Shepherd Elder Law Group, LLC

New Poverty Guidelines Announced

2012-02-12T13:19:00.000-08:00

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.

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

Missouri Medicaid Allowance has been Raised

2012-01-06T07:14:00.001-08:00

Missouri’s Medicaid personal needs allowance has finally been raised. Though this change is much appreciated, the effects on Missouri seniors will be minimal. The personal needs allowance which was previously set at $30 a month, has been raised to a monthly allowance of $35.
    This Missouri allowance is one of the lowest in the country and is in stark contrast to that of the neighboring state, Kansas, which has a monthly allowance of over $60.
    This amount is meant to cover all of the personal needs when in a nursing home. This includes all toiletries and room supplies, all hair and nail appointments (and we all know mom and grandma need to get their hair done weekly), all meals out, bingo money and birthday cards. With Hallmark cards nearing $5 a pop, we better hope that there aren’t too many birthdays in one month.
    The point of realization that mom, or dad, or grandma needs to be in a nursing home is never easy, and not being able to afford it is another stressor. This hard transition should not be exasperated by forced destitution. When moved out of a lifelong home, it is the small comforts such as hair appointments or birthday cards to grandchildren that make all of the difference.     Though this increase will only make the difference of one extra toothbrush, Missouri finally seems to be moving along the right track to a more reasonable personal needs allowance.

A prison hospice program

2012-01-03T12:45:00.000-08:00

As some of you know, one of the boards of directors on which I serve is that of Kansas City Hospice & Palliative Care, a wonderful agency that is the non-profit gem of Kansas City's many hospices.

Through that work and other experiences I've learned a lot about death and dying and the comfort that quality hospice care can provide. But I'd never thought about the need for hospice care in prison.

Until, that is, a fellow KC Hospice board member, the Rev. Bob Hill of Community Christian Church, gave me a copy of Grace Before Dying, by Lori Waselchuk.

In a series of amazing photos and accompanying text, it tells the story of the prison hospice program in Louisiana's Angola State Prison.

Until Jan. 31, photos from the book and quilts connected to the hospice program in that prison are on display in the Steeple of Light Gallery at Community Christian, 4601 Main St., Kansas City. The gallery hours are 9 a.m. to 4 p.m. Monday through Friday and 8:30 a.m. to 1 p.m. on Sundays. There is no charge to see the display, called "And You Came to Me."

What comes through this photo work so powerfully is the humanity not just of those dying in prison but also of their fellow inmates who have become caregivers in the hospice program. The whole hospice ministry (for that's truly what it is) is transformative. It changes the one receiving care and the ones giving it in radically life-affirming ways.

As Waselchuk writes in the book's introduction, "This project is not about death. It is about life, its limits, and the choices made within those limits."

I encourage you to see the display at Community Christian and then learn about hospice care options here in Kansas City.

Source:http://billtammeus.typepad.com/my_weblog/2011/12/12-27-11.html

More Changes in Medicaid Allowances

2011-12-23T07:31:00.000-08:00

In Missouri the personal needs allowance has been increased from $30.00 a month to $35.00. Though only a slight increase, this change affects many seniors in our area.

New Bill to Grant Coma Rights in Missouri

2011-12-23T07:29:00.000-08:00

A new bill in the Missouri House of Representatives is set to finally allow family members to make decisions for relatives in a coma. Missouri is one of the few states without these laws in place. This could mean big changes for health care providers and personal health care directives. Below is a copy of the bill.

HOUSE BILL NO. 1087
93RD GENERAL ASSEMBLY
INTRODUCED BY REPRESENTATIVES SCHAAF (Sponsor), TILLEY, MOORE, SMITH (118),
WHORTON, FISHER, PAGE, THRELKELD AND COOPER (155) (Co-sponsors).
Pre-filed December 8, 2005 and copies ordered printed.
STEPHEN S. DAVIS, Chief Clerk
3749L.01I
AN ACT
To repeal sections 383.035, 383.079, 383.105, 383.160, and 383.165, RSMo, and to enact in lieu
thereof seventeen new sections relating to insurance for health care providers in
Missouri.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Sections 383.035, 383.079, 383.105, 383.160, and 383.165, RSMo, are
2 repealed and seventeen new sections enacted in lieu thereof, to be known as sections 383.035,
3 383.079, 383.105, 383.111, 383.160, 383.165, 383.300, 383.302, 383.304, 383.306, 383.308,
4 383.310, 383.312, 383.314, 383.316, 383.330, and 383.335, to read as follows:
383.035. 1. Any association licensed pursuant to the provisions of sections 383.010 to
2 383.040 shall be subject to the provisions of the following provisions of the revised statutes of
3 Missouri:
4 (1) Sections 374.010, 374.040, 374.046, 374.110, 374.115, 374.122, 374.170, 374.210,
5 374.215, 374.216, 374.230, 374.240, 374.250 and 374.280, RSMo, relating to the general
6 authority of the director of the department of insurance;
7 (2) Sections 375.022, 375.031, 375.033, 375.035, 375.037 and 375.039, RSMo, relating
8 to dealings with licensed agents and brokers;
9 (3) Sections 375.041 and 379.105, RSMo, relating to annual statements;
10 (4) Section 375.163, RSMo, relating to the competence of managing officers;
H.B. 1087 2
11 (5) Section 375.246, RSMo, relating to reinsurance requirements, except that no
12 association shall be required to maintain reinsurance, and for insurance issued to members who
13 joined the association on or before January 1, 1993, an association shall be allowed credit, as an
14 asset or as a deduction from liability, for reinsurance which is payable to the ceding association's
15 insured by the assuming insurer on the basis of the liability of the ceding association under
16 contracts reinsured without diminution because of the insolvency of the ceding association;
17 (6) Section 375.390, RSMo, relating to the use of funds by officers for private gain;
18 (7) Section 375.445, RSMo, relating to insurers operating fraudulently;
19 (8) Section 379.080, RSMo, relating to permissible investments, except that limitations
20 in such section shall apply only to assets equal to such positive surplus as is actually maintained
21 by the association;
22 (9) Section 379.102, RSMo, relating to the maintenance of unearned premium and loss
23 reserves as liabilities, except that any such loss reserves may be discounted in accordance with
24 reasonable actuarial assumptions;
25 (10) Sections 383.100 to 383.111 relating to reports from medical malpractice
26 insurers;
27 (11) Sections 383.300 to 383.316 relating to notification, data reporting, and rating
28 requirements.
29 2. [Any association which was licensed pursuant to the provisions of sections 383.010
30 to 383.040 on or before January 1, 1992, shall be allowed until December 31, 1995, to comply
31 with the provisions of this section as they relate to investments, reserves and reinsurance.
32 3.] Any association licensed pursuant to the provisions of sections 383.010 to 383.040
33 shall file with its annual statement a certification by a fellow or an associate of the Casualty
34 Actuarial Society. Such certification shall conform to the National Association of Insurance
35 Commissioners annual statement instructions unless otherwise provided by the director of the
36 department of insurance.
37 [4.] 3. The director of the department of insurance shall have authority in accordance
38 with section 374.045, RSMo, to make all reasonable rules and regulations to accomplish the
39 purpose of sections 383.010 to 383.040, including the extent to which insurance provided by an
40 association may be extended to provide payment to a covered person resulting from a specific
41 illness possessed by such covered person; except that no rule or regulation may place limitations
42 or restrictions on the amount of premium an association may write or on the amount of insurance
43 or limit of liability an association may provide.
44 [5.] 4. Other than as provided in this section, no other insurance law of the state of
45 Missouri shall apply to an association licensed pursuant to the provisions of this chapter, unless
46 such law shall expressly state it is applicable to such associations.
H.B. 1087 3
47 [6.] 5. If[, after August 28, 1992, and] after its second full calendar year of operation, any
48 association licensed under the provisions of sections 383.010 to 383.040 shall file an annual
49 statement which shows a surplus as regards policyholders of less than zero dollars, or if the
50 director of the department of insurance has other conclusive and credible evidence more recent
51 than the last annual statement indicating the surplus as regards policyholders of an association
52 is less than zero dollars, the director of the department of insurance may order such association
53 to submit, within ninety days following such order, a voluntary plan under which the association
54 will restore its surplus as regards policyholders to at least zero dollars. The director of the
55 department of insurance may monitor the performance of the association's plan and may order
56 modifications thereto, including assessments or rate or premium increases, if the association fails
57 to meet any targets proposed in such plan for three consecutive quarters.
58 [7.] 6. If the director of the department of insurance issues an order in accordance with
59 subsection [6] 5 of this section, the association may, in accordance with chapter 536, RSMo, file
60 a petition for review of such order. Any association subject to an order issued in accordance with
61 subsection [6] 5 of this section shall be allowed a period of three years, or such longer period as
62 the director may allow, to accomplish its plan to restore its surplus as regards policyholders to
63 at least zero dollars. If at the end of the authorized period of time the association has failed to
64 restore its surplus to at least zero dollars, or if the director of the department of insurance has
65 ordered modifications of the voluntary plan and the association's surplus has failed to increase
66 within three consecutive quarters after such modification, the director of the department of
67 insurance may allow an additional time for the implementation of the voluntary plan or may
68 exercise his powers to take charge of the association as he would a mutual casualty company
69 pursuant to sections 375.1150 to 375.1246, RSMo. Sections 375.1150 to 375.1246, RSMo, shall
70 apply to associations licensed pursuant to sections 383.010 to 383.040 only after the conditions
71 set forth in this section are met. When the surplus as regards policyholders of an association
72 subject to subsection [6] 5 of this section has been restored to at least zero dollars, the authority
73 and jurisdiction of the director of the department of insurance under subsections 5 and 6 [and
74 7]of this section shall terminate, but this subsection may again thereafter apply to such
75 association if the conditions set forth in subsection [6] 5 of this section for its application are
76 again satisfied.
77 [8.] 7. Any association licensed pursuant to the provisions of sections 383.010 to
78 383.040 shall place on file with the director of the department of insurance, except as to excess
79 liability risks which by general custom are not written according to manual rates or rating plans,
80 a copy of every manual of classifications, rules, underwriting rules and rates, every rating plan
81 and every modification of the foregoing which it uses. Filing with the director of the department
82 of insurance within ten days after such manuals, rating plans or modifications thereof are
H.B. 1087 4
83 effective shall be sufficient compliance with this subsection. [Any rates, rating plans, rules,
84 classifications or systems in effect or in use by an association on August 28, 1992, may continue
85 to be used by the association.] Upon written application of a member of an association, stating
86 his reasons therefor, filed with the association, a rate in excess of that provided by a filing
87 otherwise applicable may be used by the association for that member.
383.079. The director shall compile a statistical summary of all data submitted and shall
2 issue a public report to the Missouri Bar and the supreme court of the state of Missouri.
3 Beginning not later than December 31, 2006, and annually thereafter, the director shall
4 report to the general assembly an accurate report as to the actual rates charged for
5 malpractice insurance and any changes in those rates from the previous year.
383.105. 1. Every insurer providing medical malpractice insurance to a Missouri health
2 care provider and every health care provider who maintains professional liability coverage
3 through a plan of self-insurance shall submit to the director of the department of insurance a
4 report of all claims, both open claims filed during the reporting period and closed claims filed
5 during the reporting period, for medical malpractice made against any of its Missouri insureds
6 during the preceding three-month period.
7 2. The report shall be in writing and contain the following information:
8 (1) Name and address of the insured and the person working for the insured who
9 rendered the service which gave rise to the claim, if the two are different;
10 (2) Specialty coverage of the insured;
11 (3) Insured's policy number;
12 (4) Nature and substance of the claim;
13 (5) Date and place in which the claim arose;
14 (6) Name, address and age of the claimant or plaintiff;
15 (7) Within six months after final disposition of the claim, the amounts paid, if any, and
16 the date and manner of disposition (judgment, settlement or otherwise);
17 (8) Expenses incurred; and
18 (9) Such additional information as the director may require.
19 3. As used in this section, "insurer" includes every insurance company authorized to
20 transact insurance business in this state, every unauthorized insurance company transacting
21 business pursuant to chapter 384, RSMo, every risk retention group, every insurance company
22 issuing insurance to or through a purchasing group, every entity operating under this chapter,
23 and any other person providing insurance coverage in this state[. With respect to any insurer
24 transacting business pursuant to chapter 384, RSMo, filing the report required by this section
25 shall be the obligation of the surplus lines broker or licensee originating or accepting the
26 insurance], including self-insured health care providers.
H.B. 1087 5
383.111. 1. Any insurer, as defined in section 383.105, that fails to timely report
2 claims information as required by sections 383.100 to 383.125 shall be subject to the
3 penalties applicable to insurance companies under section 374.215, RSMo.
4 2. For purposes of sections 383.100 to 383.125, any guarantee association paying
5 claims on behalf of an insolvent insurer shall be subject to the same reporting requirements
6 as the insolvent insurer.
383.160. 1. All association policies of insurance shall be written so as to apply to injury
2 which results from acts or omissions occurring during the policy period. No policy form shall
3 be used by the association unless it has been filed with the director and approved [or thirty days
4 have elapsed and he has not delivered to the board written disapproval of it as misleading or not
5 in the public interest]. The director shall have the power to disapprove any policy form
6 previously approved if found by him after hearing to be misleading or not in the public interest.
7 2. Cancellation of the association's policies shall be governed by law.
8 3. The rates, rating plans, rating rules, rating classifications and territories applicable to
9 the insurance written by the association and statistics relating thereto shall be subject to the
10 casualty rate regulation law giving due consideration to the past and prospective loss and expense
11 experience in medical malpractice insurance of all of the insurers, trends in the frequency and
12 severity of losses, the investment income of the association, and such other information as the
13 director may require. All rates shall be actuarially sound and shall be calculated to be
14 self-supporting.
15 4. In the event sufficient funds are not available for the sound financial operation of the
16 association, additional funds shall be raised by making an assessment on all member companies.
17 Assessments shall be made against members in the proportion that the net direct premiums for
18 the preceding calendar year of each member for each line of insurance requiring it to participate
19 in said plan bear to the net direct premiums for the preceding calendar year of all members for
20 such line of insurance; provided that, assessments made pursuant to sections 383.150 to 383.195
21 shall not exceed in any calendar year one percent of each member's net direct premiums
22 attributable to the line or lines of insurance the writing of which requires it to be a member.
23 5. All members shall deduct the amount of any assessment from past or future premium
24 taxes due but not yet paid the state.
25 6. Any funds which result from policyholder premiums and other revenues received in
26 excess of those funds required for reserves, loss payments and expenses incurred and accrued
27 at the end of any calendar year shall be paid proportionately to the general fund to the extent that
28 credit against premium tax liability has been granted pursuant to subsection 5 of this section and
29 to members which have been assessed but have not received tax credits as provided in subsection
30 5 of this section.
H.B. 1087 6
383.165. Each policyholder shall pay to the association in the first policy year, in
2 addition to the premium payment due for insurance through the association, an amount equal to
3 said premium payment. Such charge shall be separately stated in the policy. Such charge shall
4 be paid in the form of cash or cash equivalent and not in the form of a promissory note.
383.300. 1. As used in sections 383.300 to 383.316, the term "insurer" or "insurers"
2 means any insurance company, mutual insurance company, medical malpractice
3 association, any entity created under this chapter, or other entity providing any insurance
4 to any health care provider, as defined in section 538.205, RSMo, practicing medicine in
5 the state of Missouri, against claims for malpractice or professional negligence; provided,
6 however, that the term "insurer" or "insurers" shall not mean any surplus lines insurer
7 operating under chapter 384, RSMo, or any entity to the extent it is self-insuring its
8 exposure to medical malpractice liability.
9 2. Notwithstanding any other provision of law, no insurer shall, with regards to
10 medical malpractice insurance, as defined in section 383.150:
11 (1) Charge an assessment or surcharge, or increase the premium charges, by more
12 than ten percent for such insurance without first providing written notice by United States
13 mail to the insured at least sixty days prior to the effective date of such actions; provided,
14 however, such notice is not required if the premium change is due to the request of the
15 insured;
16 (2) Fail or refuse to renew such insurance without first providing written notice by
17 United States mail to the insured at least sixty days prior to the effective date of such
18 actions, unless such failure or refusal to renew is based upon a failure to pay sums due or
19 a termination or suspension of the health care provider's license to practice medicine in the
20 state of Missouri, termination of the insurer's reinsurance program, or a material change
21 in the nature of the insured's health care practice; or
22 (3) Cease the issuance of such policies of insurance in the state of Missouri without
23 first providing written notice by United States mail to the insured and to the Missouri
24 department of insurance at least one hundred eighty days prior to the effective date of such
25 actions.
26 3. Any insurer that fails to provide the notice required under subdivisions (1) and
27 (2) of subsection 2 of this section shall, at the option of the insured, continue the coverage
28 in accordance with the provisions of subdivision (2) of subsection 6 of section 379.321,
29 RSMo.
383.302. The department of insurance shall, prior to October 1, 2006, establish
2 health care provider classification codes and risk-reporting categories for medical
3 malpractice insurance premiums, as defined in section 383.150, and shall establish
H.B. 1087 7
regulations for the reporting of all premiums 4 charged by such categories and/or codes. The
5 department of insurance shall consider the available history or prior court judgments for
6 claims under this chapter, in each county and any city not within a county in this state and
7 the current risk categories in use by insurers in establishing the risk reporting categories.
383.304. All insurers shall, with regards to medical malpractice insurance as
2 defined in section 383.150, provide to the department of insurance, beginning on January
3 1, 2007, and not less than annually thereafter, an accurate report as to the actual rates,
4 including assessments levied against members, excluding members whose practice is part5
time, charged by such company for such insurance, for each of the risk-reporting
6 categories and/or codes established in section 383.302.
383.306. Not later than June 1, 2007, and at least annually thereafter, the
2 department of insurance shall, utilizing the information provided under section 383.304
3 establish and publish, a market rate reflecting the median of the actual rates charged for
4 each of the risk-reporting categories for the preceding year by all insurers.
383.308. For purposes of sections 383.308 to 383.316, the following terms mean:
2 (1) "Base rate", the premium rate designed to reflect the average aggregate
3 experience of a particular health care provider classification prior to adjustment for
4 individual risk characteristics;
5 (2) "Schedule rating or individual risk rating credits or debits", rating factors or
6 adjustments applied to an insurer's base rates to increase or decrease the premium of an
7 individual insured or unit or exposure to adjust the base rate to account for individual risk
8 characteristics not reflected in the base rate.
383.310. 1. The department of insurance shall establish reporting standards for
2 insurers by which the insurers shall report their base rates and schedule of rating or
3 individual risk rating credits or debits for the health care provider classifications and/or
4 codes designated by the department, in whatever categories the department determines to
5 be actuarially appropriate.
6 2. The department shall collect the information required in subsection 1 of this
7 section and shall create a database to be made available to the public that compares the
8 base rates and schedule of rating or individual risk rating credits or debits charged by each
9 insurer actively writing a particular health care provider classification code. Such
10 database may distinguish between base rates for different types of coverage.
383.312. 1. The department of insurance shall establish reporting standards for
2 insurers by which the insurers, or an advisory organization designated by the department,
3 shall annually report such Missouri medical malpractice insurance actual premium, actual
4 premium deviation from the base rate, loss, exposure, and other information as the
H.B. 1087 8
department may require for the purpose 5 of compiling a Missouri medical malpractice
6 ratemaking database. The reports shall be in a format determined by the department.
7 Such information shall be considered confidential information and shall be a closed record
8 under chapter 610, RSMo.
9 2. The department shall collect the information required in subsection 1 of this
10 section and compile it in a manner appropriate for assisting Missouri medical malpractice
11 insurers in developing their future base rates, schedule rating or individual risk rating
12 factors, and other aspects of their rating plans. In compiling the information and making
13 it available to Missouri insurers and the public, the department shall remove any
14 individualized information that identifies a particular insurer or provider as the source or
15 subject of the information. The department may combine such information with similar
16 information obtained through insurer examinations so as to cover periods of more than one
17 year.
383.314. After August 28, 2006, when evaluating the base rates of any medical
2 malpractice insurer, including any insurer newly admitted to write medical malpractice
3 insurance in Missouri or any insurer entering such line, in order to determine whether
4 such rates are excessive, inadequate, or unfairly discriminatory, the director of insurance
5 shall, in addition to any other methods of evaluation, use the base rates collected under
6 section 383.310 as a basis for comparison.
383.316. 1. If the director finds that any insurer or filing organization has violated
2 any provision of sections 383.300 to 383.316, the director may impose a penalty of not more
3 than five hundred dollars for each violation, but if the director finds the violation to be
4 willful, the director may impose a penalty of not more than five thousand dollars for each
5 violation. Such penalties may be in addition to any other penalty provided by law.
6 2. The director may suspend the license of any rating organization or insurer that
7 fails to comply with an order of the director relating to sections 383.300 to 383.316 within
8 the time limited by such order, or any extension thereof which the director may grant. The
9 director shall not suspend the license of any rating organization or insurer for failure to
10 comply with an order until the time prescribed for an appeal therefrom has expired or if
11 an appeal has been taken, until the order has been affirmed. The director may determine
12 when a suspension of license shall become effective and it shall remain in effect for a period
13 fixed by the director, unless the director modifies or rescinds such suspension or until the
14 order upon which such suspension is based is modified, rescinded, or reversed.
15 3. No penalty shall be imposed or no license shall be suspended or revoked except
16 upon a written order of the director, stating the director's findings, made after a hearing
H.B. 1087 9
held upon not less than ten days' written notice 17 to such person or organization specifying
18 the alleged violation.
383.330. The department of insurance shall promulgate rules defining the term
2 "claim" as it applies to claims made for medical malpractice. Any rule or portion of a rule,
3 as that term is defined in section 536.010, RSMo, that is created under the authority
4 delegated in this section shall become effective only if it complies with and is subject to all
5 of the provisions of chapter 536, RSMo, and, if applicable, section 536.028, RSMo. This
6 section and chapter 536, RSMo, are nonseverable and if any of the powers vested with the
7 general assembly pursuant to chapter 536, RSMo, to review, to delay the effective date, or
8 to disapprove and annul a rule are subsequently held unconstitutional, then the grant of
9 rulemaking authority and any rule proposed or adopted after August 28, 2006, shall be
10 invalid and void.
383.335. By January 1, 2011, all insurers writing medical malpractice insurance in
2 this state shall offer medical malpractice policies of insurance which are written so as to
3 apply to injury which results from acts or omissions occurring during the policy period,
4 regardless of the timing of the filing of a claim based on such acts and omissions.

