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Tuesday, March 24, 2015

Watch Out - Don't Fall

By: Susan M. Graham, Certified Elder Law Attorney, Senior Edge Legal, Boise, Idaho 

Falling injuries requiring medical attention occur for 115 people in 1,000 adults age 75 and older.  About 40% of those over 75 fall at least once a year.  If the person is hospitalized, only half of that number will be alive a year later.  Every 18 seconds, an older adult is treated in an emergency department for a fall.  More than 90% of hip fractures among older adults are the result of a fall. 

There are many reasons for a fall that are age-related:  osteoporosis, slowed protective reflexes, poor eyesight, medication side effects, less coordinated gait, loss of muscle tone and strength and a drop in blood pressure upon arising.  

It is possible to reduce the risk of falls with maintaining muscle strength and improving balance.  “Some age-related loss of balance is inevitable, but some is reversible.”[1]  Dr. Laurence Rubenstein suggests two self-help tests: 

         • With someone ready to steady you if you need, stand with your feet together and close your eyes.  How long before you begin to lose your balance? 

         •  Stand on one leg behind a chair without holding on.  If you cannot do this for 30 seconds, you need to improve your balance.  If you try this with your eyes closed, see how long you can remain stable.  A 25-year-old can do it for about 30 seconds, but a 65-year-old may last only a few seconds. 

What can you do if you need help with balance?  Look for local balance or “Fit & Fall” classes in your area.  Classes are often offered at the local library or community center.  Don’t become a statistic. 



[1] Dr. Laurence Z. Rubenstein, Chairman of Geriatrics at the University of Oklahoma College of Medicine, “The Far-Reaching Effects of a Fall”, by Jane E. Brody, The New York Times, March 9, 2015


Tuesday, August 19, 2014

Is it Time to Ask for Help?

By: Susan M. Graham, Certified Elder Law Attorney, Senior Edge Legal, Boise, Idaho

Are you concerned for a friend, neighbor or family member that may need some extra help to continue to live safely at home?

You may have noticed one or more of the following:

• They have bruises on their arms and are unstable when they walk
• They miss doctor, hair and/or dentist appointments
• Bills pile up and are not opened
• They have a hard time dressing or eating
• They are isolated from friends
• They have become a danger to themselves or a danger to others, because the stove is left on or they have become poor drivers.

What can you do to help? Express your concern to them and also to the person(s) they rely upon. It is best to get help before there is a crisis. Once any problems are identified, it is easier to solve them with paid or volunteer help, or with other simple solutions such as better lighting, physical therapy or removing throw rugs.

Everyone will have greater peace of mind, knowing there is a plan in place to keep loved ones safe as they age.


Tuesday, May 27, 2014

End-of-Life Treatment - "Do Not Resuscitate"?

By:  Susan M. Graham, Certified Elder Law Attorney, Senior Edge Legal, Boise, Idaho

What do young doctors think about end-of-life choices?  A Stanford University study determined that 88% of young doctors prefer to avoid resuscitation and related heroic treatments when they have an illness that will result in death in the near future.[1]

Do you want high intensity care when you are terminally ill?   Do you just want the assurance of no pain when your death is near?  These important questions are best answered by you.  If you fail to make these decisions, the legal and medical system makes the election for you and requires in most circumstances that you receive, at a minimum, nutrition and hydration with nose or stomach tubes. 

This problem is easily solved.  Sign a Living Will.  This document goes into effect when a doctor has determined that your death is imminent or you are in a persistent vegetative state.  You are permitted a minimum of three choices, all of which provide pain medication to keep you comfortable.  Choice #1 is to use all the fancy machines and medical procedures to keep you going as long as possible.   Choice #2 scales back to providing you with nutrition and/or hydration with tubes.  Choice #3 is to keep you comfortable, and let you go.  The forms and choices may vary by state.

If you have not completed one of these forms, check with your Secretary of State’s office, they may have forms available. 

You are the best person to make the choice for your end-of-life care.

 



[1] Do Not Resuscitate:  What Young Doctors Would Choose, by Paula Span, The New York Times, May 20, 2014.


Thursday, November 1, 2012

The downside of Veterans Annuities the salesperson won't tell you about

 

Florida Certified Elder Law Specialist
Nationally Certified Elder Law Attorney
Florida and New Yokr Bar
 
The pitches are everywhere in Florida: So-called Veterans Benefits experts offer free seminars to condo associations. They advertise on radio and in newspapers. The companies they represent have patriotic-sounding names. They distribute glossy brochures stuffed with red, white and blue.
 
