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The real problem in America is not the Government – it is us. Why? We are the ones who want the government to cut the deficit without touching Social Security, Medicare or taxes. Who is kidding who? We need to get real. When commentators speak of American ingenuity and resilience they speak of the capacity to intelligently make decisions even in the face of personal sacrifice (I think!). Neither of our two political parties is being honest about the solutions – but we (the voters) can do better. The politicians have their finger in the wind to navigate their actions. If we the voters would be honest and reach out to our legislators with honest opinions they too would change.
Deficit Reduction Proposals being considered and what it should mean to you. There is much being done by bi-partisan commissions and task forces to come up with realistic solutions to address the very real problem that our nation faces. In the words of one study: We believe that America is facing two huge challenges that can only be surmounted if both political parties work together: recovery from the recession and restraining the soaring federal debt. It goes on to say that this alarming prospect was created by the actions of both political parties over many years, with strong public approval. Read the Commission Report that everyone is talking about.
- Deficit report (PDF) calls for Senior Citizens paying more for Medicare: Another solution offered by a bi-partisan group. Worth looking at.
- The Wall Street Journal reports that 70% of Americans uncomfortable with making cuts to programs such as Medicare, Social Security and defense.
- US News is reports that more seniors declaring bankruptcy in retirement.
- Medicaid is a central part of the safety net for middle class Americans.
- Here is an article discussing the Republicans and the deficit.
As we struggle to balance budgets and try and shy away from raising taxes, we need to find the money somewhere. Where? Well look at the groups that supposedly is flush with money and whose numbers are small enough not to make a big difference at election time. Enter doctors and other professionals. It really is nothing short of a direct tax in an inverse way. And why should you care? Because this is all leading to the dumbing down of America. There are many physicians who simply are leaving the practice. Average doctors leave the school with hundreds of thousands of debt and if they can’t make a good living why invest the time and money it takes to be a doctor? And how would you like to have someone less than the brightest mind by your physician? Look at Dr. Mixon – he finally gave up on the system and set up his own shop. But, how many can afford his services? You want to resist attempts to constantly take the easy way to balance the budgets. The real answer is that we will all need to look at tax rates, increase in retirement ages and means testing for Medicare premiums. That is the lion share of our problem and yet the politicians pander to the senseless emotional appeal of saving the average guy from the tax man. We are smarter than that. If paying Medicare premiums, working another year and/or pay a bit more in taxes will allow us to continue to have the excellent medical care we do have, it will be an investment worth making.
What is the similarity between the characters in the musical “Fiddler on the Roof” and attorneys? Tradition!
All of my clients deal with estate planning issues: The majority of my clients who have planned their estates have done so under the traditional notions of estate planning which, unfortunately, leaves them largely exposed to the threat of uncovered long-term care costs.
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How can a Power of Attorney help keep you out of a nursing home?
A Power of Attorney is more powerful that you think and a document that is not given much thought. To clarify, a power of attorney is a document that you sign to name a person of your choice, who you wish to appoint as your surrogate to act on your behalf should you be unable to act on your own behalf. This may be because you are out of town or are physically or mentally incapacitated to a point that you cannot attend to your own affairs.
Think about how you and I decide who to name as our surrogates. We simply choose the people we love and trust the most without giving much thought to the types of decisions they will have to make. In reality the most difficult decision our surrogates will make is to step in when they see us slowing down in life.
We say to them that if you see that we cannot manage our own affairs, we trust you that you will make all the right decisions, including the decision about our housing needs. And when our surrogates find us not being able to address our own needs independently they will turn to the medical community for help. And our medical community views nursing homes and assisted living facilities like the rest of us view McDonalds. Cheap, convenient and available. Little attention is given to the effects and quality of the food. Same way, the doctors and medical providers generally do not explore the issue in any detail because institutional care is an easy fix.
This is the reason why many of us end up in nursing homes though we could well be able to stay at home. So, what you want your power of attorney to do is not just to give responsibility to your surrogate, but also to direct that your surrogate use the resources in your estate to seek out the assistance of a qualified geriatric care manager who can provide your surrogate options that should be considered about your care needs. Including whether you could stay at home and if so what services would be needed to accomplish the objective; if you could not stay at home what alternatives exist between home and nursing home and associated costs.
With this information your surrogate could make the final determination, but at least it will be based on a thorough review of the facts by an objective independent professional. In the end, you are not a burden on your surrogate and your quality of life is much improved because of this directive. Not to mention the analysis of whether Medicare or Medicaid could cover some of the costs.
As an Elder Law Attorney, I experience first hand the same pain, anguish, struggle and frustration a family goes through while taking care of their loved one. Our health care system is so broken and complicated that it has simply forgotten the notion it was created on. Every one is treated as one fit size all regardless of individual necessities and requirements.
This week I received an email from one of my loyal radio show listener, who herself is a psychiatric nurse practitioner for last 30 years & taking care of her elderly mother. Her mother is right now at a rehab facility and she has Group Health Insurance. Rehab facility and Group Health managed care wants to discharge her mother even though she cannot transfer by herself and may even have torn her shoulder rotator cuff in the fall which had not even been addressed yet.
Daughter thinks Group Health is not meeting their fiduciary duty & wants to discharge her mom, even when it is not safe for her mom to be discharged…..Daughter is struggling & fighting with the system, simply to maintain the quality, safety and dignity of her mom’s life.
Under the law, Group Health can only discharge mom if it is safe for her to be discharged. I suggested the daughter to hire the services of a care mangers (social workers) to interface with the medical community and try and work with them in developing the discharge plan. If they are given a hard time then I will write a letter as an attorney requesting their cooperation and informing them that their planned discharge will place mom in physical jeopardy for which they may have liability. If they still insist in discharging then they have to give a written notice to mom and mom will have the right to request review. While the review is pending, Group Health must pay for the care of mom. However, if the review is unfavorable to mom then mom would have to pay for the days out of her own pocket.
I also suggested daughter to have a backup plan that is to work on Medicaid and or VA benefits while trying to push the Medicare days. The ideal way to deal with this situation will be to have care managers meet the Group Health folks and get an idea of what needs to be done to ensure the safety & quality of life for mom before discharging her and simultaneously review mom’s estate for VA and Medicaid benefits……