NHDD Speak Up Video

2011-12-20T10:50:00.000-08:00

Maintenance Manual Revisions

2011-12-20T10:44:00.000-08:00

The Family Support Division announced Income Maintenance manual revisions based upon Social Security, Supplemental Security Income, CMS, and Railroad Retirement 2012 COLA's in IM # 72, dated 12/9/2011 to be effective January 1, 2012.

The Division will be doing mass system changes based on these Federally-derived numbers. Of course our penalty-divisor number that we must use in Missouri has not been announced yet (supposed to be based upon the semi-private room average cost of the cost of skilled nursing home care). Also some numbers are announced at other times such as July 1 of each year for the minimum monthly maintenance needs allowance and April 1 of each year for the Medical Assistance income limit (for non-vendor MO HealthNet).

Here is a summary of some of the changes (please look at the IM yourself for a complete report) found at http://www.dss.mo.gov/fsd/iman/memos_11/im72_11.html:

SSI single $698 (up from $674); couple $1,048 (up from $1,011).

Maximum Monthly Needs Allowance to Community Spouse, $2841 (up from $2,739) --Minimum Monthly Needs Allowance remains unchanged at $1,839 until July 1.

Minimum Community Spouse Resource Allowance, $22,728 (up from $$21,960); Maximum Community Spouse Resource Allowance, $113,640 (up from $109.560).

Maximum Home Equity (for single person), $525,000 (up from $505,000).

Home and Community Based Waiver Standard, $1,220 (up from $1,178).

Medicare Part B minimum premium, $99.90 (up from $96.40, and down for those who became eligible in 2009 and had to pay $110.50 and down for those who became Medicare eligible in 2010 and had to pay $115.40 when no COLA's were given to those receiving Social Security benefits--please note that higher income earners may have higher Medicare Part B premiums).

Occupational therapists launch new guidelines to help stop elder abuse before it starts

2011-12-19T07:31:00.000-08:00

Canadian Association of Occupational Therapists /PRNewswire/ - The Canadian Association of Occupational Therapists (CAOT) is pleased to have officially launched "Strategies for occupational therapists to address elder abuse/mistreatment, " a resource tool developed for occupational therapists that will build health human resource capacity to address and manage elder abuse.The project was made possible through funding from Human Resources and Skills Development Canada (HRSDC), who recognized the vital role occupational therapists play in managing elder abuse."Occupational therapists are in a unique position to detect and manage elder abuse due to the strong working relationship they develop with an older adult through having an intimate knowledge of their daily life and routines," said Rosemary Lester, Chair of the Elder Abuse Committee of Newfoundland and Labrador and External Member of the CAOT Board of Directors. "This tool will support this relationship and be an important resource in the ongoing effort to combat elder abuse."The resource tool provides a set of guidelines that strive to assist occupational therapists across Canada in understanding what to look for (indicators), first steps to follow when suspecting abuse (e.g. What do I ask? Look for?), and strategies for discussing the situation with the older adult.The Minister of State for Seniors, the Honourable Alice Wong attended the event in support of the new documents and the positive impact occupational therapists have on managing and working to prevent elder abuse."Our government is committed to support the well-being of seniors," said Minister Wong. "Elder abuse should be everyone's concern and that is why our government is ensuring that Canadians are aware of the issue and can take the necessary preventative action or seek support."This year the Government of Canada awarded nearly $567,000 to the National Initiative for the Care of the Elderly, to develop tools to measure elder abuse, which could support the development of strategies for prevention, detection and treatment. This initiative in addition to the release of the guidelines provides an optimistic future for seniors.Strategies for occupational therapists to address elder abuse/mistreatment is available for download off the CAOT website by all practicing occupational therapists across Canada. www.caot.ca/elderabuseCanadian Association of Occupational Therapists Canadian Association of Occupational Therapists - Strategies for Dealing with Elder Abuse SOURCE Canadian Association of Occupational Therapists

Read more here: http://www.bradenton.com/2011/11/23/v-print/3675497/occupational-therapists-launch.html#storylink=cpy

Canadian Association of Occupational Therapists /PRNewswire/ - The Canadian Association of Occupational Therapists (CAOT) is pleased to have officially launched "Strategies for occupational therapists to address elder abuse/mistreatment, " a resource tool developed for occupational therapists that will build health human resource capacity to address and manage elder abuse.

The project was made possible through funding from Human Resources and Skills Development Canada (HRSDC), who recognized the vital role occupational therapists play in managing elder abuse."

Occupational therapists are in a unique position to detect and manage elder abuse due to the strong working relationship they develop with an older adult through having an intimate knowledge of their daily life and routines," said Rosemary Lester, Chair of the Elder Abuse Committee of Newfoundland and Labrador and External Member of the CAOT Board of Directors. "This tool will support this relationship and be an important resource in the ongoing effort to combat elder abuse."

The resource tool provides a set of guidelines that strive to assist occupational therapists across Canada in understanding what to look for (indicators), first steps to follow when suspecting abuse (e.g. What do I ask? Look for?), and strategies for discussing the situation with the older adult.

The Minister of State for Seniors, the Honourable Alice Wong attended the event in support of the new documents and the positive impact occupational therapists have on managing and working to prevent elder abuse."

Our government is committed to support the well-being of seniors," said Minister Wong. "Elder abuse should be everyone's concern and that is why our government is ensuring that Canadians are aware of the issue and can take the necessary preventative action or seek support.

"This year the Government of Canada awarded nearly $567,000 to the National Initiative for the Care of the Elderly, to develop tools to measure elder abuse, which could support the development of strategies for prevention, detection and treatment. This initiative in addition to the release of the guidelines provides an optimistic future for seniors.

Strategies for occupational therapists to address elder abuse/mistreatment is available for download off the CAOT website by all practicing occupational therapists across Canada.

www.caot.ca/elderabuseCanadian Association of Occupational Therapists Canadian Association of Occupational Therapists - Strategies for Dealing with Elder Abuse SOURCE Canadian Association of Occupational Therapists

Read more here: http://www.bradenton.com/2011/11/23/v-print/3675497/occupational-therapists-launch.html#storylink=cpy

Elder Substance Abuse

2011-12-12T10:43:00.000-08:00

(Co-authored with Kimberly A. Williams)

Gladys became a drug addict at the age of 82 when the pain of arthritis got to be too much for her and she became dependent on opiates to get through the day and to sleep at night.

Frank became a dangerous, problem drinker at 66 after he retired from his job as a maintenance man in a local school. Every day he drove to a bar where he hung out with a few buddies and drank a few too many beers before he drove home.

Samuel grew up during the era of drugs, sex and rock and roll. Throughout his adult life, he smoked marijuana after work without problems at work or at home. After he retired at 65 he smoked more often and getting high began to interfere with the life he had hoped for when he retired.

For most of her adult life, Joan had had two or three glasses of wine with dinner. In her mid-60s her physical tolerance for alcohol diminished. She drank no more than usual, but by the second glass she began to slur her words and to find it hard to think clearly. She frequently fell asleep right after dinner.

These are just a few of the faces of substance abuse or misuse among older adults. They are not the images that ordinarily come to mind when we think of substance abuse, and this is a major reason why these problems often go undetected in elders. Of course, there are older adults who are alcoholics and/or addicted to illegal drugs such as heroin, but fewer and fewer as people age, in part because so many people addicted to alcohol or drugs die prematurely and in part because some survivors turn their lives around.

For older adults, drinking too much and misusing medications are the major substance use problems, affecting as many as 20 percent of them (1). They are particularly vulnerable to the mental and physical effects of alcohol and drugs because of physiological and cognitive changes that take place with age. And, even if they are not addicted to alcohol or illegal substances, they are at risk for serious problems including:

Adverse drug reactions, including fatal overdoses,
Accidents -- including falls and traffic accidents,
Exacerbation of health problems,
Social isolation,
Sleep disturbances,
Inactivity,
Loss of cognitive capacity and
Suicide -- which is more likely among older adults than any other age group.

In general, substance abuse and misuse vastly limit the potential to live well in old age.

During the elder boom there will be tremendous growth of the number of older adults with substance use problems, in part because of the growth of the population of older adults, but also because baby boomers use substances -- including illegal substances -- much more commonly than their parents' generation.

For example, a study done by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) projects the growth of people 60 or over who need substance abuse treatment from about 700,000 in 2000 to about 2,300,000 in 2020 (2). Recent surveys (3) confirm that this is already happening, with marked growth of the use of marijuana.

In addition, the CDC recently released a report projecting a vast increase in addiction to prescription painkillers and in deaths due to overdoses, which already kill more Americans than heroin and cocaine combined (4).

Will you, a member of your family, or a close friend be among the older adults with serious substance use problems? Here are a few signs that should cause concern (5).

Getting unusually high without an increase in use
Use of alcohol or drugs to sleep and then finding it difficult to get going in the morning
Reliance on opiates to manage pain in doses that exceed a doctor's prescription
Going from doctor to doctor to get additional prescriptions
Using over-the-counter drugs in amounts or in combinations of medicines that are not recommended
Cognitive or memory impairments, difficulty concentrating, or confusion
Slurred speech
Increased isolation
Difficulty participating in ordinary activities
Weight loss and/or poor nutrition
Increased fatigue and/or weakness
Poor personal hygiene
Unusual restlessness or agitation
Persistent irritability or altered mood
Balance problems and/or frequent falls

These symptoms can, of course, have causes other than substance abuse or misuse, but if a person is using alcohol or other drugs and has these symptoms, substance use may be a major cause.

You may be able to recognize substance use problems in yourself or a friend or family member. You may be able to cut back or help someone to cut back. But many people need professional help. Talk frankly with your physician. If you don't know where to turn for help, call 1-800-273-TALK. This is the National Suicide Prevention Lifeline, and it can connect you with mental health or substance abuse services near your home.

Michael B. Friedman and Kimberly Williams are the co-founders of the Geriatric Mental Health Alliance. He is now retired except for teaching at Columbia University. She is the Director of The Center for Policy, Advocacy and Education of the Mental Health Association of NYC.

(1) Blow, F. "Baby Boomers, Mental Health, and Aging: New Challenges and Opportunities." Keynote address to the Geriatric Mental Health Alliance Annual Conference, May 2011. http://www.mha-nyc.org/media/9736/fred%20blow%20keynote%20presentation%20[compatibility%20mode].pdf
(2) Gfroerer, J. et al. "Substance Abuse Treatment Need Among Older Adults in 2020: The Impact of the Baby Boom Generation" in Drug and Alcohol Dependence, 2003.http://johnstrogerhospital.org/cru/images/education/519cd99e959493c0c6ad6bf40b928794.pdf
(3)Substance Abuse and Mental Health and Services Administration. "Illicit Drug Use Among Older Adults." National Survey on Drug Use and Health, 2011.http://oas.samhsa.gov/2k11/013/WEB_SR_013_HTML.pdf
(4) Center for Disease Control. "Prescription Painkiller Overdoses At Epidemic Levels: Kill More Americans Than Heroin and Cocaine Combined." Press Release, November 1, 2011.http://www.cdc.gov/mmwr/pdf/wk/mm6043.pdf.

(5) Blow, F. "Substance Abuse Among Older Adults." SAMHSA TIP 26, 1998http://www.ncbi.nlm.nih.gov/books/NBK14467/?report=printable

The Ups and Downs of Medicare Part B Premiums: Frequently Asked Questions

2011-12-04T16:22:00.000-08:00

What will the Medicare Part B standard monthly premium be for 2012?

The U.S. Department of Health and Human Services (HHS) recently announced that the standard monthly Medicare Part B premium for 2012 will be $99.90. This premium is paid by, or on behalf of, beneficiaries who are enrolled in the Supplementary Medical Insurance part of the Medicare program (Part B), which covers physician and other outpatient services. The standard Part B premium amount is calculated to cover 25 percent of annual Part B spending, although higher‐income enrollees pay a greater share of costs, ranging from 35 percent to 80 percent, depending on their income. Medicare Part B premiums are typically deducted from most beneficiaries’ Social Security payments.1

The 2012 standard Part B premium amount represents a $15.50 decrease from the 2011 standard amount of $115.40 (and $6.70 less than actuaries had projected for 2012 earlier this year). According to HHS, the decrease in Part B premiums is due to the Social Security cost‐of‐living adjustment (COLA) that Part B enrollees will receive in 2012, and to lower‐than‐expected Part B spending in 2011. The 3.6 percent COLA for Social Security recipients in 2012 is the first COLA since 2009, following two years of no cost‐of‐living increase, which affected the Medicare Part B premium amount in 2010 and 2011, as explained below. Moreover, the COLA increase for 2012 is larger than was previously projected in the 2011 Social Security Trustees report.

How does the Social Security COLA affect the Medicare Part B premium?

In a year where the Social Security COLA is insufficient to cover the amount of the Medicare Part B premium increase for an individual, the law prohibits an increase in the Part B premium that would otherwise result in a reduction in that individual’s monthly Social Security payments. This is known as the “hold‐harmless” provision. In 2010 and 2011, with no Social Security COLA, the hold‐harmless provision prevented the majority of Medicare beneficiaries from paying any increase in Part B premiums. Thus, in both 2010 and 2011, the majority of Medicare beneficiaries paid monthly premiums of $96.40, which was the standard Part B premium amount in 2009.2

Roughly one‐quarter of all Part B enrollees were not held harmless in 2010 and 2011, including new Medicare enrollees (3 percent); higher‐income beneficiaries (5 percent); and Medicare beneficiaries who do not have their Part B premium deducted from their Social Security benefit payment (19 percent) – this group consists mainly of beneficiaries dually eligible for Medicare and Medicaid, for whom Medicaid pays the monthly Part B premium (17 percent).3 These beneficiaries were subject to a higher Part B premium than those who were protected by the hold‐harmless provision to ensure that Part B enrollee premium contributions continued to cover 25 percent of program costs. The standard monthly premium for these beneficiaries was $110.50 in 2010 and $115.40 in 2011.

With an increase in the Social Security COLA scheduled for 2012, fewer beneficiaries will be affected by the hold‐ harmless provision, and the beneficiary portion of annual Part B expenditures will be spread across a greater share of Part B enrollees than in 2010 and 2011. This results in a monthly Part B premium of $99.90 in 2012 – an increase for the majority of beneficiaries who have been protected by the hold‐harmless provision in 2010 and 2011 who were paying $96.40, and a decrease for all others who were paying the standard amount in both years – including states, which pay the standard premium amounts on behalf of dual eligibles.

How will Part B premiums change for Medicare beneficiaries who were protected by the

hold‐harmless provision for both 2010 and 2011?

For Medicare beneficiaries who have been protected by the hold‐harmless provision since 2009, the Part B premium will increase by $3.50, or 3.6 percent, from $96.40 to $99.90. Some of these beneficiaries – generally those with a relatively low Social Security benefit payment – might experience another year of being held harmless from the Part B premium increase if the dollar amount by which their Social Security payment increases is less than the increase in the Part B premium.

1 Or from Railroad Retirement payments, if applicable. Certain individuals are exempt from this requirement, including beneficiaries enrolled in both Medicare and Medicaid (“dual eligibles”). See Section 1840 of the Social Security Act. 2 For more details on the relationship between the Social Security COLA and the Medicare Part B premium, see “The Social Security COLA and Medicare Part B Premium: Questions, Answers, and Issues,” Kaiser Family Foundation, December 2010.

3 Centers for Medicare & Medicaid Services, “Medicare Premiums, Deductibles for 2011,” November 4, 2011.KAMILY F

How will Part B premiums change for Medicare beneficiaries who were not protected by the

hold‐harmless provision in 2010 and/or 2011?

The monthly Medicare Part B premium for those who have been paying the 2011 standard Part B premium (i.e., not protected by the hold‐harmless provision this year) will decrease by $15.50 per month, from $115.40 to $99.90 (a 13.4 percent decrease). For those who have been paying the 2010 standard Part B premium (e.g., beneficiaries who enrolled in Medicare in 2010), the monthly Part B premium will decrease by $10.60 per month, from $110.50 to $99.90 (a 9.6 percent decrease).

How will Part B premiums change for higher‐income Medicare beneficiaries?

Approximately 5 percent of Part B enrollees pay the income‐related Part B premium. Beneficiaries are required to pay the higher Part B premium if their income is equal to or greater than $85,000 for an individual and $170,000 for a couple. For 2011, the income‐related Part B premium amounts range from $154.70 to $353.60, based on income. For 2012, these amounts will range from $139.90 to $319.70, a decrease of 13.4 percent – the same percentage decrease at each level as for the standard Part B premium amount.

How does the Medicare Part B premium amount affect state Medicaid spending for dual

eligibles?

Medicaid spending is also directly affected by changes in the Part B premium because Medicaid pays premiums on behalf of the roughly 9 million Medicare beneficiaries who are also covered by Medicaid, known as “dual eligibles.” Therefore, changes in the Medicare Part B premium contribute to changes in state Medicaid spending on dual eligibles. The majority of those who were not held harmless from higher Part B premiums in 2010 and 2011 are low‐income beneficiaries dually eligible for both Medicare and Medicaid, for whom the states are responsible for paying Part B premiums.

This publication (#7912-04) is available on the Kaiser Family Foundation’s website at www.kff.org. ThE hEnRy J. KaISER FamIly FoUndaTIon

The MetLife Study of Elder Financial Abuse

2011-11-28T15:27:00.000-08:00

Crimes of Occasion, Desperation, and Predation Against America's Elders

The study is a follow-up of MetLife's 2009 "Broken Trust: Elders, Family, and Finances" and examines the prevalence and impact of elder financial abuse in America today. It demonstrates how these crimes continue to decimate incomes, impact the health and well-being of its victims, and fracture families. Yet it still is underreported, under-recognized, and under-prosecuted.

