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

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

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

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

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

Missouri Medicaid Allowances Increase Effective July 1st, 2012

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

Cohousing - What is it? Where is it?

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

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

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

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

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

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

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

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

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

Source: Taken from an article from Kevin Knapp

MO Seniors' Legal Helpline

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

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

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

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

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

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

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

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

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

Congratulations (and thank you) Samantha!

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

Federal Patient Self-Determination Act

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

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

AHRQ

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

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

Pew Research

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

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

Annals of Internal Medicine

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

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

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

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

The Older Americans Act Should Be Reauthorized by Congress This Year

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

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

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

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

Bipartisan Support

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

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

Congress Should Make the OAA and Its Critical Services a Priority

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

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

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

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

The bill also:

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

·         Requires better data collection and program evaluation.

Others who have stepped up with OAA ideas:

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

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

Get the OAA Back Into Law

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

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

Contact the House and Senate. 

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

Read the OAA Reauthorization Bill.

See a video of Sen. Sanders’ introductory remarks.

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

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