So what are these folks selling? Veterans Annuities. The pitch is this: If you are an otherwise eligible veteran who cannot get Aid and Attendance benefits because of excess assets, all you need to do is buy one of these annuities with the excess assets, and voila: instant access to benefits to help you pay the costs of long-term care nursing home, assisted living or home care. It is true enough that the V.A. does not "look back" at asset transfers, but there's a lot more to this issue that you need to consider before taking the leap. 
 
First, tying up money in an annuity is almost never a good idea for an elderly person. If you ever need the money, you'll incur substantial penalties when you withdraw it.
 
Second, people need more intensive help as they age, not less. So if you're a veteran or surviving spouse in need of Aid and Attendance benefits, somewhere down the line you may want to apply for Florida Medicaid benefits for long-term care to help you with your more extensive needs. In Florida, if the veteran purchases an annuity and then has to apply for Medicaid for long-term care, the state of Florida MUST be designated as a beneficiary of that annuity for Medicaid expenses. That's the part that the annuity salesperson doesn't tell you, and may not know himself. One thing is for sure: the commission to the salesperson on these products is quite handsome.

Iif you are a veteran or a veteran's surviving spouse and need help, DO NOT purchase an annuity without consulting with a Florida Bar Certified Elder Law Attorney who is also accredited by the V.A. to give benefits advice. Your attorney will help you fully understand the pros and the cons  and explain alternatives  to buying an annuity. All the attorneys of The Karp Law Firm are V.A. accredited.

 


Thursday, November 1, 2012

Medicare changes policy on "Improvement Standard"

By Joseph S. Karp

Florida Bar Certified Elder Law Specialist
Nationally Certified Elder Law Attorney
Florida and New York Bar
 
A sweeping change in Medicare policy may greatly help beneficiaries with chronic conditions who need skilled nursing and rehabilitation.  
In the past, Medicare would continue to cover skilled nursing care and short-term rehabilitation, like physical and speech therapy, only if the patient demonstrated that he had the potential to improve as a result of treatment. Obviously, those with chronic conditions like Alzheimer's Disease, heart disease, Parkinsons, Lou Gehrigs disease, arthritis - in other words, those who could not meet the so-called improvement standard -- were most impacted by this rule. (In fact, the so-called "improvement standard" was technically never a part of Medicare law; it had simply become the de facto standard used by Medicare decision makers.)
Now, a federal court has ruled that the improvement standard cannot be used to deny Medicare coverage for skilled nursing care and rehabilitation. The settlement in the class action lawsuit Jimmo v. Sibelius requires Medicare to cover skilled nursing and therapy even if it just maintains a person's medical condition or prevents further deterioration.  The proposed settlement was reached in federal district court on Oct. 16, 2012.
However, it's critical to note these important caveats: 
  1. The case does not change the maximum number of days of skilled care Medicare covers per benefit period. Medicare will pay 100% for a maximum of 100 days, and only if it follows a hospital stay or stay in a rehab facility.
  2. The case does not impact whatsoever on long-term, custodial nursing care, which is still not covered by Medicare, but may be covered under certain circumstances and with proper planning byFlorida Medicaid.
Details on the Medicare rule change here.

Thursday, November 1, 2012

Medicare changes policy on "Improvement Standard"

By Joseph S. Karp

Florida Bar Certified Elder Law Specialist
Nationally Certified Elder Law Attorney
Florida and New York Bar
 
A sweeping change in Medicare policy may greatly help beneficiaries with chronic conditions who need skilled nursing and rehabilitation.  
In the past, Medicare would continue to cover skilled nursing care and short-term rehabilitation, like physical and speech therapy, only if the patient demonstrated that he had the potential to improve as a result of treatment. Obviously, those with chronic conditions like Alzheimer's Disease, heart disease, Parkinsons, Lou Gehrigs disease, arthritis - in other words, those who could not meet the so-called improvement standard -- were most impacted by this rule. (In fact, the so-called "improvement standard" was technically never a part of Medicare law; it had simply become the de facto standard used by Medicare decision makers.)
Now, a federal court has ruled that the improvement standard cannot be used to deny Medicare coverage for skilled nursing care and rehabilitation. The settlement in the class action lawsuit Jimmo v. Sibelius requires Medicare to cover skilled nursing and therapy even if it just maintains a person's medical condition or prevents further deterioration.  The proposed settlement was reached in federal district court on Oct. 16, 2012.
However, it's critical to note these important caveats: 
  1. The case does not change the maximum number of days of skilled care Medicare covers per benefit period. Medicare will pay 100% for a maximum of 100 days, and only if it follows a hospital stay or stay in a rehab facility.
  2. The case does not impact whatsoever on long-term, custodial nursing care, which is still not covered by Medicare, but may be covered under certain circumstances and with proper planning byFlorida Medicaid.
Details on the Medicare rule change here.