Key Findings:

Instances of fraud perpetrated by strangers comprised 51% of articles related to elder financial abuse, followed by family, friends, and neighbors (34%), the business sector (12%), and Medicare and Medicaid fraud (4%).
Medicare and Medicaid fraud resulted in the highest average loss per case in that category.
Women were twice as likely as men to be victims of elder financial abuse, with most being between the ages of 80 and 89, living alone, and requiring some level of help with either health care or home maintenance.
Nearly 60% of perpetrators were men, mostly between the ages of 30 and 59.
Dollar losses over the holidays due to family, friends, and neighbor perpetrators were overall higher than any other category due to number of instances, although the highest average dollar loss per individual was from business perpetrators.

Methodology:

Data on elder financial abuse were obtained by examining articles from the National Center on Elder Abuse (NCEA) newsfeed gathered from April through June 2010 to compare it with the data in the 2009 MetLife Broken Trust Study. Data were also gathered between November 2010 and January 2011 to examine the impact of the holiday period on elder financial abuse. This newsfeed database tracks media reports of all types of elder abuse through Google and Yahoo alerts, which scanned billions of pages.

Source:http://www.metlife.com/mmi/research/elder-financial-abuse.html#methodology

Medical testing companies' Medicare deal scrutinized

2011-11-20T12:00:00.001-08:00

Researchers also fear doctors may be ordering tests that don't need to be performed so they can receive kickbacks from insurers.

Sens. Max Baucus, D-Mont., and Chuck Grassley, R-Iowa, have asked five major health care companies — Cigna, Laboratory Corp. of America, Aetna,UnitedHealth Group and Quest Diagnostics— to send copies of lab service agreements, contract information and corporate communications, including documents provided in recent court cases relating to the practice.

Baucus is the committee chairman and Grassley its ranking Republican.

Cigna and UnitedHealth said they have received the letters and are reviewing them, and the other companies have informed Grassley's office they have also received the letters.

"We treat such requests seriously, and plan to cooperate," Quest spokeswoman Wendy Bost said.

Called "pull-through," laboratories sign contracts with insurers offering extremely low rates for a medical test in exchange for the insurers verbally agreeing that their physicians will send all of their Medicare and Medicaid cases to those laboratories.

Earlier this month, the state of California settled with Quest for $241 million and LabCorp for $49 million after a whistle-blower lawsuit accused Quest of charging California's Medicaid five times more per test than it did other customers. A similar case in New Yorkis under appeal after a judge dismissed the case because a plaintiff released confidential information.

"The inspector general has raised a flag and recent court cases raise concerns," Grassley told USA TODAY.

Andrew Baker, a whistle-blower who refused to participate in the alleged practice and eventually lost his business, said the issue needs to be raised to the national level.

"The practice is blatant manipulation of Medicare to grow your market," Baker said. "We're talking billions of dollars per year."

The senators said they had looked into the California and New York lawsuits. In the meantime, there had been several reports, including from the Department of Health and Human Services inspector general and MedPac, showing the companies had been overpaid.

"The procedures given to Medicare and Medicaid beneficiaries should not be influenced by improper relationships between labs and insurance companies," Baucus said.

Baker said both the insurance companies and the labs pressured doctors to send their lab work, and that doctors received kickbacks. The labs made more money off the Medicaid and Medicare cases because the government pays a fixed rate, and because those patients usually need more lab work than do privately insured patients because Medicare patients are older. Baker said he wrote a letter to his clients saying he would not participate, and for that, he lost his job. Quest later bought Baker's company, Unilab.

Last month, Baucus and Grassley released another committee investigation that said home health care companies were unfairly manipulating the Medicare system to increase their billings.

By Kelly Kennedy, USA TODAY

http://www.usatoday.com/money/industries/health/story/2011-11-10/medicare-fraud-probe/51159336/1

Pfizer, Humana form research pact on elderly health

2011-11-14T12:57:00.001-08:00

(Reuters) - Pfizer Inc has formed a partnership with health insurer Humana Inc to research ways to improve healthcare for the elderly.

The five-year partnership, announced on Thursday, will focus initially on three chronic conditions: pain, cardiovascular disease and Alzheimer's disease.

Humana is one of the largest providers of plans under Medicare, the U.S. government health plan for the elderly. Pfizer is the world's largest drugmaker.

The companies cited U.S. Census projections showing that over the next 10 years the Medicare-eligible population is expected to grow to 65 million -- a 36 percent increase from 2010. The collaboration also could evolve beyond seniors in the longer term, the companies said.

The companies will seek "to develop an important body of knowledge" to advance their work, said William Fleming, vice president of Humana Pharmacy Solutions.

The companies will seek to study prescription drug use and how it affects areas such as cost and quality of care and patient outcomes, Fleming said.

One result, he said, could be that it affects how Humana designs its benefit and coverage plans or develops programs to influence how seniors take their medications.

James Harnett, Pfizer's senior director of U.S. health economics and outcomes research, said the information generated through the partnership could influence decisions about the company's development products.

MetLife's Market Survey

2011-11-05T12:44:00.001-07:00

Costs for long-term care varies quite a bit throughout the state and even from provider to provider in the same community. MetLife stopped selling long-term care insurance beginning in 2011 although it continues to service its existing policies.  MetLife continues to conduct a market survey.

For those of you interested, MetLife issued its 2011 Market Survey of Long-Term Care Costs, which is found at http://www.metlife.com/mmi/research/2011-market-survey-long-term-care-costs.html#findings. It indicates the following about National and Missouri's costs:

The national average daily rate for a private room in a nursing home rose 4.4% from $229 in 2010 to $239 in 2011 ($205 to $214 for semi private).

    Missouri average of a private room daily rate is $160 -- Kansas City area average, $157; St. Louis area average, $186; and rest of state, $186.
    Missouri average of a semi-private room daily rate is $141--Kansas City area average, $144; St. Louis area average, $194; and rest of state, $132

The national average monthly base rate in an assisted living community rose 5.6% from $3,293 in 2010 to $3,477 in 2011.

    Missouri's assisted living facilities are licensed as residential care facilities and assisted living facilities.
    Missouri's average monthly base rate is $3,490--Kansas City area average, $3,398; St. Louis area average, $4,289; and rest of state, $3,050.

The national average daily rate for adult day services rose 4.5% from $67 in 2010 to $70 in 2011.

    Missouri's average daily rate for adult day services is $70--Kansas City area average, $69; St. Louis, $72; and rest of state, $69.

The national average hourly rates for home health aides ($21) and homemakers ($19) were unchanged from 2010.

    Missouri's average hourly rate for home health aides is $19 and homemakers ($19)--Kansas City area average, $19 and $18; St. Louis,

Economy Delays Boomers' Plans to Sell Homes

2011-10-31T09:39:00.001-07:00

Economy Delays Boomers' Plans to Sell Homes

CNBC

By Lulu Chiang, Senior Field Producer, CNBC

NEW YORK (CNBC) -- In a survey conducted by Coldwell Banker Real Estate, 9 out of 10 brokers said "the economy is delaying baby boomers' plans to sell their homes, compared to a few years ago."
The big issue is the huge number of foreclosures. Jim Gillespie, CEO of Coldwell Banker Real Estate, said it really depends on how long it will take to work through the foreclosures in the system.
However, the survey pointed out that baby boomer desire to purchase and own a home remains strong. The reason? Gillespie believes the American dream of owning a home is alive and well.No one seems to have a definitive answer on the timeline. All of this is based on Americans going back to work and consumer confidence coming back. That's the big overhang.
Home ownership is still the American dream. "60-75% of Americans say investing in a home is the safest or second safest investment," said Gillespie. It all boils down to lifestyle. "The long-term future of the housing market looks good," added Gillespie.
Gillespie pointed out that a lot of young people are living with their parents, grandparents or other family members. Once we see job creation and consumer confidence bounce back, Gillespie expects demand to pick up. Right now, many young people out there are renting because the economy is weak, and there may be not as much funding available to them.
Is this just a temporary trend? Gillespie dismisses the idea we are turning into a renter's society. "That is not the case," added Gillespie.
Currently, the baby boomer generation accounts for 79 million Americans. The survey divided up the boomers into two groups, younger baby boomers (ages 47-55) and older baby boomers (ages 56-64). "31% of respondents say that younger baby boomer clients are selling their current home and looking for a larger home, compared to 6% of older boomers," based on results of the survey.
Four out of five agents said that 'older' baby boomers are two times more likely to want to downsize than 'younger' ones. Gillespie stressed that half are downsizing for a simpler lifestyle, not downsizing for economic reasons.
According to the survey, "49% of agents say the primary reason boomers want to downsize is because they desire a simpler lifestyle, while only 28% said the leading reason boomers are downsizing is to save money."
Coldwell Banker Real Estate conducted this online survey across the country about housing trends for baby boomers. Over 1,300 agents participated in this survey. The survey was conducted during the week of September 6 and September 15, 2011.
-- Written by Lulu Chiang, Senior Field Producer and Senior Booker of CNBC's "Closing Bell with Maria Bartiromo" and "The Wall Street Journal Report with Maria Bartiromo."

Medicare's Annual Open Enrollment is from Oct. 15 - Dec. 7

2011-10-22T13:09:00.001-07:00

Medicare's Annual Open Enrollment is from Oct. 15 - Dec. 7

Every year, people with Medicare get to explore new choices and pick the health and drug plans that work best for them. This year, this Open Enrollment period is starting earlier – on October 15 – and ending sooner – December 7. This gives people with Medicare a full seven weeks to compare and make decisions, and ensures that they will have essential plan materials and membership cards in hand on January 1, 2012 when new coverage starts.

There'll be a wide range of health and drug plan options available across the country, including Original Medicare. Most people with Medicare can choose a "Part D" plan to help them pay for prescription drugs. And people who have chosen to enroll in a "Part C" Medicare Advantage plan for their basic health care services have the option of staying in that plan, choosing a different plan, or going back to the Original Medicare program. Plans can change from year to year, so these are important choices that should be made with care. People can turn to www.medicare.gov, call 1-800-MEDICARE, or consult with a local State Health Insurance Assistance Program (SHIP) for help.

House Panel Hunts the Elusive 'Millionaire on Medicaid'

2011-10-17T14:35:00.001-07:00

Oct 03, 2011 01:52:48am

A House subcommittee convened a hearing September 21 on alleged abuses of Medicaid long-term care eligibility rules. None of the four witnesses identified significant gaming of the system by the well-to-do, although the "elder law bar" came in for some abuse.

In his opening remarks, Rep. Trey Gowdy (R-SC), chair of the House Oversight and Government Reform Subcommittee on Healthcare, contended that some are trying to "turn the [social] safety net into a hammock or a trampoline."

"Medicaid is not being used solely by the indigent," Gowdy said. "Income and asset tests are easy to circumvent and abuse. In fact, a cottage industry has arisen seeking to educate the wealthy on how to transfer or hide assets so taxpayers can pay for their long-term care."

"Millionaires should not be on welfare," Gowdy concluded.

The committee heard from four witnesses, including one former elder law attorney. Only one witness appeared to think that abuse of the Medicaid eligibility rules by the well-off was much of a problem, and even she defined the alleged abusers as those with a few hundred thousand dollars in assets beyond their home.

Moses Says Middle Class Eligibility Is the Problem

Lead witness Stephen Moses, President of the Center for Long-Term Care Reform, chose to focus the committee's attention on reforming Medicaid's "generous" eligibility rules that allow the middle class to qualify, and he characterized "egregious Medicaid planning" by the wealthy as just "the tip of the iceberg."

"Income almost never disqualifies anyone from Medicaid long-term care eligibility," Moses told the committee, and he went on to claim that there is "no meaningful limit" on how many exempt assets applicants may retain and still qualify for benefits.

"Because of these very generous basic eligibility rules, the vast majority of America's elderly qualify easily for Medicaid when they need long-term care," he said. Such easy qualification discourages most people from planning early to "save, invest or insure for long-term care."

As an example of the changes he would recommend, Moses claimed that Medicaid could save up to $30 billion a year if people had to consume their home equity before qualifying for public benefits.

David A. Dorfman, who said that he was a "Medicaid planning attorney" in New York until this past January, called the alleged abuse of Medicaid eligibility rules by the well-heeled "a myth. That's not really what's happening. That's not what any of my clients wanted. None of them wanted to game the system."

"Soup kitchens are free and nobody checks five years' worth of bank statements, and millionaires don't go there for lunch," Dorfman said. "We can't mandate abject poverty, because that's what people are terrified of. And if that has to be created, no matter what the rules, people will do whatever they have to do to get the necessary health care for their loved ones, or they'll suffer and die without care. . . Let's create a system that invites people in who need health care, not one that punishes them."

The third witness, Janice Eulau, the Assistant Administrator of the Suffolk County (New York) Department of Social Services, was the only one to claim that alleged abuses of the Medicaid system are a significant problem. Conceding that her county is relatively affluent, Eulau said that "people often come in and they have total resources of $300,000 to $400,000 beyond their home" and other exempt assets. She singled out promissory notes as a legal tool most often used, at least by single clients. For couples, she said spousal refusal is the most common method for preserving resources.

The last witness, Julie Hamos, Director of the Illinois Department of Healthcare and Family Services, also declined to climb aboard the "millionaires on Medicaid" bandwagon. "What we are finding in Illinois is that this is more of a middle class family issue than millionaires. Let's say there's a saving of a little pot of money, say $100,000, the family doesn't want all of that to go into nursing home care."

Hamos said that there is bipartisan acceptance of these practices in her state. She then said that her department was looking to another front to exact savings: ending Medicaid's institutional bias.

"Millionaires Don't Want Medicaid"

In questioning, Rep. Gowdy tried to trap Dorfman into conceding that a program designed for the poor is nevertheless aiding the non-poor. Dorfman replied that "Medicaid is not for the indigent, but for those who qualify for the program."

Dorfman told Gowdy that his picture of millionaires who voluntarily impoverish themselves so their children can have an inheritance and taxpayers can pay for their long-term care was "not the typical experience across 20 years of doing Medicaid planning, although there are certainly exceptions." Later, Dorman said, "Millionaires don't want Medicaid . . . they want fancy care, they want care that they control."

Gowdy also asked Moses to explain spousal refusal. After pointing out that it is used primarily only in New York and Florida, Moses added that "The elder law bar, in frequent annual conferences, urges the rest of the country to take advantage of what they consider a 'right' under the federal law to simply have the spouse refuse to contribute to the cost of the care. It's very, very expensive in New York and Florida and frankly I don't think most of the other states have the impunity to try to pull that off."

Towards the hearing's end, Rep. Elijah Cummings (D-MD) closely questioned Moses about his professional affiliation. "When I asked my staff to learn more about you to try to understand where you were coming from," Cummings said, "it seems that your views are really nothing more than the views of the insurance industry."

Cummings then tried to determine the sources of funding for Moses's Center for Long-Term Care Reform. He established that the Center is a for-profit entity that is supported at least in part by the long-term care insurance industry, but Moses repeatedly refused to name his corporate contributors, although he did say they do not include David and Charles Koch, brothers who have funded conservative and libertarian advocacy groups.

Committee spokesperson Jeff Solsby said the hearing was "designed to raise awareness" and that no legislation was immediately planned.

The hearing, titled "Examining Abuses of Medicaid Eligibility Rules," took place on September 21, 2011. For hearing documents, including a link to the YouTube video of the hearing, click here.

Prevent Medicare Fraud with the CMS Fraud Prevention Toolkit

2011-08-25T07:50:00.000-07:00

The Affordable Care Act provides additional resources to enable the Centers for Medicare & Medicaid Services (CMS) to expand efforts to prevent and fight fraud, waste, and abuse. The CMS Fraud Prevention Initiative aims to ensure that correct payments are made to legitimate providers for covered appropriate and reasonable services in all federal health care programs. Fraud prevention efforts focus on moving CMS beyond its former “pay and chase” recovery operations to a more proactive “prevention and detection” model that will help prevent fraud and abuse before payment is made. Many of these new initiatives acknowledge that the first and best line of defense against fraud remains the health care consumer. You can help by making sure that Medicare beneficiaries have the information they need to identify and report suspected fraud. This information is available in the CMS Fraud Prevention Toolkit on the web.

Get the toolkit here: https://www.cms.gov/Partnerships/04_FraudPreventionToolkit.asp#TopOfPage

NAELA

Senior Driving Seminar

2011-08-23T07:42:00.000-07:00

Villa Ventura Senior Living Community and the Rehabilitation Institute of Kansas City
are pleased to present the following seminar:

Aging and Changing: How Age Affects Driving

As we age, there are changes in our body which include visual changes and reaction time. Our senses may
grow weaker and we may experience joint stiffness. We can also experience changes in the way we process
information along with physical and mental side effects from medications. This community classroom presentation will help address these matters, along with what a person can do to accommodate for changes caused by aging. Techniques will be presented on how to keep physically and mentally fit for driving. Information will be presented on when to consider getting a professional driving evaluation in a caring, non-threatening environment. After the classroom presentation, a demonstration will be given in the parking lot of Villa Ventura about tools, techniques and assistive devices seniors can use to help accommodate for physical changes caused by aging. If you’re concerned about changes you’ve noticed in your driving or those of a loved one, this is an easy and safe way tobrush up on driving skills.

When: August 24th at 2:00 PM
Where: Villa Ventura Senior Living Community
12100 Wornall Road; Kansas City, MO 64145
Cost: Free to the Community
Reserve your Seat by calling Villa Ventura at 816-941-0525

August Newsletter - Alzheimer's, On the Rise.

2011-08-11T10:55:00.000-07:00

August Newsletter - Alzheimer's, On the Rise

NAELA Fall Newsletter

2011-08-05T12:13:00.001-07:00

Hospice improves care for dementia patients and their families

2011-08-04T07:27:00.001-07:00

Hospice improves care for dementia patients and their families

Survey data come amid debate over Medicare funding

PROVIDENCE, R.I. [Brown University] — Hospice services substantially improved the provision of care and support for nursing home patients dying of dementia and their families, according to an analysis of survey responses from hundreds of bereaved family members. The research comes as hospice funding has received particular scrutiny in the debate over Medicare spending.
"People whose loved ones received hospice care reported an improved quality of care, and had a perception that the quality of dying was improved as well," said Dr. Joan Teno, a Brown University gerontologist and the lead author of the study published online in the Journal of the American Geriatrics Society. "This is one of just a few studies out there that has examined dying with dementia where the predominant site of care is a nursing home and can report the benefits of hospice services. As just one example, for nursing home patients not in hospice, one in five family members reported an unmet need for shortness of breath while that was only 6.1 percent for people in hospice."
Hospice care was a great comfort to Bartley Block, of Providence, when he lost his wife, Janet, to dementia in October 2010. He and Janet received service from Home and Hospice Care of Rhode Island on and off for about a year as her condition wavered, and then ultimately declined. Block said that even after his wife began struggling to eat, she still would get up and walk. Hospice workers would help the couple take walks at the nearby Tockwotton Nursing Home and patiently feed her food that they'd puree.
"It meant a great deal to her and to me," Block said. "It not only was able to calm her, but it was calming to me. There were spiritual sessions for me. They did so much for her to make her life easier."
That kind of experience is reflected in the responses of hundreds of families in the survey. In all, Teno's team asked 538 family members of nursing home patients who died of dementia to reflect on the care and support they experienced and observed at their loved one's end of life. Of that group, 260 received hospice care and 278 did not. Among the report's key findings:
Family members of hospice recipients were 51 percent less likely to report unmet needs and concerns with quality of care. They were 49 percent less likely to report an unmet need for management of pain. They were 50 percent less likely to have wanted more emotional support before their loved one's death. They rated the peacefulness of dying and the quality of dying more positively than families whose loved ones did not receive hospice care.
The survey also found that people who felt their loved one received hospice care "too late" had stronger concerns about care and support in almost every one of the survey's many measures. They felt worse off than people who had no hospice care at all.
"These are people who get slammed around the healthcare system in the last days of life," Teno said. "These are people with transitions who go from an acute care hospital to a nursing home in the last 24 hours. They are reacting to a set of circumstances that shouldn't have occurred."
Dementia is a particularly important area to study, Teno said, because the untreatable condition has only recently gained recognition as being terminal illness. The unpredictability of its progress, however, has led to a large number of dementia patients staying in hospice for longer than people with other conditions. That has made dementia a focus for scrutiny in discussions of cost.
But the study provides new evidence that hospice provides a meaningful benefit to nursing home patients with dementia and their families, such as the Blocks, Teno said. Policymakers should therefore factor in that evidence as they discuss the future of Medicare funding.
"It is a terminal illness," Teno said. "As we do payment reform we should preserve access and quality of care for those persons dying of dementia."

