (QMBs):  States must pay all Medicare cost-sharing for Medicare beneficiaries with incomes up to 100% FPL and limited resources.  For this group, the 2012 level is $930.83/month ($11,170/year) for an individual; $1,260.83/month ($15,130/year) for a couple.

Specified Low-Income Medicare Beneficiaries (SLMBs):  States must pay the Medicare Part B premium for Medicare beneficiaries with incomes between 100% FPL and 120% FPL and limited resources. The limit for this group is $1,117 /month ($13,404/year) for an individual; $1,513/month ($18,156/year) for a couple.

Qualified Individual (QI): States have a limited amount of money from which they must pay, on a first come, first served basis, the Medicare Part B premium for Medicare beneficiaries with incomes between 120% FPL and 135% FPL and limited resources.  The limit for this group is $1,256.63/month ($15,079.50/year) for an individual; $1,702.13/month ($20,425.50/year) for a couple.

3. Qualified Disabled and Working Individual (QDWI)

States must pay the Medicare Part A premium for certain working disabled Medicare beneficiaries who have exhausted their entitlement to premium-free Part A benefits and whose incomes do not exceed 200% FPL.  The limit for this group is $1,861.67/month ($22,340/year) for an individual; $2,521.67/month ($30.260/year) for a couple.

Add $20 to each of the monthly amounts listed above to determine the actual eligibility limit, since applicants are allowed a $20 disregard from any income before their income is measured against the poverty levels.  Couples only get one $20 disregard.  The $20 disregard applies nationally, but states also have the option of increasing the disregard, which has the effect of increasing the eligibility ceiling and, thus, making more people eligible for benefits.  Check with your State Medicaid Agency for details on your state's specific policy.

4. Part D Low-Income Subsidies:

Full Subsidy:  Medicare Part D provides a full drug subsidy with low co-payments to Medicare beneficiaries with incomes up to 135% FPL and limited resources.  For those individuals, the 2012 eligibility limit is $1,256.63/month ($15,079.50/year) for an individual; $1,702.13/month ($20,425.50/year) for a couple.

Partial Subsidy: Medicare Part D provides a partial subsidy of premium, deductible and co-insurance to Medicare beneficiaries with incomes up to 150% FPL and limited (but higher than allowed for full subsidy) resources.  The income limit for this group is $1,396.25/month ($16,755/year) for an individual; $1,891.25/month ($22,695/year) for a couple.

As with the Medicaid and MSP monthly amounts, add $20 to account for the disregard.

Unlike rules for Medicare Savings Programs, which allow (but do not require) states to measure income against the amount for a family unit of only one or two, eligibility rules for  Part D subsidies recognize larger family units, to the extent that those family members rely on the applicant or her spouse for one half of their financial support.  To calculate the levels for larger family units, start with the yearly amount for one ($11,170), add $3,960 for each additional family member, multiply by the applicable percentage of poverty (135% or 150%) and divide the result by 12 for a monthly amount.

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http://www.medicareadvocacy.org/2012/02/02/2011-poverty-guidelines-issued-poverty-levels-affect-eligibility-for-many-federal-public-benefit-programs/