Friday, July 6, 2012

Do You Know a Child May Have To Pay for Their Elderly Parent’s Care? Ouch!

By Susan M. Graham, Certified Elder Law Attorney, Senior Edge Legal, Boise, Idaho

Paying for long-term care in a nursing home or assisted living facility is expensive.  It can range from $3,000 to $10,000 monthly.  What if the senior cannot pay the bills?

In 2011 a Pennsylvania nursing home received a $90,000 judgment against an adult child of a parent who had an unpaid nursing home bill. [1]  The suit was based on a law that states[2]

 (a) Liability. --

(1) Except as set forth in paragraph (2), all of the following individuals have the responsibility to care for and maintain or financially assist an indigent person, regardless of whether the indigent person is a public charge:

(i) The spouse of the indigent person.

(ii) A child of the indigent person.

(iii) A parent of the indigent person.

(2) Paragraph (1) does not apply in any of the following cases:

(i) If an individual does not have sufficient financial ability to support the indigent person.

(ii) A child shall not be liable for the support of a parent who abandoned the child and persisted in the abandonment for a period of ten years during the child's minority.

North Dakota has an old law adopted in 1877, which creates a duty to support a parent.  

“It is the duty of the father, the mother, and every child of any person who is unable to support oneself, to maintain that person to the extent of the ability of each.  This liability may be enforced by any person furnishing necessaries to that person.  The promise of an adult child to pay for necessaries furnished to the child’s parent is binding.”  North Dakota Statutes § 14-09-10

An article in the North Dakota Dickinson Press highlighted the potential that nursing homes are considering using this old law to recoup unpaid bills.[3]

 



[1] Health Care & Retirement Corp. of America v. Pittas, 2012 PA Super 96, 536 EAD 2011 (May 7, 2011)

[2]  23 Pa.C.S.A. § 4603.

[3]   “Nursing homes eye old law as tool to recoup unpaid bills” by Dave Olson, The Dickinson Press, June 23, 2012.

 


Saturday, February 4, 2012

Want Advice From Those in the Last 1/3 of Their Lives?

 

By:  Susan M Graham, Certified Elder Law Attorney, Senior Edge Legal, Boise, Idaho 83702

Cornell University (my alma mater) created a Legacy Project to find out from those in the last third of their lives, what life experiences, both positive and negative, have taught them about living effectively.  There is a new book called "30 Lessons for Living", Hudson Street Press, by Dr. Karl Pillemer which gathers advice from more than 1,000 elders.1

Here are some highlights:

1.  Marriage:  "A satisfying marriage that lasts a lifetime is more likely to result when partners are fundamentally similar and share the same basic values and goals."

2.  Careers:  Be involved in work that you absolutely love and look forward to doing every day.

3.  Parenting:  Spend more time with your kids.  Share in their interests and activities.

4.  Aging:  "Embrace it.  Don't fight it."  Most of the 1,000 people found old age had more opportunity than they thought.  If you are worrying about dying, then plan for it.  "Get things organized, let others know your wishes, tidy up to minimize the burden on your heirs."

5.  Regrets:  Take advantage of opportunities.  Say "yes" more.  Fill out your Bucket List and start checking off items once they are done.

6.  Happiness:  Happiness is a choice, not what life deals you.

"Even if their lives were nine decades long, the elders saw life as too short to waste on pessimism, boredom and disillusionment."

If you want to share your own wisdom and need help in getting started, on the web go to "New York Times."  Type in "Questions for Your Own Circle of Experts."  I bet your family and friends would be delighted to hear from you.

__________________________

1"Advice From Life's Graying Edge on Finishing with No Regrets" by Jane E. Brody, The New York Times, January 10, 2012, page D7.


Saturday, December 17, 2011

There Go The Social Safety Nets (to help pay for catastrophic long-term care!!)