In addition to Teno, other authors of the paper are Pedro Gozalo, Ian Lee, and Sylvia Kuo of Brown, Carol Spence of the National Hospice and Palliative Care Organization, Stephen Connor of the Worldwide Palliative Care Alliance, and David Casarett of the University of Pennsylvania.
The National Institute of Aging funded the research.

Study: Kids safer in grandma's car

2011-07-27T11:54:00.000-07:00

Let Gramps or Grandma drive the kids: It's safer.

That's the finding of a new study by researchers at The Children's Hospital of Philadelphia, who say that the risk of injury to children in crashes was 50% lower when grandparents were behind the wheel.

Hospital researchers studied data from State Farm insurance claims covering 11,859 children 15 and younger in motor vehicle crashes from 2003 to 2007 in 15 states and the District of Columbia; they also conducted telephone interviews with drivers.

The findings were counterintuitive, because previous studies have found that drivers over age 55, and especially those past 65, have a higher risk of motor vehicle crashes.

"It was the exact opposite of what we expected to find," says Fred Henretig, lead author of the study and a staff physcian in the emergency department at the hospital. "(Why) is the million-dollar question."

Henretig speculates that the reason might be quite simple: "Grandparents, when they have the opportunity to interact with their grandchildren find that to be the primary focus of their time together," he says. "They're perhaps not as distracted by trying to do a million errands, or get the dinner on the table, or wonder about their response to the latest e-mail.

"Speaking as a grandparent, about the worst thing that could happen is one of your grandchildren getting hurt on your watch, and trying to communicate that to your children," Henretig says.

He says it's also possible that automobile trips with the grandparents involved shorter distances and less time on interstates. He says the surprising results require more study: "Let's figure out what the grandparents are doing right, and get everybody to do it."

The study was published online Monday in the journal Pediatrics.

"I'm really happy to see this study that debunks some of the myths about older drivers," says Amy Goyer, AARP's family expert. "A study last year by the Insurance Institute for Highway Safety found that older drivers tend to self-regulate. When grandchildren are in the car with grandparents, they're motivated to self-monitor the danger."

Falls, eye test may give clues to Alzheimer's

2011-07-25T11:55:00.000-07:00

Falls, eye test may give clues to Alzheimer's

By MARILYNN MARCHIONE, AP Medical Writer – 3 days ago

PARIS (AP) — Scientists in Australia are reporting encouraging early results from a simple eye test they hope will give a noninvasive way to detect signs of Alzheimer's disease.
Although it has been tried on just a small number of people and more research is needed, the experimental test has a solid basis: Alzheimer's is known to cause changes in the eyes, not just the brain. Other scientists in the United States also are working on an eye test for detecting the disease.
A separate study found that falls might be an early warning sign of Alzheimer's. People who seemed to have healthy minds but who were discovered to have hidden plaques clogging their brains were five times more likely to fall during the study than those without these brain deposits, which are a hallmark of Alzheimer's.
Both studies were discussed Sunday at the Alzheimer's Association International Conference in France.
More than 5.4 million Americans and 35 million people worldwide have Alzheimer's, the most common form of dementia. It has no cure and drugs only temporarily ease symptoms, so finding it early mostly helps patients and their families prepare and arrange care.
Brain scans can find evidence of Alzheimer's a decade or more before it causes memory and thinking problems, but they're too expensive and impractical for routine use. A simple eye test and warning signs like falls could be a big help.
The eye study involved photographing blood vessels in the retina, the nerve layer lining the back of the eyes. Most eye doctors have the cameras used for this, but it takes a special computer program to measure blood vessels for the experimental test doctors are using in the Alzheimer's research, said the study's leader, Shaun Frost of Australia's national science agency, CSIRO.
Researchers compared retinal photos of 110 healthy people, 13 people with Alzheimer's and 13 others with mild cognitive impairment, or "pre-Alzheimer's," who were taking part in a larger study on aging. The widths of certain blood vessels in those with Alzheimer's were different from vessels in the others and the amount of difference matched the amount of plaque seen on brain scans.
More study is planned on larger groups to see how accurate the test might be, Frost said.
Earlier work by Dr. Lee Goldstein of Boston University showed that amyloid, the protein that makes up Alzheimer's brain plaque, can be measured in the lens of the eyes of some people with the disease, particularly Down syndrome patients who often are prone to Alzheimer's.
A company he holds stock in, Neuroptix, is testing a laser eye scanner to measure amyloid in the eyes. Goldstein praised the work by the Australian scientists.
"It's a small study" but "suggestive and encouraging," he said. "My hat's off to them for looking outside the brain for other areas where we might see other evidence of this disease."
Eye doctors often are the first to see patients with signs of Alzheimer's, which can start with vision changes, not just the memory problems the disease is most known for, said Dr. Ronald Petersen, a Mayo Clinic dementia expert with no role in the new studies.
Other signs could be balance and gait problems, which may show up before mental changes do. Susan Stark of Washington University in St. Louis led the first study tying falls to a risk of developing Alzheimer's disease before mental changes show up.
It involved 125 people, average age 74, who had normal cognition and were taking part in a federally funded study of aging. They kept journals on how often they fell, and had brain scans and spinal taps to look for various substances that can signal Alzheimer's disease.
In six months, 48 fell at least once. The risk of falling was nearly three times greater for each unit of increase in the sticky plaque that scans revealed in their brains.
"Falls are tricky" because they can be medication-related or due to dizziness from high blood pressure, a blood vessel problem or other diseases like Parkinson's, said Creighton Phelps, a neuroscientist at the National Institute on Aging.
Falls also can cause head injury or brain trauma that leads to cognitive problems, said Laurie Ryan, who oversees some of the institute's research grants but had no role in the study. Older people who hit their heads and suffer a small tear or bleeding in the brain might seem fine but develop symptoms a month later, she said.
The bottom line: "If you see somebody who's having falls for no particular reason," the person should be evaluated for dementia, said William Thies, the Alzheimer's Association's scientific director.
The warning signs of Alzheimer's:
—Memory loss that disrupts daily life
—Trouble planning or solving problems
—Difficulty completing tasks
—Confusion with time or place
—Trouble understanding images and spatial relationships
—New problems with speaking or writing words
—Misplacing things and inability to retrace steps
—Decreased or poor judgment
—Social withdrawal
—Changes in mood or personality

On the Net:

National Institute on Aging: http://www.nia.nih.gov/Alzheimers
Alzheimer's Association: http://www.alz.org

Home care cutbacks put strain on elderly

2011-07-20T11:53:00.001-07:00

Plans sacrificed to trim budgets

July 17, 2011|By John Seewer and Shaya Tayefe Mohajer, Associated Press

TOLEDO, Ohio - Born with cerebral palsy, Jennifer McPhail relies on a home health aide to help her get dressed for work and ready for bed at night.
Her motorized wheelchair keeps her active, working as an organizer with a disability rights group in Austin, Texas, and volunteering to help people find housing and to staff hurricane shelters. She now fears deep reductions in the state’s Medicaid spending will prevent her from living independently.
“What it says to me is that the state doesn’t value the lives of people with disabilities,’’ said McPhail, 39. “A lot of people are going to be hurt in a very intimate way.’’

It’s a concern facing families across the nation as states with budget deficits cut home health services that help keep the elderly and disabled out of nursing homes. States are reducing how much time a nurse can spend making house calls and ending meal deliveries for the homebound. Many also are gutting adult day-care programs that give seniors a safe place to spend their days while relatives work.
Aging and disability services in three out of four states have been reduced during the past two years or face cuts, even though demand is increasing.
Texas lawmakers underfunded Medicaid by nearly $5 billion in the state budget, a move that home health advocates say leaves the elderly and adults with disabilities unsure how their care at home will be provided.
California eliminated funding for about 330 adult day centers, a move that will affect some 35,000 seniors who use them for medical care and socializing. Lawmakers are hoping to restore about $85 million to transition seniors into an as-yet undetermined alternate program - about half the amount cut from the budget.
Minnesota is considering cuts to home-health aides and a program that allows disabled people to live on their own.With each cut, the ability to live at home becomes more difficult. “You end up losing control over your decisions,’’ said Neil Johnson of the Minnesota HomeCare Association.
Home-health services are an easy target for budget-cutters because they are not required by federal law, have been subject to fraud, and don’t have deep-pocketed special interests advocating for them. Steep cuts in these services eventually could cost states more money by pushing more people from their houses to nursing homes that would require taxpayer subsidies.
“Just because you cut the budget doesn’t mean their needs go away,’’ said Anita Bradberry of the Texas Association for Home Care & Hospice Inc.
Medicaid, the state-federal program that pays for medical and long-term care for the poor and disabled, is generally required to help fund nursing homes but not home care.
Because the programs are not required, most states first look at cutting home health care funded through Medicaid, even though such programs are much cheaper than nursing homes.
The price of an adult day health center is $67 a day on average, compared with $229 a day for a private room at a nursing home, according to a 2010 survey released by MetLife Inc.
Overall, Medicaid spending on nursing homes came to $46.5 billion in 2007, the latest figures available, while home health services cost $6.3 billion, according to the US Department of Health and Human Services.

New End-of-Life Care Laws

2011-07-14T07:57:00.001-07:00

Law on End-of-Life Care Rankles Doctors

By JANE E. BRODY

I shouldn’t be surprised when doctors object to laws telling them how to practice medicine, as does New York State’s new Palliative Care Information Act — not surprised, but in this instance, distressed.
Vehemently opposed by the Medical Society of the State of New York, the law passed last summer by a two-thirds majority of the Legislature and took effect in February. The legislation was written in collaboration with Compassion and Choices of New York, an organization that advocates for informed choices and greater physical and emotional comfort at the end of life.
The act, which I discussed in this column last August, states that when patients are found to have a terminal illness or condition, health care practitioners must offer to provide information and counseling about appropriate palliative care and end-of-life options. Patients or their surrogates are entirely at liberty to refuse an offer to discuss these options.
California passed a similar law in 2009, and other states are considering them. These measures promise to reduce the cost of care at the end of life, as well as the suffering often associated with it; palliative care is meant to reduce the severity of disease symptoms, pain and stress.
Although there are penalties for violation, it is not the specter of punishment that raises the hackles of some physicians. Rather, they say the new requirement interferes with how they choose to deal with their patients and does not take into account the nuances of a doctor-patient relationship.
In an article in The New England Journal of Medicine last month, Dr. Alan B. Astrow and Dr. Beth Popp of Maimonides Medical Center in Brooklyn wrote that they were troubled by “the law’s heavy-handed intrusion into the doctor-patient relationship.” They stated, “In asserting power over the way in which deep and troubling human questions should be addressed, the New York Legislature seems likely only to generate cynicism at the times when critically ill patients and their families are most in need of honesty, kindness and engagement.”
Another New York physician, Dr. Yashar Hirshaut, an oncologist at NewYork-Presbyterian/Weill Cornell Medical Center who also objects to the act, said in a letter to me that “the new law is going to have a direct negative effect on too many cancer patients.” He wrote that when he explained what the law required to a patient with a life expectancy of six months, her response was, “What, are they trying to kill me?”
How the Law Can Help
This law is not about ending a patient’s life. Rather, it is intended to make the end, when that end is near, as physically and emotionally painless as possible. The law is intended to spare terminally ill patients from futile medical interventions that can detract from the quality of their remaining days.
Despite their opposition to this legislation, Dr. Astrow and Dr. Popp acknowledged that “seriously ill patients and their families need accurate information about prognosis and treatment options; physicians’ repeated failure in this realm is clearly a public health problem that the profession should be required to address.”
David C. Leven, who heads Compassion and Choices of New York, said in an e-mail that “the law simply requires physicians to do what the authors say should be required of them. The profession has not addressed this public health problem. The Legislature did.”
While legislation may not be the ideal way to go about this, the fact is that too many doctors fail to inform their terminally ill patients about the risks of continuing aggressive treatments to the bitter end and the benefits of opting only for treatment of discomforting symptoms through palliative or hospice care.
Doctors are notorious death-deniers, often more reluctant than their patients to admit that it is pointless to pursue treatment that is medically futile. They either fail to mention hospice care or suggest it far too late — usually within a week of death, when hospice personnel have little time to get to know the patient and family and to provide the kind of care that can make for a graceful exit from this world.
Studies have shown that patients with a short life expectancy who choose hospice over continued treatment and last-ditch assists like ventilators and feeding tubes live not only better but, surprisingly, longer on average. Researchers also have found that surviving family members are less likely to experience prolonged depression and grief when their loved ones are spared grotesque medical interventions and receive only comfort care at the end of their lives.
Even knowing these facts, some patients are likely to choose to take advantage of anything and everything in the medical armamentarium that could conceivably grant them extra days, weeks or months of life. And such a choice is the prerogative of every terminally ill patient; the new law does not in any way deny that choice. It merely says that patients should be offered the chance to learn about the alternatives.
Nor does the law prohibit patients (or families) from changing their minds and requesting aggressive measures after an initial acceptance of palliative care.
Communication Skills Needed
Many physicians fear that merely broaching the subject of palliative care will strip terminally ill patients of hope. But I have to wonder whether offering unrealistic hope for a cure, or overly optimistic prognoses, isn’t more harmful to patients and their families. If patients are unaware that the remaining time is short, they may lose the chance to resolve important personal issues, say meaningful good-byes, and leave legacies or memories that survivors can cherish long after death.
Few physicians trained more than a decade ago were taught how to communicate emotionally challenging information to their patients. But in recent years the medical literature and continuing education courses have sought to fill in this gap.
For example, Dr. James A. Tulsky of the Center for Palliative Care at Duke University Medical Center wrote in The Journal of the American Medical Association that “talking about treatment choices at the end of life does not necessarily rob patients of hope. Redirecting the patient’s goal toward realistic hopes and being present with compassion can serve as a powerful act in helping patients make decisions while maintaining a hopeful outlook.”
Dr. Tulsky advised that patients be told, in effect, to hope for the best but to prepare for the worst. Their goals can be broadened to include not just successful treatment, he suggested, but also the measures they want taken if they cannot be cured and advice on how to accomplish important tasks that might otherwise be left undone.
Terminally ill patients may fear not just death, but also that in choosing palliative or hospice care, they will be abandoned by their primary physicians. Disappearing doctors are all too common when curative treatment options are exhausted. If doctors truly want to preserve hope, they owe it to their patients to stick around until the end.

Missouri Bar Publishes New Version of Durable Power of Attorney

2011-07-14T07:51:00.001-07:00

Missouri Bar Publishes New Version of Durable Power of Attorney
for Health Care and Health Care Directive

Although the statute hasn’t changed, the bar’s DPA for Health Care form has – online where it can be downloaded, as well as in hard copy. The online version can now be filled out on screen, and then printed. Instructions for the online version are included as hover text, next to the lines they pertain to.
A number of changes have made the printed form more useful and convenient. The old form included the DPA for health care, a health care directive and the HIPAA privacy authorization form. The new form offers Missourians the ability to control several other related end-of-life decisions. Part of the form can authorize the Agent to execute an outside-the-hospital do not resuscitate order. Additionally, the form provides an option to give the Agent the right of sepulcher and instructions on whether or not to make anatomical gifts or to consent to an autopsy. The HIPAA Privacy Authorization form has been modified so that medical records can be disclosed to the Agent and several other individuals.
The old form included Spanish along with the English text. To make the form easier to follow and less bulky, two separate versions will be available. The English version has been printed already; a Spanish version will be available in a few weeks, after translation has been completed. The new form is also designed so that after it has been completed, the legal documents can be separated from the instructions, making the document easier to file.
The form was approved at the May Board of Governors meeting. Work on developing the new form was conducted by the Task Force to Review and Revise the Bar’s Durable Power of Attorney for Health Care and Health Care Directive Form. Representatives of the Task Force were appointed by the Elder Law Committee, Health Law Committee and Probate and Trust Committee. The following lawyers comprised the Task Force:
Christine Alsop, St. Louis
Dan Berry, Cape Girardeau
Ann Curchin, Jefferson City
Brigid Fernandez, MSW, St. Louis
Ellen Harmon, RN, MBA, St. Louis
Steve Newman, Jefferson City
Don Otto, Jefferson City
Jerry Sill, Jefferson City
Reg Turnbull, Jefferson City
Scott C. Yost, St. Louis
Martin Zehr, PhD. (clinical psychology), Kansas City

Via: http://www.mobar.org/

2011-06-07T10:20:00.001-07:00

For the first time in 27 years, new criteria and guidelines for the diagnosis of Alzheimer's disease have been published by three expert workgroups spearheaded by the Alzheimer's Association and the National Institute on Aging (NIA) of the National Institutes of Health (NIH)....

Alzheimer's Reading Room

The workgroups published four articles including ready-to-use clinical diagnostic criteria for Alzheimer's disease dementia and mild cognitive impairment (MCI) due to Alzheimer's. A research agenda was proposed for preclinical Alzheimer's. The use of biomarkers in Alzheimer's dementia and MCI due to Alzheimer's was also proposed as a research agenda only, and is not intended for application in clinical settings at this time.

New Alzheimer's Definition Moves Researchers Closer to Early Detection and Intervention

The articles – collectively, the National Institute on Aging/Alzheimer's Association Diagnostic Guidelines for Alzheimer's Disease – expand the definition of Alzheimer's to include two new phases of the disease: (1) presymptomatic and (2) mildly symptomatic but pre-dementia, along with (3) dementia caused by Alzheimer's. This reflects current thinking that Alzheimer's begins creating distinct and measurable changes in the brains of affected people years, perhaps decades, before memory and thinking symptoms are noticeable.

"It is our hope that incorporating scientific knowledge gained and technological advances made over the past quarter century will improve current diagnosis, bring the field closer to earlier detection and treatment, and ultimately lead to effective disease-modifying therapies," said William Thies, Ph.D., Chief Medical and Scientific Officer at the Alzheimer's Association. "Development and publication of these articles is a major landmark in the field. That said, publication of these articles is not yet the end of the process of developing new diagnostic criteria for Alzheimer's, but is another major step in the process."

"The new guidelines reflect today's understanding of how key changes in the brain lead to Alzheimer's disease pathology and how they relate to the clinical signs of mild cognitive impairment and Alzheimer's disease dementia," said Creighton Phelps, Ph.D., Program Director of the Alzheimer's Disease Centers Program at the National Institutes of Health. "We are also beginning to be able to detect these changes at a preclinical stage, long before symptoms appear in many people. With further research on biomarkers, as set forth in the new guidelines, we may ultimately be able to predict who is at risk for development of mild cognitive impairment and Alzheimer's dementia, and who would benefit most as interventions are developed."

The proposed new Alzheimer's disease diagnostic guidelines were published online by Alzheimer's & Dementia: The Journal of the Alzheimer's Association. Hard copy publication is scheduled for the May 2011 issue of the journal.

Three Stages of Alzheimer's Disease

The current diagnostic criteria for Alzheimer's*, for the most part, focus on reliable diagnosis when signs of problems in thinking, learning, and memory are noticeable to an individual, family, and friends. But research tells us that Alzheimer's likely begins years, maybe even decades, prior to symptoms appearing.

The new articles refer to three phases of Alzheimer's disease progression over time:

Preclinical Alzheimer's Disease – Measurable changes in biomarkers (such as brain imaging and spinal fluid chemistry) that indicate the very earliest signs of disease, before outward symptoms are visible. Currently, there are no clinical diagnostic criteria for this phase, but the group provides a scientific framework to help researchers better define this stage of Alzheimer's.

Mild cognitive impairment (MCI) due to Alzheimer's Disease – Mild changes in memory and thinking abilities, enough to be noticed and measured, but not impairment that compromises everyday activities and functioning.

Dementia due to Alzheimer's Disease – Memory, thinking and behavioral symptoms that impair a person's ability to function in daily life.

According to the authors, in order to facilitate the possibility of future presymptomatic treatment of Alzheimer's, it was important to define the disease from the earliest changes in the brain, not only the observable, symptomatic stages of the disease. The authors propose that Alzheimer's begins with a long asymptomatic period during which detrimental changes are progressing in the brain, and individuals with biomarker evidence of these changes are at increased risk for developing cognitive and behavioral impairment and progression to Alzheimer's dementia.

A biomarker is a naturally occurring, measurable substance or condition in the body that reliably indicates the presence or absence of disease or the risk of later developing a disease; for example, blood glucose levels are a biomarker of diabetes, and cholesterol levels are a biomarker of cardiovascular disease risk. Both fluid and imaging measures are being tested as possible biomarkers for Alzheimer's.

There was a broad consensus within the workgroups that much additional research needs to be done to validate the application of biomarkers as they are proposed in the newly-published articles. According to the authors, "The definitive studies … are likely to take more than a decade to fully accomplish. Thus, we must move quickly … and adjust our models and study designs as new data become available."

"If we can definitively determine the risk of developing Alzheimer's dementia in people who have biomarker evidence of brain changes but are not showing outward symptoms, we will open an important window of opportunity to intervene with disease-modifying therapies, once they are developed," Thies said.

"In addition, the new criteria give us powerful tools to accelerate our knowledge in the fight against Alzheimer's disease. They give us guidelines for getting a more accurate assessment of Alzheimer's prevalence. In that way we can better assess the need for everything from research dollars to care services, to patient and caregiver education materials, to nursing home beds, to the number of gerontologists and nurses that we need. And, they give us a basis for creating the next generation of Alzheimer's treatments that will be effective in each stage of the disease," Thies said.

Moving the Field Toward Earlier Diagnosis and Treatment of Alzheimer's

The Alzheimer's Association, in its 2010 report titled "Changing the Trajectory of Alzheimer's Disease: A National Imperative," showed that a hypothetical intervention that delayed the onset of Alzheimer's dementia by five years would result in a nearly 45 percent reduction in the number of people with Alzheimer's by 2050, and reduce the projected Medicare costs of Alzheimer's from $627 billion to $344 billion dollars.

The authors of the newly-released articles write,

"It is our hope that the advances in preclinical detection of Alzheimer's will enable earlier, more effective treatment, just as nearly all of therapeutic gains in cancer, cardiovascular disease, osteoporosis, and diabetes involve treatment before significant clinical symptoms are present. Screening and treatment programs instituted for other diseases … have already been associated with a decrease in mortality due to these conditions."
Thies adds, "Currently, Alzheimer's therapies are in development that may be able to slow or stop the progression of the disease. By improving early detection and risk evaluation, we will better be able to test potential therapies and eventually prescribe them for people at increased risk. Ultimately, this approach envisions for Alzheimer's what is now common practice in cardiovascular disease, where early signs of risk – for example, in genetic markers or in blood cholesterol and/or blood pressure levels – can be treated to reduce the likelihood of heart attack or stroke later on."

The challenge for Alzheimer's now is that there is currently no single, generally accepted way to identify the disease in the earliest stage – before symptoms are evident.

It is hoped that the research agenda outlined in the new preclinical Alzheimer's article will correct this deficit.

Presymptomatic Disease Detection and Treatment – Not a New Idea, Except in Alzheimer's

According to the authors, "The concept of a preclinical phase of disease should not be too foreign. Medical professionals readily acknowledge that cancer can be detected at the stage of 'carcinoma in situ' and that hypercholesterolemia and atherosclerosis can result in narrowing of coronary arteries that is detectable prior to myocardial infarction. It is widely acknowledged that symptoms are not necessary to diagnose human disease. Type II diabetes, hypertension, renal insufficiency, and osteoporosis are frequently detected through laboratory tests, and effective treatment can prevent the emergence of symptoms."

"We should be open to the idea that Alzheimer's could one day be diagnosed preclinically by the presence of biomarker evidence, which may eventually guide therapy prior to the onset of symptoms. We treat people with diabetes, elevated cholesterol, hypertension and a variety of other illnesses – we do not wait for strokes, heart attacks or other long term complications that we know will occur in significant numbers of those affected. Similarly, our intention is to use these criteria to better determine an individual's risk of developing Alzheimer's disease. This diagnostic research will help us discover the drugs of the future and prepare for the day when we can administer them to those at risk in order to prevent or delay the emergence of symptoms," wrote the authors.

What Was Published

The proposed new diagnostic criteria and research agenda for Alzheimer's disease are presented in three documents, plus an introduction.

One workgroup updated the 1984 diagnostic criteria for the dementia due to Alzheimer's disease. Guy McKhann, M.D., Johns Hopkins University School of Medicine, Baltimore, and David Knopman, M.D., Mayo Clinic, Rochester, Minn., co-chaired this panel.

A second workgroup focused on refining the criteria for the symptomatic, pre-dementia phase, referred to as Mild Cognitive Impairment due to Alzheimer's disease. Marilyn Albert, Ph.D., Johns Hopkins University School of Medicine, Baltimore, chaired this workgroup.

The third workgroup proposed a research agenda (NOT criteria for clinical diagnosis; this is an important distinction. See supplement 4.) for the asymptomatic, preclinical phase of Alzheimer's. Reisa Sperling, M.D., Brigham and Women's Hospital, Harvard Medical School, Boston, chaired this group.

The introduction provides an overview of the changes that have occurred in the Alzheimer's field since the first diagnostic criteria were published in 1984, and outlines future challenges that need to be addressed. Clifford Jack, M.D., Mayo Clinic, Rochester, Minn., is lead author of this article.

Preliminary recommendations were announced in July 2010 at the Alzheimer's Association International Conference on Alzheimer's Disease (AAICAD). These early drafts were then made available for comment on the Alzheimer's Association website, along with further presentation and discussion at a variety of medical and scientific meetings.

The three sets of recommendations differ in terms of relevance to current clinical practice.

The clinical diagnostic criteria for Alzheimer's dementia and MCI due to Alzheimer's are intended to guide diagnosis in the current clinical setting, such as a doctor's office, including settings where no access to testing for biomarkers exists.

The use of biomarkers in both Alzheimer's dementia and MCI due to Alzheimer's disease is intended only for research at this time. However, some biomarkers, especially those using advanced imaging techniques, could enter clinical practice in the near future, though much remains to be learned about their utility in this setting.

The recommendations of the preclinical Alzheimer's workgroup are intended for research purposes only, and do not have any clinical utility at this time.

A fourth workgroup has been organized to examine the postmortem, pathological criteria for Alzheimer's. The results of their deliberations are expected to appear later in 2011.

Alzheimer's Association
The Alzheimer's Association is the world's leading voluntary health organization in Alzheimer's care, support and research. Our mission is to eliminate Alzheimer's disease through the advancement of research; to provide and enhance care and support for all affected; and to reduce the risk of dementia through the promotion of brain health. For more information, please visit alz.org, or call 800-272-3900.

National Institute on Aging (NIA)
NIA, part of the National Institutes of Health, a component of the U.S. Department of Health and Human Services, leads the federal government effort conducting and supporting research on aging and the health and well being of older people. For information on age-related cognitive change and neurodegenerative disease, go to the NIA's Alzheimer's Disease Education and Referral (ADEAR) Center at www.nia.nih.gov/Alzheimers. For more on health and on aging generally, go to www.nih.nia.gov.

* McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34,939-44.

SOURCE Alzheimer's Association

The Baby Boomers are Retiring

2011-06-02T07:10:00.001-07:00

The Baby Boomers are retiring…and staying that way. What the aging world population means.

The Baby Boomers are at the age of retirement; this means a huge shift from the workforce to the retired community. But this trend is not limited to the United States, the world s aging as a whole, and this presents many challenges that have not been faced before. These challenges include changes to social insurance, pension systems, social support, economic growth and disease patterns and prevalence.
In 2006, there were 500 million people worldwide 65 and older. By 2030 that number is estimated to increase to 1 billion, meaning 1 in every 8 people in the world would be 65 and older. The most significant jumps will occur in the developing countries, with a rise of approximately 14%.
One of the biggest challenges that the world will have to face is increased life expectancy. As life expectancy rises, birthrates are decreasing, which causes the ratio of the elderly people to the young to increase. Life expectancy increases every year, and while this is a major accomplishment to the medical and social word, what does it mean in our day to day lives? There has been a shift of deaths from infectious diseases to deaths from non-communicable diseases such as heart disease, cancer and diabetes. This puts a strain on the current health care system, Medicare and Medicaid plans.
The age of retirement is also posing a challenge. Because of the aging population, more and more people are not only retired, but are also spending a longer portion of their life in retirement. This poses issues with personal and government savings programs, and also shrinks the ratio of workers to pensioners. Soon, the labor supply will be disproportionate to the number of pensioners a company is supporting.
Another aspect of the aging population that is often overlooked is the change in family dynamic and structure. As more and more people are living well into their 80’s, there will be a significant increase in the number of grandparents and great-grandparents in the family structure. Also, personal care and savings will have to be approached in a new way to accommodate for increasing longevity.
Now is an important time for the world: these trends are predicted and we still have time to act personally and globally in a way to prepare for the new population distribution.

Sources:
http://nia.nih.gov
http://csis.org/program/global-aging-initiative

These websites will also provide further information on the aging populations and how it is affecting the world.

Early signs of Alzheimer’s disease

2011-05-31T09:19:00.000-07:00

Early signs of Alzheimer’s disease

Loss of memory and increasing difficulty with daily tasks are normal in the aging process.
But certain symptoms are signs of the more serious Alzheimer’s disease. The following signs are the ten major symptoms provided by the Alzheimer's Association.

Ten Warning Signs of Alzheimer’s Disease
1. Memory changes that disrupt daily life. One of the most common signs of Alzheimer’s, especially in the early stages, is forgetting recently learned information. Others include forgetting important dates or events; asking for the same information over and over; relying on memory aides (e.g., reminder notes or electronic devices) or family members for things they used to handle on their own. What's typical? Sometimes forgetting names or appointments, but remembering them later.

2. Challenges in planning or solving problems. Some people may experience changes in their ability to develop and follow a plan or work with numbers. They may have trouble following a familiar recipe or keeping track of monthly bills. They may have difficulty concentrating and take much longer to do things than they did before. What's typical? Making occasional errors when balancing a checkbook.

3. Difficulty completing familiar tasks at home, at work or at leisure. People with Alzheimer’s often find it hard to complete daily tasks. Sometimes, people may have trouble driving to a familiar location, managing a budget at work or remembering the rules of a favorite game. What’s typical? Occasionally needing help to use the settings on a microwave or to record a television show.

4. Confusion with time or place. People with Alzheimer's can lose track of dates, seasons and the passage of time. They may have trouble understanding something if it is not happening immediately. Sometimes they may forget where they are or how they got there. What's typical? Getting confused about the day of the week but figuring it out later.

5. Trouble understanding visual images and spatial relationships. For some people, having vision problems is a sign of Alzheimer's. They may have difficulty reading, judging distance and determining color or contrast. In terms of perception, they may pass a mirror and think someone else is in the room. They may not recognize their own reflection. What's typical? Vision changes related to cataracts.

6. New problems with words in speaking or writing. People with Alzheimer's may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves. They may struggle with vocabulary, have problems finding the right word or call things by the wrong name (e.g., calling a "watch" a "hand-clock"). What's typical? Sometimes having trouble finding the right word.

7. Misplacing things and losing the ability to retrace steps. A person with Alzheimer’s disease may put things in unusual places. They may lose things and be unable to go back over their steps to find them again. Sometimes, they may accuse others of stealing. This may occur more frequently over time. What's typical? Misplacing things from time to time, such as a pair of glasses or the remote control.

8. Decreased or poor judgment. People with Alzheimer's may experience changes in judgment or decision-making. For example, they may use poor judgment when dealing with money, giving large amounts to telemarketers. They may pay less attention to grooming or keeping themselves clean. What's typical? Making a bad decision once in a while.

9. Withdrawal from work or social activities. A person with Alzheimer's may start to remove themselves from hobbies, social activities, work projects or sports. They may have trouble keeping up with a favorite sports team or remembering how to complete a favorite hobby. They may also avoid being social because of the changes they have experienced. What's typical? Sometimes feeling weary of work, family and social obligations.

10. Changes in mood and personality. The mood and personalities of people with Alzheimer's can change. They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, at work, with friends or in places where they are out of their comfort zone. What's typical? Developing very specific ways of doing things and becoming irritable when a routine is disrupted.

For more information, go to www.alz.org/10signs or call 877-IS IT ALZ (877.474.8259).
This is an official publication of the Alzheimer’s Association but may be distributed by unaffiliated organizations or individuals. Such distribution does not constitute an endorsement of these parties or their activities by the Alzheimer’s Association.
Copyright 2009 Alzheimer’s Association. All rights reserved.

New Research in the Treatment of Alzheimer's Disease

Scientists continually look for new insights to a cure for Alzheimer’s disease. Currently, research is being done regarding cellular treatment for Alzheimer’s patients. Common in the patients is the build-up of the protein beta-amyloid in the nerve cells and in the brain; this excess protein is thought to be a cause of many Alzheimer's Symptoms.

Research is being done at the Fisher Center for Alzheimer's Disease Research under the direction of Dr. Raul Greenard. The researchers think that the most difference will be made by simultaneously stimulating the break-down of the beta-amyloid protein and preventing future accumulation. This prevention of accumulation naturally occurs in the body by a process called autophagy, which the cell uses to eliminate waste from its interior. The Alzheimer patient's body does not effectively clean its cells and therefore the protein accumulation occurs.

The researchers’ goal is to create an anti-amyloid drug without harsh side effects of previous treatments. Scientists think that this is possible through small molecule therapy, either naturally or through medications.

For more information on current Alzheimer's research please visit:

http://www.alzinfo.org/treatment-care

Should Your Elderly Mom Or Dad Drive a Car?

2011-05-16T12:36:00.000-07:00

Should Your Elderly Mom Or Dad Drive a Car?

We all know the pain of being stuck behind a dangerous driver. My vehicle was recently hit by a young lady who had only been driving a year. Young drivers certainly lack the experience of road warriors like ourselves, yet there will come a time for all of us, when we will come full circle. The following article explicates the challenges of that difficult transition from the driver's seat, to riding shotgun.

How to Talk to Parents about Giving up the Keys

By Carolyn Rosenblatt

from: www.agingcare.com

In the 29 years I handled personal injury cases, most of them were car accidents. I represented injured people hundreds of times. When the victim was hit by an elder or older driver who should never have been driving, I always wondered why no one had taken the car keys away. Where were the adult children as elderly aging parents began to lose the ability to safely operate a car?

If we're talking about your Mom or Dad, and you've notice that he or she just isn't safe behind the wheel anymore, this is to encourage you to get involved. Most older drivers who are losing their ability to drive safely don't recognize it or are in denial and can't face the terrible thought of giving up their independence and control. Sometimes, loss of the ability to drive a car is a life changing event, as the elder can no longer maintain himself at home without transportation. Denial is a very common reaction to the early warning signs of becoming a dangerous older driver. Denial can occur both among the elderly, who really, really don't want to have this privilege taken from them, and in their adult children, who then have to deal with the consequences of Mom or Dad becoming a burden around transportation.
If this is happening in your aging parents, try these tips to handle this emotionally charged and difficult issue.

Tips for Dealing with a Dangerous Elderly Driver:

1. Approach the subject respectfully and at the best time of day for your parent. Ask if it's ok to talk about this now.

2. Bring up the issue of driving while you express caring and concern for how difficult it must be to even talk about it, but gently insist if your parent resists the subject.

3. Encourage your elderly parent to see a doctor to find out what physical problems could be going on. Some people need a change in medication or other health care treatment to correct alertness, vision, or ability to attend to detail in driving. Go with him or her to the doctor if you can.

4. If the doctor concurs that your aging parent should give up the keys, use the doctor as the reason for bringing up the subject and the reason for suggesting limiting or giving up driving.

5. Research alternative kinds of transportation where your parent lives. If you are in a rural area, there may be none, but family, neighbors, or church or synagogue members may be willing to help. Public transportation may be a good alternative in urban areas, even if your elderly parent has not used it before.
The subject of driving is always a "charged" one.
________________________________________
Carolyn Rosenblatt is a registered nurse and attorney who has 40 years of experience. She is the author of "The Boomer's Guide to Aging Parents."

Is a Beneficiary Deed a Good Option in Missouri?

2011-05-09T14:26:00.000-07:00

The short answer is "Maybe." The following is an excerpt from Reg Turnbull, a well-known elder law attorney in Missouri.

"Those of us who do estate planning counsel our clients that beneficiary
deeds are not panaceas. Often the following issues arise:

1. The grantor-decedent's Creditors still must be paid. Under section
461.300, RSMO, creditors can go after transfer on death (including
beneficiary deed) transferees (beneficiaries) to get bills paid. Creditors must
force open a probate within one year of the date of death to get paid and
bring in the transferees to the extent of the bill. Thus, such transfers do
not avoid estate recovery.

2. No one is in charge. An involuntary partnership arises if the
transfer is to more than one transferee. In probate, someone takes charge to
make sure that the maintenance of the real estate continues, e.g., the
utilities get paid so the "pipes don't freeze," that the real estate is
maintained, and that the RE taxes are paid. Also if some want the property to be liquidated, then it takes all of the transferees to sell it. If
disagreement, then may have to partition.

3. Any grantor-decedent's special intent is legally disregarded.
Intents for one or some but not all of the transferee-beneficiaries to farm
the farm or to live in the dwelling requires agreement (or at least
acquiescence) of the other family members. This can result in resentment from those who want the real estate liquidated for fair market value so that each can
get his or her fair share. If disagreement, then those wanting the money
must be bought out.

4. Any issues with real estate before the TOD are not resolved and
usually get passed on to the beneficiaries.
In Missouri, many people use Beneficiary Deeds because they are obsessing
about how to avoid probate. Some people should have used trusts to avoid
probate and still have central administration of their assets with clear
responsibility to carry out intent rather than just kicking the real estate
with problems down to the beneficiaries to deal with.

In the zeal to avoid probate, many issues are not worked out in a planned
manner with the TOD-beneficiary deeds when more is needed as they arguably
would be with more directions/instructions in a will (through probate) or
trust (without probate).

When our clients ask what we think about beneficiary deeds, we tell them
that we see beneficiary deeds as options that may or may not be appropriate
depending upon the situation."

Federal budget negotiations propose radical changes in Medicare and Medicaid

2011-05-02T07:30:00.000-07:00

This article posted by Naela summarizes the proposed changes to Medicare and Medicaid in the current budget debate. It is a great resource for understanding how the proposals could impact the way older and disabled Americans have access to affordable health care.

Federal budget negotiations propose radical changes in Medicare and Medicaid

Briefly, Medicare and Medicaid have provided health insurance coverage to older people, the disabled, women, and families with children for more than 45 years. These programs ensure that vulnerable populations who could not get health care coverage from private health insurance have access to basic health coverage.

The futures of Medicare and Medicaid are uncertain as a result of proposed reform and deficit reduction proposals under discussion in Congress.

One such proposal which promotes radial change is that of Congressman Paul Ryan (R-WI) who chairs the House of Representatives Budget Committee. Ryan’s proposal, “The Path to Prosperity: Restoring America’s Promise” would reduce the deficit primarily by cutting government spending by $6.2 trillion over a ten year period.

As part of this reduction in government spending, the Ryan proposal would end the Medicare and Medicaid system as they currently operate. Instead, Medicare benefits would shift to a premium support or voucher model and federal funding for Medicaid would be converted to a block grant system.

What Happens to Current Nursing Home Residents if the House Budget Resolution Becomes Law?

2011-04-25T07:48:00.000-07:00

I want to let you know about an informative alert from the Center for
Medicare Advocacy.