 

by Susan M. Graham, Attorney at Law, Senior Edge Legal, Boise, Idaho

We have no money in this country.  We all know that.  How does this impact on you if you need to pay for residential long-term care in a nursing home, assisted living or in your own home?

There are two government programs that are available to seniors to help pay for care - Medicare and Medicaid.

Medicare is a national health insurance program for people 65 and older.  Medicare will help pay for a maximum of 100 days of care.  To access this benefit a few requirements must be met.  First, a person must be admitted to a hospital and stay there at least three days.  Then, when they are discharged to a rehabilitative facility, such as the Boise Elks, if that person is improving, Medicare will pay 100% for the first 20 days of care.  If the person continues to improve, Medicare will pay part and the individual or their supplemental insurance will pay part of the expense for the next 80 days.

What are the holes in this "safety net"?  First, the Medicare recipient must be ADMITTED to the hospital and not there for OBSERVATION.  The difference is huge.  If a person is not admitted, Medicare will not pay a dime toward the rehabilitative care.  If Medicare does not pay, then in most cases the supplemental health insurance coverage will not pay for the care as well.  This problem is happening here in Idaho as well as nationwide.  The bills for the first 20 days that I've seen range from $6,000 to $30,000.  This is a huge bill for most individuals and families to absorb.

The next hole in the Medicare safety net requires that the person be "Improving" during their rehabilitative care.  My cousin, Kathie, at age 98, went to the hospital for three days.  She was admitted.  They discharged her back to her nursing home and I was called two days later saying Medicare would not pay for her care because she was not "improving."  She was old and could not follow instructions.  I was not surprised that she failed this second test.

Another "safety net" is the federal and state Medicaid program.  Part of this program helps to pay the long-term residential care expenses for people 65 and older who meet a list of criteria.  The cost for privately paying these bills ranges from $20 per hour for a bath aide to $8,000 per month for skilled nursing care.  To access this benefit, it is necessary to complete an application form and submit it to the Idaho Department of Health and Welfare.  The last two application forms we submitted on behalf of a married couple were approximately 400 pages each.

There were at least six more inches of back-up information.  It took hours and hours to sort out and complete the application and deal with the follow-up issues.  All of our Medicaid applications have been approved in the past 5 years, but remember I have a law office.  The process is onerous and next to impossible for regular families in crisis to complete on their own.  That is not fair, but it is the real world.

We have no money in this country to continue to provide the safety nets that have been available.

What can you do to protect yourself and your loved ones?

  1. Make certain you have up-to-date legal documents that include your Living Will, Health Power of Attorney and Financial Power of Attorney.
  2. Let the people you plan to rely upon in a crisis know you have nominated them to help.
  3. If you need help, seek it out.  Your failure to make informed decisions may cost you and your family thousands of dollars and unnecessary worry.
  4. Contact your government representatives and let them know you want honest safety nets that really work, not ones that exist on paper and are not really accessible to regular people.

 


Friday, December 2, 2011

Yesterday, I Spent 3 Hours in the Emergency Room [E.R.] With a Friend. Who Will Go With You When You Need Help?

 

By:  Susan M. Graham, Certified Elder Law Attorney, Senior Edge Legal, Boise, Idaho

Sam had a cough that started about 10 days ago, and he became so uncomfortable it was difficult to breathe.  We ended up spending 7 hours in the doctor's office and E.R. until they decided what to do.

Did you know there are 4 drugs that cause two-thirds of the E.R. visits for people 65 and older?1  What are they?

1.  Warfarin, also known as Coumadin, a blood thinner, accounts for 33% of emergency visits.

2.  Insulin injections account for 14% of the visits.

3.  Aspirin, clopidogrel and other anti-platelet drugs that help prevent blood clotting result in 13% of visits.

4.  Lastly, diabetes drugs taken by mouth [oral hypoglycemic agents] accounts for 11% of the hospitalizations.

Why are these drugs a problem?  One reason mentioned in the New York Times article is these drugs have a narrow window between an effective and a dangerous amount to be taken.  Another problem is these drugs are not considered "high risk" drugs, so less attention is paid to the actual dosage.

What is the answer so you don't end up in the E.R. because of prescribed drugs?  Be proactive.  Talk to your doctor about all the medications you are taking (prescribed or not) and take the appropriate dosage.

What plans do you have if you are too ill to care for yourself?

 

______________________

1The New York Times, Tuesday, November 29, 2011, p. D6, "4 Drugs Cause Most E.R. Visits in Elderly."

 





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