You can read the alert here:
"What Happens to Current Nursing Home Residents if
the House Budget Resolution Becomes Law?"

National Healthcare Decisions Day 2011 - Locations around KC

2011-04-11T09:52:00.000-07:00

For a complete listing of events in the Kansas City area, please go to www.nhdd.org or www.practicalbioethics.org.

On Friday, April 15th, local elder law attorneys will volunteer at locations throughout the Kansas City area with free information about advance care planning and advance directive forms. The following locations will be welcoming the public throughout the day:

Gamber Center 4 SE Independence Avenue Lee's Summit, Missouri 64063 Friday, April 15th, 11:00 a.m.- 1:00 p.m.

Liberty Silver Center 1600 S. Withers Road Liberty, Missouri 64068 Friday, April 15th, 9:00 a.m. - Noon

Irene B. French Community Center 5701 Merriam Drive Shawnee Mission, Kansas 66203 Friday, April 15th, 10:00 a.m.- 1:00 p.m.

Kansas City North Community Center 3930 NE Antioch Road Kansas City, Missouri 64117 Friday, April 15th, 10:00 a.m.- 2:00 p.m.

Participating attorneys: Kara Burgess, Northland Elder Law Linda Hart Tabory, Hardwick Law Firm Lisa R. Joyce, Shepherd Elder Law Group Samantha L. Shepherd, Shepherd Elder Law Group Timothy Murphy, Murphy & Tobin Law Offices

National Healthcare Decisions Day 2011

2011-04-07T07:07:00.000-07:00

Rallying to Encourage and Empower Us All to Make Our Healthcare Decisions Now for the Unknown Later…

College education. Career path. Relationships. Starting a family. Buying or selling a house. Vacations. Retirement. From the age that we’re old enough to understand, most of us are taught and accept that these are the markers in life that we plan for. However, there’s one key marker that’s all-too-often missing from this list: healthcare decision-making. Like planning for these other life events, planning for the time (or times) that we are unable to express our healthcare wishes is of the utmost importance. It is something that should be well thought out, documented and revisited at different points in life to reflect any change in our desires or family situation or the person we wish to advocate for us. Unfortunately, it is a planning point that that majority of us have missed. As a consequence patients’ families suffer the added burden of having to guess when a health crisis happens. That’s why Nathan Kottkamp founded National Healthcare Decisions Day (NHDD) back in 2008 and why this nationwide advance care planning awareness initiative is as important as ever. So this year, I’ve joined my fellow bloggers throughout the country to spread the word about the importance of advance care planning with this special NHDD edition blog.

NHDD, which happens every April 16, is a collaborative effort of national, state and community organizations as well as dedicated individual advocates committed to ensuring that adult Americans – like you and me —have the information and opportunity to communicate and document their healthcare decisions.

April 16 is rapidly approaching, so it’s time to kick the engagement effort into high gear. Here are some things you can do for yourself and your loved ones to prepare for NHDD 2011:
· Lead by example. Schedule time with your loved ones (on or before April 16) to “Have the Talk” and complete your own advance directive. There are many tools, including free forms, you can use to walk you through the process and make your wishes known; access them through the NHDD Public Resources page.
· Encourage your loved ones and friends to learn more about advance directives and to complete their advance directives. You can forward this link: http://www.nhdd.org/p/resources.html to them. Or, encourage them to find a nearby participant and attend a local NHDD event.
· Share your advance directive with your healthcare providers and make sure it is on file in the event it is needed.

Already had the conversation with your loved ones, but want to do more? Here a few suggestions to rally support for NHDD and encourage even more action:
· Like the NHDD Facebook fan page and share it with your Facebook friends
· On Twitter? Follow @NHDD and share the information with your followers, i.e. ‘Just 5 days to #NHDD, when will you #havethetalk? @NHDD can help: http://bit.ly/glff1V’
· Send an email to your friends, staff, colleagues, lodge/social club members, and/or house of worship, telling them that you are participating in NHDD and encouraging them to do the same. Share the information above with them and/or use this template email:

April 16 is National Healthcare Decisions Day, and I hope that you will join me in taking this time to discuss and document your healthcare wishes. We all need to be prepared in the event of a health crisis, and having the talk is easier than most people think, but many of us need a little inspiration or a reminder to do it. I hope that this message and National Healthcare Decisions Day are all you need for inspiration. Please mark your calendar for April 16 to have the talk with your loved ones. There are all sorts of free resources, including free advance directive forms for each of the 50 states, on the NHDD website: http://www.nhdd.org/. Additionally, please help me spread the word with Twitter, Facebook, and LinkedIn. Advance care planning is something we ALL should do and encourage others to do, regardless of age or current health. Discussing your wishes can be one of the most important gifts you ever give your loved ones.

Take the “pledge” to complete or update your advance directive on the NHDD website
. Please use and share the resources available through the NHDD website and encourage and empower us all to make our healthcare decisions now for the unknown later.

Advocates for the aging fear waiting list for services is on the way

2011-03-18T07:47:00.000-07:00

Advocates for the aging fear waiting list for services is on the way:
But administration officials say they are working on a plan to avert that
By Dave Ranney
Monday, March 14, 2011
TOPEKA — A spokeswoman for the Kansas Department on Aging said the agency is doing all it can to avoid putting frail seniors on a waiting list for in-home services.
“We know that in the past when people have gone on the waiting list, one-third of them end up in nursing homes, which increases the nursing-home portion of our budget," said Sara Arif of KDoA. "We're trying not to let that happen."
But advocates for the elderly said a waiting list is almost inevitable.
“Judging from the (legislative) committee discussions that have taken place so far, I’d have to say it’s almost guaranteed some time in fiscal 2012,” said Craig Kaberline, executive director at the Kansas Area Agencies on Aging.
The state’s next fiscal year begins July 1.The agency initially requested an operating budget of about $579 million. The governor instead proposed about $561 million. His plan was to avoiding a waiting list, in part, by cutting KDoA salaries and positions by $3 million from all funds; $1.2 million from the state general fund, and using that money to pay for senior services.
KDoA, Arif said, will formally announce its intent to lay off 20 full-time employees later this week. But agency officials have said that to avoid a waiting list, the department needs an additional $4.6 million for the services shifted from other agency spending.
An additional 787 frail seniors are expected to seek in-home services in the coming year.
KDoA Secretary Shawn Sullivan has said he thinks he can free up the needed extra money from elsewhere in the state-funded portion of the department’s budget but has not said how.
Last week, the House Appropriations Committee told Sullivan to cut the state-funded portion of his budget an additional $800,000.
“We don’t see how the secretary going to be able to do that,” Kaberline said.
Arif said she expects the department to outline its cost-cutting plan later this week.
“We’re within $1.3 million of where we need to be,” she said. “We’re at the point now where we’re trying to work with CMS (Centers for Medicare and Medicaid Services) on allowing us some flexibility in certain areas. It’s difficult to know at this point how that’s going to go.”
Rep. Jerry Henry, D-Cummings, said he’s was skeptical the agency would be able to avoid a waiting list.
“This whole thing doesn’t make sense to me,” he said. “We’ve got more and more people with more and more needs coming into a system that’s already stretched pretty thin and we’re being told we can do it with fewer staff and for less money. If you ask me, the Brownback administration is rolling the dice on this one."
Henry is the ranking minority on the House Social Services Budget Committee.
“I think we’re either going to have a waiting list or there’s going to be a lot of corner-cutting going on,” he said. “I don’t know that the secretary is going to propose. I suspect we may not like it.”
The committee’s chairman, Rep. David Crum, R-Augusta, defended Brownback’s proposal.
“I think people tend to overlook the fact that the governor funded Medicaid, he fully funded people who are on the frail elderly waiver now and he put an additional $1.2 million in the waiver,” Crum said. “That’s a substantial amount of money.”
Crum said he hoped the department would be able to avoid a waiting list.
“But, still, it’s a possibility that some seniors may have to wait for services,” he said. “Time will tell.”
Brownback also has proposed and budget committees in both the House and Sentate have upheld a 10 percent cut in the state-funded portion of the department’s home-delivered and congregate meals programs and a 20 percent cut in Senior Care Act-funded grants.
Across the state, area agencies on aging use Senior Care Act dollars Meeting the Needs of Older Kansans

(Article from the Kansas Area Agencies on Aging Association)

KS Legislative Update: Governor's budget includes cuts in elderly services

2011-02-15T12:07:00.000-08:00

Kansas Legislative Update: Governor's budget includes cuts in elderly services
KDoA told to cut employees costs by almost 25 percent

By Dave Ranney, KHI News Service

Originally published Feb. 14, 2011 at 10:13 a.m., updated Feb. 14, 2011 at 12:20 p.m.
TOPEKA — Hoping to avoid making frail seniors wait for services that help keep them out of nursing homes, Gov. Sam Brownback has told the Kansas Department on Aging to cut its salaries by $3 million. That’s almost one-fourth of the agency’s employee costs.

“I don’t see how they can do that,” said Jim Beckwith, a former executive director with the Northeast Kansas Area Agency on Aging in Hiawatha. “This is a department that doesn’t have that many employees to begin with and that, last year, said it was already operating in the red. So, here we are now, seven months into the state’s fiscal year and the demands being put on KDoA haven’t gone down, they’ve gone up.
“I think we’re headed for frail-elderly waiting list.” Beckwith predicted.
The Senate Ways and Means Subcommittee on KDoA is expected to begin its review of the department’s budget later this week.
Attempts to reach KDoA officials for comment were unsuccessful.
KDoA imposed its first and only waiting list for services for the frail elderly in 2002. That hold was lifted in 2004 after funding was restored.
Historically, KDoA has avoided a waiting list because limiting frail seniors’ access to services increases the likelihood more will be admitted to nursing homes, which generally ends up costing the state more than home- and community-based services.
States are required to cover nursing-home care for frail, low-income seniors; in-home services are not subject to a federal mandate.
More than 91 percent of KDoA’s $572.9 million annual budget is spent on nursing home care.
Brownback also proposed a 10 percent cut in the state-funded portion of the department’s home-delivered and congregate meals programs; a 20 percent cut in Senior Care Act-funded grants.

Across the state, area agencies on aging use Senior Care Act dollars — $6.3 million in the current fiscal year — to pay for in-home services for frail seniors who are low-income but ineligible for Medicaid.
Typically, if these seniors have to move to nursing homes, they’re soon eligible for Medicaid.
“It’s an incredibly effective program when it comes to keeping people off of Medicaid,” and out of nursing homes, said Annette Graham, executive director at the Central Plains Area Agency on Aging in Wichita. “In Wichita, we already have a waiting list for Senior Care Act services. We’ve made revision after revision in our budget, but the demands just continue to grow. We didn’t have a choice.”
The economic recession has put more pressure on the programs, she said.
“Judging from the phone calls we get from seniors and their families — they know they need help or they need services, but they also know they can’t afford them,” Graham said. “They’re maxed out. They’re coming to us because they have nowhere else to go.”
Jane Metzger, who runs the Meals on Wheels programs in Shawnee and Jefferson counties, said she’s worried that lawmakers will underestimate the impact of the proposed $300,000 cut to the meals program.

“I’m sure that in the scheme of things, that looks pretty insignificant and maybe it is — unless you’re that senior citizen who’s not going to be able to get on the program,” Metzger said. “We understand why all this is happening, but we also understand that people who are frail, elderly, homebound, and need a security check and a daily meal are going to suffer.”

Long-term care "Conversation Checklist" for families and seniors

2011-02-14T09:46:00.000-08:00

Long-term care "Conversation Checklist" for families and seniors.

Having a conversation about long-term care with an aging loved one can be difficult. Initiating a conversation can be awkward or uncomfortable for family members or caregivers. Although it is impossible to know what the future will bring, SNAPforSeniors, a national database for senior housing, offers the following hints and checklist that may help to begin a conversation about housing options with your loved one.

1. Determine if it’s time to think about long term care facilities.
Reasons to seek long-term care vary from person to person. In addition to potentially offering a more comfortable and safer environment for the aging loved one, long-term care may be necessary for the mental and physical health of the caregiver.
To ensure your loved one is able to contribute to his/her future, introduce alternate housing options as early as possible, even before necessary. Ask your loved one questions about lifestyle or health-related challenges. Continue the conversation over time by sharing your observations and concerns, including any of the following physical and mental symptoms:

Physical Symptoms
• Are they able to move around easily given the physical layout of the home? For example, are stairs, carpet, bath/shower or door handles obstacles for mobility? Is the heating and lighting adequate for any sensory impairments including hearing, sight and circulation problems?

• Are they experiencing balance issues, especially when changing positions? Are you concerned about them falling?

• If they fell, are you confident he or she would be able to call for help? Is there a reliable source to respond to a call at all times?

• Is your loved one repeatedly complaining of physical aches and pains?

• Are they experiencing frequent incontinence? Can they attend to the problem when this happens or is help needed?

• Do they have difficulty dressing, bathing or with personal hygiene such as hair and foot care?

• Is your loved one experiencing frequent, significant sleep disturbances?

• Are they capable of cooking or preparing healthy meals?

• Have operating gadgets or appliances such as the can opener, stove or telephone become difficult?

• Have household chores become a burden? Is vacuuming, sweeping, taking out the garbage, cleaning the dishes or bathroom being done in timely ways?

• Are finances such as bill payment, deposits, and investments being handled in a timely manner?

• Is your loved one still driving? If so, are you concerned about his/her and others wellbeing? Is public transportation a safe and viable option?

• Are prescribed medications obtained and taken as indicated consistently?

Mental Symptoms:
• Is your loved one demonstrating personality changes, including but not limited to:
• Frequent irritability? • Insensitivity to others? • Disoriented to place and time?
• Aggressive behaviors? • Repetitive behaviors?
• Communicating with inappropriate language? • Is your loved one socially withdrawn and not able or not wanting to get together with friends or family? Are there signs of depression?
• Do they express negative comments about him or herself?
• Are they demonstrating an inability to make decisions or making poor decisions? Is your loved one able to understand communication or instructions from others?

2. Schedule a family meeting.
A family meeting can move the topic of long-term care to a more focused discussion that can lead to a plan. Here is a checklist for planning your family meeting:

• Determine the family members that should be involved directly or indirectly in decision making. This may include extended family members, close friends or paid caregivers. Always include the person if he/she is capable of taking part in any decision making.
• Consider including an independent third party to play the role of mediator. This could be a minister or other member of the clergy, a social worker or case manager.
• If necessary, find a neutral place to hold the meeting.
• Prepare an agenda to help you stay focused.

It may include:
• A medical update • Sharing of feelings about the illness and caregiving
• Daily caregiving needs • Financial concerns
• Who will make decisions • What support role each person will play
• What support the primary caregiver needs • Next steps moving forward

3. Continue to involve family.
The move to a long-term care facility is an immense transition for any family, so it’s important to involve everyone relevant to the person: • Reach out to siblings to secure their input and support. For example, share online information about long-term care facilities to secure greater involvement and participation. • Is there is an unequal financial or time burden to one family member? If so, acknowledge the distribution of resources and discuss a strategy for achieving a balance that appeals to everyone.

4. Continue to engage your parent or loved one.
• Have ongoing conversations at times when your loved one is feeling best and there are few distractions. • Introduce the idea of an overnight visit to a long-term care facility or an extended afternoon visit to get a feel for the various available options.

5. Begin researching long-term care options in your area.
• Go to snapforseniors.com to access a nationwide senior housing database.
• Enter your city, state, zip, county or address and begin researching options by category of housing.
• View the listing details or contact the facility to ask questions and schedule a site visit. • Read comments from consumers on the listing if available.
• Ask the facility you visit for a copy of their last annual licensing survey report.
• Contact your local senior ombudsman to get perspective from a local trusted resource.
• Check references from existing or prior residents or families.

This article is provided by SNAPforSeniors, the most current and comprehensive senior housing resource in the nation.Start a free search in your area at http://www.snapforseniors.com/.

What Seniors Need to Know on the Fifth Birthday of Medicaid Law, Deficit Reduction Act

2011-02-08T07:12:00.000-08:00

Washington DC (ZeiglerSeniorNews.com) Happy fifth birthday, DRA. Only Medicaid workers, nursing home personnel and elder law attorneys would be likely to notice the anniversary of the Deficit Reduction Act. It was signed into law by President George W. Bush five years ago, on February 8, 2006.

Now universally called "the DRA", the act generated controversy from its first week and is still generating controversy.

The DRA made dozens of changes, but none were more important, controversial and confusing than changes in Medicaid rules for long-term care eligibility.

To read the full article, Click here:

New Alzheimer's Law

2011-01-25T14:09:00.000-08:00

From the ALZ.ORG website:

On January 4, 2011, President Obama signed the National Alzheimer's Project Act (NAPA) into law. For the first time, we will have a coordinated national strategy to combat Alzheimer's.

Click here to read more about NAPA.

Medicare's policy on therapy comes under attack - Medicare & Insurance News - AARP Bulletin

2011-01-24T09:32:00.000-08:00

Please clink on the link below to read about a lawsuit recently filed against Medicare by the Center for Medicare Advocacy.

Medicare's policy on therapy comes under attack - Medicare & Insurance News - AARP Bulletin

Tax code estate planning changes made in 2010

2011-01-18T12:08:00.000-08:00

2010 ended with Congress passing new laws that have significant impact on estate planning. Under the new laws, there is a $5 million estate tax exemption, a $5 million lifetime exemption for gifts, a 35% tax rate for both estate and gift taxes, and full basis adjustment to date of death value.

Executors for those who died in 2010 will have the option of electing no estate tax with a modified carryover basis (unlimited step-down for loss assets and a limited step-up of $1.3 million plus $3 million for assets passing to a spouse). Executors have an additional nine months after the enactment date to decide, file and estate tax return, pay taxes and make disclaimers.
The executor of an estate in 2010 with less than $5 million can elect to administer the estate under the new laws that provide full step-up basis for all property, including property in which a life estate was reserved by the decedent or property held in a wholly owned irrevocable grantor trust.

The above changes expire on January 1, 2013. If Congress does not act again, the gift, estate and GST exemptions will be $1 million (adjusted for inflation).

-Posted by Lisa Joyce, JD

Governor-Elect Nominates Shawn Sullivan as Secretary for the Kansas Department on Aging

2011-01-07T09:50:00.000-08:00

In Wichita today, Governor-Elect Brownback introduced his nominee for the Secretary of the Kansas Department of Aging. His nominee is Shawn Sullivan, executive director of the Kansas Masonic Home, and he will lead the Department of Aging.

(Information provided by Kansas Area Agencies on Aging Association, www.k4a.org)

Free Ethics CEU for Social Workers

2011-01-05T13:01:00.000-08:00

Ethics of End-of-Life Decision Making:

Training for Case Managers, Social Workers,

and Geriatric Care Managers

1 Ethics CEU for Social Workers
Lunch and Learn Webinar
Thursday, February 17th, 2011
11:30 AM- 12:30 PM

This course will address the legal and ethical issues surrounding end-of-life decision making. The course has been approved by the State of Kansas Regulatory Board as a CEU for social workers at all levels of accreditation. As such, this CEU will also be accepted for social workers licensed in Missouri.

To register, please contact Georgina Green, Director of Community Education, at 816-979-3533, georgina@shepherdelderlaw.com.

News You Can Use: 2011 Figures for Medicare

2011-01-05T08:14:00.000-08:00

Medicare Premiums, Deductibles, and Copayments:

Inpatient hospital- $1,132 deductible for first stay during a year (was $1,100)
Day 1 through Day 60- $0
Day 61 throughDay 90- $283 per day
60 Day Lifetime Reserve- $566 per day
Skilled Nursing Day 1-20- $0
Skilled Nursing Day 21-100- $141.50 per day

MO HealthNet:
For the second year in a row, there will be no increase in the community spouse resource allowance (CSRA) and the maximum monthly maintenance needs allowance for 2011, spousal impoverishment figures for 2009 will remain in effect.

(Information provided by the Missouri Bar Courts Bulletin, December 2010)

The New Tax Law and You

2010-12-23T11:24:00.000-08:00

The following links provide insight into the new tax law signed by the President in December of 2010.

The following bulletin comes from the Partnership for Philanthropic Planning:
Legislative Bulletin
December 20, 2010

President Signs into Law IRA Charitable Rollover Extension

President Obama has now signed into law the Tax Relief, Unemployment Insurance Reauthorization, and Job Creation Act of 2010, which provides a two-year retroactive extension of the IRA Charitable Rollover. Specifically, the new law reinstates the Rollover for 2010 and allows any eligible gifts made by January 31, 2011 to be treated as a 2010 donation and be used to satisfy the taxpayer's minimum distribution requirement for 2010. The new expiration date for the Charitable Rollover is December 31, 2011.

In addition to the Rollover extension, the new law contains a number of significant provisions that will impact the work of charitable gift planners. These include:
• Two-year extension of all the 2001 and 2003 tax cuts.
• Two-year adjustment of the estate tax with a $5 million individual exemption and 35 percent rate.
• Two-year extension of the alternative minimum tax "patch"
• Two-year extension of various charitable giving provisions such as enhanced deductions for contributions of food inventory, increased limits for contributions of capital gain real property for conservation purposes, and special rules for contributions of property by S corporations.
For a detailed summary of the new law, click here. For background information and helpful articles on the specifics of IRA Charitable Rollover gifts, click here.
New York Times article:
“Estate Tax Will Return Next Year, but Few Will Pay It”
IRS
FAQs about the New Tax Rules for Executors for 2010

UMKC Communiversity Class

2010-12-20T09:50:00.000-08:00

Samantha L. Shepherd will be teaching a class about Long-term Care Planning through the University of Missouri - Kansas City's Communiversity.

Course #5305 A
Estate and Long-term Care Planning for Seniors
Join us for a seminar to help you understand the basics of estate and long-term care planning.

CONVENER: Samantha Shepherd
CLASS FEE: $9
Sec. A: 1 session; Wednesday, February 9; 12:00 PM - 1:30 PM;
Plaza Library, Small Meeting Room, 48th & Main, KCMO;
LIMIT: 30
Register by phone at 816-235-1407.

Good News for Seniors in Jackson County, Missouri

2010-12-15T14:26:00.000-08:00

Jackson County Real Estate Tax Bills can now be spread over four payments. It's called the Senior Citizen Quad Payment Program. If you were previously registered in the half payment program, you will be automatically registered in the new quad payment program. This is great news for seniors who are managing their budgets based on fixed incomes.

Quad Payment Deadlines For 2010 Tax Bills:
December 31, 2010
February 28, 2011
May 31, 2011
August 31, 2011

For more information about the Quad Payment Program or to download the application form, please click on the link below.

http://www.jacksongov.org/content/3971/4605.aspx

If you know of similar programs in other parts of the country, please let us know.

Missouri NAELA Elections 2011

2010-12-15T11:54:00.000-08:00

Samantha L. Shepherd has been nominated for the position of Treasurer of the Missouri Chapter of NAELA, the National Academy of Elder Law Attorneys. Ms. Shepherd currently serves as a Director on the Board of Directors for Missouri NAELA and is the Chair of the Membership Committee.

New Leadership Position for Samantha L. Shepherd

2010-12-13T11:48:00.000-08:00

Ms. Shepherd has been appointed as a Vice-Chair of the Elder Law Committee for the Missouri Bar and will serve during the 2010-2011 bar year.

Scam Alert: Taking Aim at Old Soldiers; Seminars Target Vets With Unwise Investments - AARP Bulletin

2010-12-10T07:58:00.000-08:00

AARP published this brief, excellent article that explains how veterans are being exploited by unscrupulous investment advisors. This is a serious problem in Missouri, Kansas, and the rest of the United States. If you have questions about how to qualify for veterans benefits, contact your state's veterans affairs agency (nasdva.net) or contact an elder law attorney who has been accredited by the Office of Veterans Affairs.

Scam Alert: Taking Aim at Old Soldiers; Seminars Target Vets With Unwise Investments - AARP Bulletin

Elder Care Costs Surge - Life and Health Insurance News

2010-12-06T11:29:00.000-08:00

"Nursing home and assisted living rates rose significantly from 2009 to 2010, the MetLife Mature Market Institute (MMMI) reports.
A market survey of long term care costs by MMMI, Westport, Conn., found private room nursing home rates rose 4.6% to $229 per day, or $83,585 per year. Assisted living facilities rose 5.2% on average to $3,293 per month, or $39,516 per year.
In contrast, the 2010 inflation rate reported by the Bureau of Labor Statistics was 1.1%."

Elder Care Costs Surge - Core Protection Products - Life and Health Insurance News

Fall Newsletter

2010-11-24T08:25:00.000-08:00

Featured Article: Helping Veterans Pay for Long Term Care

Please click the link below to read our Fall Newsletter. Happy Thanksgiving from all of us at Shepherd Elder Law!

http://myemail.constantcontact.com/News-from-Shepherd-Elder-Law-Group--LLC-.html?soid=1102938290702&aid=mJHHvBPQdME

Holidays Without Cheer - Elderly Are Especially At Risk For Depression This Time Of Year

2010-11-22T12:52:00.000-08:00

This is an article from several years ago, but it's still very relevant. What can you do to bring some holiday cheer to your elderly friends and neighbors?

http://www.cbsnews.com/stories/2002/12/02/earlyshow/health/main531415.shtml

CBS News Story - Alzheimer's and Money Problems

2010-11-18T07:24:00.000-08:00

Wed., Nov. 17, 2010- On the CBS Evening News, Katie Couric highlighted a new report about Alzheimer's disease that suggests that the percentage of the US population with Alzheimer's is steadily increasing. CBS is beginning a new series about the medical, caregiver and financial impact that Alzheimer's has on patients and families. The first report is focused on Alzheimer's and Money Problems.

(CBS) The oldest of the Baby Boomers turn 65 next year. They have a lot on their minds, including health concerns like Alzheimer's. About five million American seniors are now battling the disease. That's expected to increase by 50 percent over the next 20 years. With no cure right now, spotting the early warning signs are so important to treating this disease. Dr. Jon LaPook begins a series of reports by CBS News and USA TODAY called "Senior Moment," exploring the aging of an iconic generation and the impact on the nation.

Alzheimer's and Money Problems
Suffering from Alzheimer's disease, Dr. Max Gomez lost his life savings and doesn't remember how it happened. Dr. Jon LaPook tells his story and how money problems can be a warning sign of the disease.

http://www.cbsnews.com/stories/2010/11/17/eveningnews/main7064638.shtml?tag=cbsnewsMainColumnArea

The "Sandwich" Generation

2010-11-16T12:52:00.000-08:00

The "Sandwich" Generation

How to Balance Life in the Middle

Date: November 18, 2010

Time:
Registration 6:00 p.m.
Presentation 6:30 p.m. to 9:00 p.m.

Location:
Marriott Country Club Plaza - Grand Ballroom
4445 Main Street, Kansas City, Missouri

The event is being organized by Creative Care Consultants, and Shepherd Elder Law Group is one of the sponsors.

Please visit the event website at: www.gltoyne.com/Sandwich

How To Balance Life in the MiddlePresented By: Barbara E. Friesner, MBA

Helping your aging parents is one of the most loving things you can do. Unfortunately, as much as you’re trying to help, the life of a caregiver can be draining, stressful, overwhelming, frustrating, and for some, even filled with guilt, resentment or anger. As a result, a lot of family members will just drop difficult eldercare issues and hope that it will all resolve itself – or drop it until it becomes a crisis – ESPECIALLY IF YOU’RE A MEMBER OF THE SANDWICH GENERATION.THE GOOD NEWS IS THAT IT DOESN’T HAVE TO BE THAT WAY!

That’s why I’m so excited to be doing this program – to help you relieve some of the pressure of being caught in the middle.
In this program you will learn how to:
-Understand Why Your Parents Are the Way They Are
-Organize Eldercare
-Get Help That Helps
-Know What Your Aging Loved One Wants – And Help Them Get It
-And Much, Much More

REPORT ELDER ABUSE

2010-08-30T05:54:00.000-07:00

Report Elder Abuse. You can make a difference.

The following is a Kansas telephone number to report suspected elder abuse:

1-800-842-0078.

Elder abuse comes in many forms. There are the more obvious scenarios, where an elder is physically mistreated or neglected. There are also the scenarios that are more subtle, but equally damaging.

One example of a subtle, yet extremely damaging, form of elder abuse is financial exploitation. Are the children acting in their own best interests rather than in the interest of their parents? Are the decisions of the children money motivated, resulting in inferior care for the elder? Both Missouri and Kansas offer 1 800 numbers for concerned citizens to alert state authorities to the possibility of elder abuse. If you suspect elder abuse, contact those who can assist.

The following is a Missouri telephone number to report suspected elder abuse:

1-800-392-0210.

Concert Series for Seniors

2010-08-23T09:25:00.000-07:00

Concert Series for Seniors

Love in the Afternoon

Enjoy fine cuisine and music with friends.

shawneeheartlandal.com/pages/%5Cnewsletter%5CNEWSLETTER.pdf

Come out and see what everyone is talking about!

2010-08-17T04:59:00.000-07:00

1-800-392-0210

In Missouri, the Department of Health and Senior Services investigates elder abuse. Please do not hesitate to call if you believe that an elder is the victim of abuse, whether it is financial abuse, physical abuse or any other abuse.

45th Anniversary of Older Americans Act: The birth of Medicare and Medicaid

2010-07-17T06:43:00.000-07:00

The following is a Statement by Assistant Secretary Greenlee on the 45th Anniversary of the
Signing of the Older Americans Act.

"On July 14, 1965 President Johnson signed the Older Americans Act into law. Sixteen days later, on July 30, he signed legislation creating Medicare and Medicaid. These three programs, along with Social Security enacted in 1935, have served as the foundation for economic, health and social support for millions of seniors, individuals with disabilities and their families. Because of these programs, millions of older Americans have lived more secure, healthier and meaningful lives. The Older Americans Act has quietly but effectively provided nutrition and community support to millions. It has also protected the rights of seniors, and in many cases, has been the key to independence.

In 1965, there were about 26 million Americans age 60 and over. Today, there are 57 million older Americans 60 and over, with many more on the immediate horizon. Our senior population is not only growing larger, but becoming more diverse. Adults over 80 are our fastest growing group, and many will need long term care. Reliance on family members, who currently provide 80 percent of the long term care assistance for our nation's seniors, will increase.

The historic enactment of the Affordable Care Act (ACA) by President Obama on March 23, 2010 provides us with another tremendous opportunity to harness the successes and progress of the last four decades to further improve the health and lives of older Americans and support their caregivers. The ACA represents the biggest change in our national health care delivery system since 1965. And just as they were in 1965, the programs of the Older Americans Act - and our national aging network of state, tribal and community-based organizations, service providers, volunteers and family caregivers - will be called upon to complement, support and enhance these changes. How successfully we weave these multiple responsibilities together will say much for how we will care for seniors in the future. "

‘Doughnut hole’ checks go out to half a million Missourians

2010-07-15T05:29:00.000-07:00

‘Doughnut hole’ checks go out to half a million Missourians

2010-07-15T04:59:00.000-07:00

Donut Hole Checks: Beware of Scams

CMS (The Centers for Medicare and Medicaid Services) said checks will be mailed monthly, starting as early as this summer, and will continue throughout the year as Medicare beneficiaries hit the donut hole. Those who qualify can expect to receive their check within 45 days of reaching the gap.

Seniors beware of scams involving confidential information: Seniors who qualify for the $250 check will not have to give their social security number or bank account information. CMS does not need the Seniors to fill out any forms. The process is automatic: if the senior reaches the donut hole, a check will automatically be sent out in the mail.

The $250 check in the mail is the first tangible benefit the seniors will see from the March 2010 health care reform.

“One of the biggest ways the new law is going to help seniors is by gradually phasing out the Medicare prescription drug doughnut hole, which has made it hard for seniors to afford their medications,” Sebelius said.

2010-07-14T21:30:00.000-07:00

What is the donut hole?

The context is seniors and their pharmacy costs.

The donut hole is the commonly used reference to the middle of the year for a senior, where she must pay the full cost of her monthly prescriptions without any assistance from Medicare. Medicare helps around the edges:

First, the senior receiving Medicare must pay her annual deductible. The deductible is $310. On a fixed income, the beginning of the year is not an easy time. Next, after paying the first $310 of pharmacy bills for the year, the senior must pay 25% of her drug costs until her total drug cost reaches $2,830 for the year.

Then, the senior falls into a coverage gap. In this coverage gap or "donut hole," the senior must pay for drugs out of pocket until her annual expenses exceed $6,440. In other words, while the cumulative annual drug costs are between $2,830 and $6,440, the senior is paying 100% out of pocket. Once the senior's drug costs exceed $6,440, she will only pays 5% of her drug costs for the rest of the year.

Eliminating the donut hole is one of the major benefits for seniors of the March 2010 Health Care Reform.

2010-07-14T21:13:00.000-07:00

How Health Care Reform Affects Older Americans

On March 23, 2010, President Obama signed a comprehensive health care reform bill (H.R. 3590) into law. On March 25, Congress passed the Reconciliation Act of 2010 (H.R. 4872) which modifies H.R. 3590. Taken together, these two bills comprise the health care reform package. Important provisions for older adults and people with special needs include:

SOME OF THE MEDICARE CHANGES

*The new law provides a $250 rebate to Medicare beneficiaries who reach the Part D coverage gap in 2010 (Effective January 1, 2010).

*The new law also gradually eliminates the Medicare Part D doughnut hole by 2020:

***For brand-name drugs, the new law requires pharmaceutical manufacturers to provide a 50% discount on prescriptions filled in the Medicare Part D coverage gap beginning in 2011, in addition to federal subsidies of 25% of the brand-name drug cost by 2020 (phased in beginning in 2013)

***For generic drugs, provides federal subsidies of 75% of the generic drug cost by 2020 for prescriptions filled in the Medicare Part D coverage gap (phased in beginning in 2011)

*Under the new law, Medicare will cover an annual wellness visit and creation of a personalized prevention assessment and plan. There is no co-payment or deductible for the annual wellness visit and the assessment. Prevention services include referrals to education and preventive counseling or community-based interventions to address risk factors.

*The new law eliminates Part D cost-sharing for full-benefit, dual eligible beneficiaries receiving home- and community-based services.

The changes to Medicare extend by nine years the life of the Medicare Trust Fund, which was projected to be depleted in 2017.

For a full version of this article, please see the NAELA website. The authors are Brian Lindberg and Gail MacInnes.

2010-07-11T12:21:00.000-07:00

HIPPA RELEASE AND AUTHORIZATION

In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA). Access to our health records is now regulated through this piece of federal legislation.

If you would like some person other than yourself to have access to your medical records and information, and you would like health care providers to release your medical information to that person, you must authorize the release of the information in writing.

Q: Is it a good idea to include a specific “HIPAA release” in the health care proxy/ power of attorney or to have a stand-alone HIPAA release version?

A: Either will work. In fact, it’s not legally required to have specific language related to HIPAA. Practically speaking, it is a good idea to either have a stand-alone HIPAA release or HIPAA specific language in your health care proxy.

THE HEALTH CARE PROXY ROUTE:

The federal law does not require a separate HIPAA release document; however, the health care providers and those whose job it is to release or not to release information are more comfortable when they have a HIPAA release in hand. In addition, a power of attorney for health care becomes effective after you lose your capacity to make or communicate decisions. That means that, unless the draftsperson clarifies otherwise, the power of attorney does not authorize release of medical information to the person named while you remain competent. To clarify, a good, well-written health care proxy or power of attorney authorizes the agent or attorney-in-fact to have access to medical records and personnel of the principal.

THE STAND ALONE HIPAA RELEASE ROUTE:

The primary reason to have a stand-alone HIPAA release is simplicity.

In our experience, a stand-alone HIPAA release document that accompanies the health care proxy is the simplest means of gaining access. It’s a page or two and it’s drafted for lay people to read; in other words, it’s simple and intelligible and gets the job done.
-----------------
If you want some person other than yourself to have access to your medical information and records while you remain competent, you need to complete and sign a HIPAA release or ensure that your attorney has drafted your Health Care Proxy with the correct legal language enabling immediate access.

2010-07-09T06:22:00.000-07:00

Veterans Benefits: Aid and Attendance (Basic Eligibility Part II)

Periods of War: What does this mean? In order to be eligible for Aid and Attendance (or the lesser included pensions) the veteran must have served for 90 consecutive days, and one day must have been during a Period of War.

Our senior population participated in World War II, the Korean conflict and Vietnam. The history book dates are perhaps not an exact match with the dates set forth in the law establishing VA pension benefits. Here are the pivotal dates:

World War Two (WWII): December 7, 1941 through December 31, 1946.

Korean conflict: June 27, 1950 through January 31, 1955.

Vietnam: February 28, 1961 through May 7, 1975 (if the veteran was physically in the Republic of Vietnam) or August 5, 1964 through May 7, 1975 (if the veteran was serving outside of the actual Republic of Vietnam.)

Authority: 38 U.S.C. 101(29)

2010-07-07T16:42:00.001-07:00

Special Needs Trusts- Do you Have An Early Termination Provision?

The Trusts and Special Needs Section of the National Academy of Elder Law Attorneys recently advised NAELA members of a change to the POMS (the Social Security Program Operations Manual). While the change to the manual appears now, the actual implementation date is not until later this year.

Effective October 1, 2010, First Party Trusts (D4As and D4Cs) must undergo another test to pass muster with Social Security. Very often the goal of an SNT is to ensure that the assets of the SNT are not considered countable resources by Social Security and thus passing muster is pivotal.

The Social Security manual directs the field officer to review all d4a and d4c trusts established after January 1, 2000. First Party Trusts (in other words, those established with the monies of an individual) drafted over ten years ago need a second look.

A d4c or a d4a trust with a clause that allows a trust to terminate before the individual (the beneficiary) dies are under scrutiny. The clause allowing for a trust to terminate is called an early termination clause, or an early termination provision. The typical clause states that the trust may terminate when the individual is no longer disabled. Another typical clause states that the trust may terminate when the trust fund runs so low on assets that it is not economical to continue the trust.

What to look for in your d4a and d4c trust:

If there is a provision in the trust that permits the trust to terminate before the beneficiary dies, look for these 3 points:

1. All remaining $ in the trust must first be applied to Medicaid debt.

2. After the State has been paid, all remaining $ must go to the beneficiary (OR directly to another d4c trust, per specific limiting language.)

3. The beneficiary CAN NOT have the power to terminate the trust him/herself.

First Party SNTS will be considered countable resources if the early termination clauses gives the beneficiary authority to terminate the trust.

2010-07-06T05:03:00.000-07:00

Veterans Benefits: Aid and Attendance (Basic Eligibility Part I)

There are three basic components to eligibility for the Aid and Attendance benefit for WWII, Vietnam and Korean War Veterans:

1). Active duty of 90 days.

2). One day of service during a period of wartime.

3). Honorable Discharge.

Veterans of our more recent conflicts have different eligibility criteria, and the emphasis in this blog post is eligibility for seniors who have served in the military.

Each of the eligibility criteria requires an in depth analysis, as the complexities and nuances are the nature of the law. For example, a "period of wartime" is an artificial, VA created, set of dates that does not entirely match the history books. It is best to confirm your dates of service against the list of VA dates.

2010-07-05T13:49:00.000-07:00

I would like to set forth a basic primer for those people exploring VA benefits for themselves or for their loved ones.

I will start by addressing some general scenarios that arise in my practice regarding a little known benefit called Aid and Attendance.

Aid and Attendance is a needs based program. It is there to help those Americans who served our country during a period of war time, who now find themselves in need.

As you walk through your day, I challenge you to look around you and query whether there are these veterans in your life that you could be helped by this benefit.

What do these Veterans look like?

They are your neighbors. They are your parents. They are your friends. They own homes. They are not penniless; they just have exceedingly high medical costs.

Example:

Bill is a WWII veteran. He has worked hard all of his life to provide for his wife, Sara, and family. Together they have raised four children. He is now 90 years old and she is 88. A recent fall sent Bill to the hospital. He fractured his hip, requiring surgery and extensive rehabilitation. He has now been in a skilled nursing facility for three months and is ready to come home. He has no intention of dying in the nursing home and Sara is eager to have him home. Bill has an easy smile and a sweet sense of humor. He is really a great guy and someone you would find easy to like.

Sara is fairly healthy; but at 100 lbs she can hardly help lift Bill into his wheelchair or into the shower. Sara can feed Bill and do the laundry, but she can't bathe him by herself. She can't take care of his toileting needs either. This upsets them both. Bill and Sara need help in their home. It's hard to ask for help and it's hard to pay for help. This is not an easy time for either of them. If Bill is like most veterans I know, he does not want to ask for money and he certainly doesn't want hand-outs. He would, however, love to hear from the VA that his time served in WWII now draws a benefit for Sara. He feels awful about the pressure she is under to provide for his care and if cost were not a factor he feels sure she would be open to having help.

Please tell Bill that the Aid and Attendance benefit can step in at this crucial time. While there are income limitations that often deter people from applying for Aid and Attendance, there is significant confusion in this area. Bill's income may seem high, but costs for his care are subtracted from his income.

May is National Elder Law Month

2010-05-05T15:31:00.000-07:00

Elder Law attorneys throughout the country contribute to their communities by educating seniors and people with disabilities about their legal options and by providing pro bono services.

A Guide To Women's Health: Fifty and Forward

2010-04-25T17:46:00.000-07:00

From Harvard Medical School:

For both men and women, many of the things we need to do to stay healthy are one and the same: Eat right, exercise, don't smoke. But women have health concerns that are unique to them: Mammograms, bone density tests, menopause, ovarian cancer. Some medical conditions—like heart disease—may present different symptoms, or different degrees of risk in women. And for a woman at midlife, medical decisions are changing and need to be made more frequently.

That's why the experts at Harvard Medical School have created A Guide to Women's Health: Fifty and Forward, a comprehensive report to help women take stock of their health at midlife, understand their health risks, and discover the things they can do to stay healthy and strong. Women's health studies have shown that it's never too late to feel better by living better. Whether you're just entering midlife, or are in your 80s and beyond, there are steps any woman can take today to ensure the best possible health tomorrow.

This report also includes a Special Bonus Section: 10 steps to a longer, healthier life, which outlines ten things a woman can do to reduce her risk of many major degenerative diseases.

A Guide to Women's Health: Fifty and Forward is every woman's blueprint for good health today, tomorrow, and for the years ahead. It can help you make important health decisions, improve your quality of life, and greatly reduce the likelihood of landing in a nursing home

Health Care Reform Provisions Affecting Older Adults and People with Special Needs

2010-04-24T14:35:00.000-07:00

The National Association of Elder Law Attorneys has modified their document "Health Care Reform Provisions Affecting Older Adults and People with Special Needs" to include information on Medicaid maintenance of effort provisions. You can access the updated document at the link above and by visiting the "Health Care Reform Information" section on the "Government Affairs" page of the NAELA website.

Other helpful resources released in the last few days are:
The Scan Foundation Policy Brief
Kaiser Family Foundation Summary of the New Health Reform Law
Small Business Administration Health Care Reform Resources
Chris Jennings' article on health care reform implementation in the New England Journal of Medicine
Register now!: Thursday, April 15 from 2:00 - 3:30 p.m. ET NAELA will host a telephonic training entitled "The New Health Care Reform Law: Understanding Its Impact on Older Adults and People with Special Needs"featuring presentations by experts on the Medicare, Medicaid andlong-term care provisions of the new law.
UPDATED: Health Care Reform Provisions Affecting Older Adults and People with Special Needs (March 30, 2010)
Text of H.R. 3590 (Now P.L. 111-148)
Text of H.R. 4872 (Now P.L. 111-152)

FIve Big Myths - Free Podcast Series from ABA

2010-04-24T14:32:00.000-07:00

Health Law Section Podcast Series | Free to the General Public

Five Big Myths of Advance Care Planning and How to Stay Anchored in Reality (4/13/10) | Podcast
Click here to download slides and materials for the teleconference.

This program addresses the five biggest myths that plague advance care planning and how to steer clear of them and make advance care planning more effective.

Myths:

People should use their state’s official advance directive form(s).
Your advance directive should include as specific instructions as possible.
Advance Directives are legally binding so doctors have to follow them.
Doing everything possible for dad means keeping dad alive at all costs.
A written advance directive is better than talk.

National Healthcare Decisions Day

2010-04-18T07:38:00.000-07:00

On the eve of National Healthcare Decisions Day, President Obama issued a memorandum that asked his administration, among other things, to:

Ensure that all hospitals participating in Medicare or Medicaid are in full compliance with regulations, codified at 42 CFR 482.13 and 42 CFR 489.102(a), promulgated to guarantee that all patients' advance directives, such as durable powers of attorney and health care proxies, are respected, and that patients' representatives otherwise have the right to make informed decisions regarding patients' care.

You may find the full Memorandum here: http://www.whitehouse.gov/the-press-office/presidential-memorandum-hospital-visitation While this Memorandum was specifically directed at dealing with GLBT patient visitation issues, the reference to advance directives is important for all patients.

Improving the Lives of America's Elderly Poor

2010-04-14T08:08:00.000-07:00

The National Senior Citizens Law Center advocates before the courts, Congress and federal agencies to promote the independence and well-being of low-income elderly and disabled Americans.

Since 1972, the National Senior Citizens Law Center has worked to promote the independence and well-being of low-income elderly and disabled Americans, especially women, people of color, and other disadvantaged minorities. Because we believe in publicly-funded safety net programs, we work to preserve and strengthen Medicaid, Medicare Part D, Social Security and SSI. To guarantee fair treatment, we work for greater access to federal courts for citizens and for better enforcement of consumer’s legal rights in safety net programs.

NSCLC works toward an America in which elderly people and people with disabilities can live in dignity and safety, free of the worries and pain of poverty, able to afford health care to the end of their days, and able to contribute to their families and societies to the best of their abilities.

Check out more at www.nsclc.org/consumer.

When Harry Met Sally

2010-04-11T18:36:00.000-07:00

The Today show recently interviewed a national elder law expert, Hy Darling, about the topic of Divorce and Medicaid. How do those topics align, you wonder? As unsavory as it may sound to any of us, divorce is sometimes the chosen course for a couple when one of the two faces long term care.

Before passing judgment on this choice one must fully grasp the scenario. What does this situation look like? Well, when Harry met Sally they were both young and healthy and very much in love. Time has passed. Sally is now 68. Sally was diagnosed with Alzheimers five years ago. Her decline progressed rapidly. She now requires 24 hour supervision. Harry is a devoted husband; he has had 40 wonderful years with Sally. He is suffering on many levels. He misses his wife; he is terribly lonely and he is riddled with guilt. The Sally he knew is no longer there; there are many days when Sally does not even recognize Harry, but still he goes to visit her with the hope that she will be having a "good" day. He tried to keep Sally at home, but this became unsafe for Sally and extremely stressful for Harry: Sally would go for walks and get lost. Sally would take three days worth of her medications on one day because she forgot she had already taken the first and then the second dose.

Harry and Sally are "upper middle-class" Americans. They worked hard during their working years and were frugal with their spending. They own a modest home and had other assets, including IRAs, retirement funds, CDs and savings accounts totalling $600,000. Will it be enough? Sally's monthly cost for care in the long-term care facilitytops $6000 a month. Long term care is not paid for by Medicare. Long term care is not paid for by Medical insurance or Supplements. Harry and Sally, like most Americans, do not have Long Term Care Insurance. After five years of paying for Sally's care in the Alzheimer's unit of the Long-term care facility, Harry and Sally's funds are nearly depleted--they have spent $400,000 on care and prescriptions. Sally is only 68 years old. She has a life expectancy of 78. What is Harry to do? He needs the support and guidance of an elder law attorney who will guide him through his options for paying for Sally's care.

Married couples are legally obligated to support one another. Medicaid will not help Harry and Sally until they are broke. Is this true? Yes, sadly, this is accurate. Harry can go through a Division of Assets process to prevent complete impoverishment; the question of whether this is the chosen course is Harry's decision. The most that Medicaid rules permit Harry to retain is approximately $100,000---and this assumes that Harry is sufficiently savvy to fully utilize the Division of Assets process to its fullest. And in addition, Harry can live in his house, but when Harry dies Medicaid will have to be repaid from the sale of Harry's house. As attorney Hy Darling mentioned in the Today Show interview, on rare occasion divorce is the answer. I think Harry would rather poke out his eye and go broke, but I believe in love over money.

Alzheimer's to Double Every 20 Years

2010-04-10T11:59:00.000-07:00

Alzheimer's Disease International released a new report indicating that the number of people with Alzheimer's or another dementia, currently 35 million worldwide, is expected to nearly double every 20 years, to 65.7 million in 2030 and 115.4 million in 2050.

According to the 2009 Alzheimer's Disease Facts and Figures report, issued by the Alzheimer's Association, someone in the United States develops the disease every 70 seconds, and an estimated 5.1 million Americans over age 65 have the disease. This report also states that about 2.7 million people over age 85 have Alzheimer's, and that by the time the first of the baby boomer generation reaches 85 in 2031, an estimated 3.5 million seniors in that age group will have disease.

These statistics highlight the need for estate planning in general and incapacity planning in particular, as well as disability, long-term care, and special needs planning.

The Quest for a Satisfying Career

2010-02-23T12:56:00.000-08:00

Rachel Brimm, a second year student at the University of Missouri Kansas City Law School, recently interviewed Samantha as part of a class project called "The Quest for a Satisfying Career." With Rachel's permission, here's a synopsis of the interview:

Last week, I interviewed Samantha Shepherd for this project. She is a solo practitioner who specializes in Elder Law. Samantha graduated from Boston College Law School in 1994. She began her legal career working with children’s legal issues while in college and law school. Her first job as an attorney was working as in-house counsel for a bank. However, she did not feel that this job fed her soul. Under the tutelage of a mentor, Samantha embarked on a rewarding career helping the elderly, those with disabilities and their families.

When asked to define success, Samantha replied that success occurs when one can go home at night and feel good about what they did. She elaborated by explaining that the law gives her the power to help people navigate the legal system. It was evident from talking with her that she was able to successfully retain autonomy over her work. She gets involved with clients to the extent that she wants to be involved. For example, the day I met her she was planning to meet a client’s daughter to tour a nursing home. This had nothing to do with the legal work she was performing for her client, but because she had developed a positive relationship with the client’s family they had invited her to join the tour and she happily agreed. Another way she retains autonomy over her work is her choice to only go to court when there is no adversary. For example, she assists clients with uncontested guardianships but chooses not to get involved in disputes.

Overall, Samantha radiated happiness with her chosen profession. She is truly passionate about what she does and believes she is pursuing good for other people. I think one source of her happiness is the close relationships she is able to develop with not only her clients, but also their families. On a day-to-day basis, she receives hugs from clients. This really struck me because it must feel wonderful to have clients express on a daily basis how much they appreciate you.

She also talked about how the nuances involved with high-net-worth can be intellectually stimulating. She said that clients are so relieved to give her their problems involving estates, trusts and Medicaid planning. And while some aspects of her job can be more tedious than others, the key is that she has found her passion and purpose in life.

In addition to her law practice, Samantha is also the mother of four and very committed to her family. When asked about maintaining the work/life balance, she gave the following advice: It helps to remember that until your kids are completely grown, there is no right answer. When you are at home, you think you should be at work and vice versa. Having these thoughts is the norm. She also said it is helpful to realize that we are fighting against the cultural assumption that moms will be more involved in their kids’ lives than dads. For Samantha, her purpose of practicing law is helping other families. Thus, in order to effectively help others it is important that her own family comes first.

She elaborated by explaining that sometimes this means she does not get as much sleep as she would like. Other times, things like getting her nails done takes second place to spending time with her kids. She also talked about the importance of accepting help. She hires someone to clean her house because it is efficient and frees up time for her to spend time with her kids. These are just some of the personal choices that she has made to maintain the balance between her work and family life.

I am personally interested in the area of elder law and asked Samantha for advice on finding happiness in that specific area. She advised that it was a relatively young area of law and encouraged me to seek out a mentor in the field. She cautions young attorneys not to start their own practice until they have had both a mentor and years of experience in practice. She said there are two ways of learning: (a) find someone whose expertise you find valuable and has a good reputation to mentor you or (b) learn by trail-and-error which is very painful for the client.

Samantha impressed me with her ability to find happiness within the legal profession. She admitted that she did not know anyone from her law school class who is happy doing what they are doing. However, her own story showed me that it is possible to find happiness within the field of law. Her ability to retain control over her work and the amount of gratitude she receives on a daily basis from her clients inspired me. Hopefully, one day I too will have a career in which I am truly passionate.

Free Seminar Feb 21st - Medicaid, Nursing Homes & You

2010-01-24T15:13:00.000-08:00

How do I pay for a nursing home? Do I qualify for Medicaid? Can planning ahead save me money? Shepherd Elder Law Group is holding a free seminar February 21st.

The recent downturn in the nation's economy has created a crisis for state Medicaid programs. Do you know the rules? Medicaid is a joint federal and state program that provides payment for medical care for persons unable to afford to pay. Medicaid covers physicians' services, hospital care, supplies and other necessary services once a person has been made eligible for the program. It also pays for the expenses of long–term care in a nursing home.

The Medicaid program is administered independently in each state. While the
basic eligibility standards are the same throughout the United States, there are
significant differences between the state Medicaid programs. Despite these
differences, eligibility is generally based upon the amount of assets a person has along with the income that the person receives. Eligibility is determined at state Medicaid offices and, in the case of married individuals, the assets and income of both spouses are considered in the determination process.

Medicaid is often of importance to middle-income Americans because Medicare does not cover the costs of longterm care for illnesses such as Alzheimer’s disease or paralysis caused by a stroke. Most people who need such care for extended periods will eventually deplete their assets and become unable to pay the costs of their care.

Shepherd Elder Law Group is dedicated to providing solutions for the elderly, the disabled and their families. No matter what your situation, we listen to the needs of our clients and provide information, advice and most importantly, support.

Long-term care costs leave medicaid as the option

2009-12-14T18:09:00.000-08:00

If you are not familiar with the term "long-term care," you probably will be soon. Over 10 million people in the U.S. need long-term care today. That number, while shockingly large, is increasing by the day. Use of long-term care is projected to double between 2000 and 2040.

Of these 10 million people who currently need long-term care, 86% receive services in their community and 14% live in nursing homes. Neither care in the community nor care in a nursing home is cheap. The cost of a nursing home stay is quite astounding. Rates are charged daily, much like a hotel. The average cost of a nursing home stay in 2009 was $70,000 per year. Some states are, of course, more pricey than others. The Midwest is significantly less expensive than the coasts, for example. The average cost of a nursing home stay in Missouri is closer to $50,000. Given this data regarding the high cost of a year's stay in a nursing home, it is hardly surprising that two-thirds of older people in the community indicate that they would be unable to pay for even one year of nursing home care.

A substantial portion of older Americans turn to Medicaid to pay for their long-term care. In deed, Medicaid currently pays for approximately half of all nursing home care costs. Qualifying for medicaid is rather straight forward, but daunting: reduce your assets down to $2000 in most states, or $999 in Missouri. Reducing one's assets to $999 translates into impoverishment. There are planning techniques to assist older Americans as they face this challenge. Planning can help avoid bumps and hurdles. The situation of each individual is unique. Become informed. Attend seminars and learn how you can best preserve your assets.

For more detailed information related to the above statistics, see the article from the NAELA JOURNAL - National Academy of Elder Law Attorneys* Volume 5* 2009* Number 2 - entitled "Future Challenges Facing Medicaid's Role As A Provider Of Long-Term Care," by Molly O'Malley Watts, MPP, Judith Kasper, PHD, and Barbara Lyons, PHD.

Written by
Samantha Shepherd, JD
LL.M Estate Planning

Bartle Hall FREE health Clinic

2009-11-30T19:09:00.000-08:00

Great opportunity for Kansas City seniors to receive free health care.
Enormous free health clinic planned at Bartle Hall - KansasCity.com

Shepherd Elder Law Group, LLC

New Poverty Guidelines Announced

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

Missouri Medicaid Allowance has been Raised

A prison hospice program

More Changes in Medicaid Allowances

New Bill to Grant Coma Rights in Missouri

NHDD Speak Up Video

Maintenance Manual Revisions

Occupational therapists launch new guidelines to help stop elder abuse before it starts

Elder Substance Abuse

The Ups and Downs of Medicare Part B Premiums: Frequently Asked Questions

The MetLife Study of Elder Financial Abuse

Medical testing companies' Medicare deal scrutinized

By Kelly Kennedy, USA TODAY

Pfizer, Humana form research pact on elderly health

MetLife's Market Survey

Economy Delays Boomers' Plans to Sell Homes

Economy Delays Boomers' Plans to Sell Homes

CNBC

Medicare's Annual Open Enrollment is from Oct. 15 - Dec. 7

House Panel Hunts the Elusive 'Millionaire on Medicaid'

Prevent Medicare Fraud with the CMS Fraud Prevention Toolkit

Senior Driving Seminar

August Newsletter - Alzheimer's, On the Rise.

NAELA Fall Newsletter

Hospice improves care for dementia patients and their families

Hospice improves care for dementia patients and their families

Survey data come amid debate over Medicare funding

Study: Kids safer in grandma's car

Falls, eye test may give clues to Alzheimer's

Home care cutbacks put strain on elderly

Plans sacrificed to trim budgets

New End-of-Life Care Laws

Law on End-of-Life Care Rankles Doctors

By JANE E. BRODY

Missouri Bar Publishes New Version of Durable Power of Attorney

Missouri Bar Publishes New Version of Durable Power of Attorneyfor Health Care and Health Care Directive

The Baby Boomers are Retiring

Early signs of Alzheimer’s disease

Should Your Elderly Mom Or Dad Drive a Car?

Is a Beneficiary Deed a Good Option in Missouri?

Federal budget negotiations propose radical changes in Medicare and Medicaid

What Happens to Current Nursing Home Residents if the House Budget Resolution Becomes Law?

National Healthcare Decisions Day 2011 - Locations around KC

National Healthcare Decisions Day 2011

Advocates for the aging fear waiting list for services is on the way

KS Legislative Update: Governor's budget includes cuts in elderly services

Long-term care "Conversation Checklist" for families and seniors

What Seniors Need to Know on the Fifth Birthday of Medicaid Law, Deficit Reduction Act

New Alzheimer's Law

Medicare's policy on therapy comes under attack - Medicare & Insurance News - AARP Bulletin

Tax code estate planning changes made in 2010

Governor-Elect Nominates Shawn Sullivan as Secretary for the Kansas Department on Aging

Free Ethics CEU for Social Workers

News You Can Use: 2011 Figures for Medicare

The New Tax Law and You

UMKC Communiversity Class

Good News for Seniors in Jackson County, Missouri

Missouri NAELA Elections 2011

New Leadership Position for Samantha L. Shepherd

Scam Alert: Taking Aim at Old Soldiers; Seminars Target Vets With Unwise Investments - AARP Bulletin

Elder Care Costs Surge - Life and Health Insurance News

Fall Newsletter

Holidays Without Cheer - Elderly Are Especially At Risk For Depression This Time Of Year

CBS News Story - Alzheimer's and Money Problems

The "Sandwich" Generation

REPORT ELDER ABUSE

Concert Series for Seniors

45th Anniversary of Older Americans Act: The birth of Medicare and Medicaid

‘Doughnut hole’ checks go out to half a million Missourians

May is National Elder Law Month

A Guide To Women's Health: Fifty and Forward

Health Care Reform Provisions Affecting Older Adults and People with Special Needs

FIve Big Myths - Free Podcast Series from ABA

National Healthcare Decisions Day

Improving the Lives of America's Elderly Poor

When Harry Met Sally

Alzheimer's to Double Every 20 Years

The Quest for a Satisfying Career

Missouri Bar Publishes New Version of Durable Power of Attorney
for Health Care and Health Care Directive