Weekly selection of important articles and topics from around the web.
Rajiv Nagaich and his staff are continually monitoring the latest developments in the aging-oriented heath, housing, financial, legal and family sectors.
Each week the most insightful and thought-provoking articles and news items from their research and reading are gathered here to keep you up to speed in this ever-changing socio-economic-political environment.
Half of the hospitals in America will see Medicare payments go down
A less than one percent change in payments either way wouldn’t seem like much of a carrot or stick in the effort to improve quality of care in the nation’s hospitals but when you’re talking about $1 billion dollars the differences can add up. Which is what Medicare is hoping will happen under its Value-Based Purchasing Program.
Don’t be penny-wise but pound foolish when it comes to Medicaid asset transfers
“Work with an elder attorney when transferring assets to qualify for Medicaid because even a small miss-step in the timing of transfers can be very expensive,” said Jerrica Pierson Seeger, an attorney at Johnson and Nagaich. Of course a lawyer would say that, you might say because who will benefit? The lawyer. You have some cause to be skeptical; after all you’re reading that opinion on a site operated by a lawyer. Here’s something to keep in mind though. If you value your own time at least as much as you value your own money, you want to avoid having something called into question due to a Medicaid technicality and then spending time and other resources trying to prove that nothing untoward was happening because that’s exactly what people end up doing time and again. Here’s yet another example, there’s a case out of New York in which the daughter of a Medicaid applicant transferred money out of a joint account to her own account. Then the nursing home where the Medicaid applicant resided applied for Medicaid benefits for her. The state issued a 13-month penalty period due to the transfer of funds and to top it off then the nursing home argued that the daughter improperly gifted herself and exceeded her authority as her mother’s attorney-in-fact under a power of attorney.
The state held that transfers were made only for the purposes of qualifying for Medicaid so the daughter won the case technically but she lost on every other count. She lost because the transfer still cost her mother the 13-month penalty. She lost because instead of dealing with her grief (her mother died during the appeal) she was fighting a legal battle. This is like driving 30 miles to save one or two cents a gallon on gas when you fill up your car. There’s no doubt that paying for a lawyer is expensive but the cost of a lawyer will be made up fairly quickly when compared to the cost of a nursing home.
The Supreme Court will hear two cases involving gay marriage
The court has agreed to hear a case out of California about marriages. The more interesting case though is out of New York. That case challenges a federal law that requires the federal government to deny benefits to gay and lesbian couples married in states that allow same-sex unions. The case involves the estate of Edith Windsor and Thea Clara Spyer who married in Canada. Spyer died in 2009 and Windsor inherited her property. Because the law does not allow Windsor to be treated as a spouse, she was forced to pay $360,000 in estate taxes that a spouse in a heterosexual relationship would not have had to pay. Both cases are likely to be heard in March.
The high cost of dying
Dying is expensive. A typical funeral costs about $10,000. That’s a fairly substantial amount of money to drop just as you’re going through the grieving process. So some families try to go around that problem by pre-paying for their funeral expenses. There are some really nice benefits to doing so including how it impacts Medicaid claims but also making major financial decisions when you’re just out “shopping” can provide you with more time to consider what is important such as where you want your last resting place to be or if you really need the gold encrusted, velvet-lined Elvis Presley casket. A recent Money article surveyed regulators in 48 states and found that one of the top sources of complaints revolves around funeral arrangements.
The article’s author found that the FTC rarely pursues litigation against funeral homes that don’t follow the law and it doesn’t release the names of homes or their violations so determining which apple is the bad apple is difficult for consumers. Prepaid arrangements are high on the list of complaints in the funeral industry. The article pointed out that prepaid arrangements are so problematic that AARP, the FTC and Consumer Federation of America all recommend against it. Money and AARP both recommend creating a joint savings account with someone you trust to pay the bills.
As with most things in life, the solution is to do your homework, find other people who can give you referrals and give yourself plenty of time. If you have an elder law attorney, talk to your attorney about options. The last piece of advice: you don’t get to take it with you so don’t allow someone to pressure you into something you clearly don’t want or don’t need.
Having ‘the conversation’
My grandfather died his way but my step-grandfather did not. What was the difference? My grandfather was a tough old coot that held death back by the scruff of the neck until he was able to talk with each male in the family (definitely a paternalistic family on his side of the family) and only when everything was taken care of did he choose to die. My step-grandfather had a medical emergency and while he laid in the hospital bed his daughters argued over my grandmother’s say about whether or not to have his tubes pulled. The doctors, having no idea what he would have liked bowed to his daughters’ much more vocal wishes. This week there’s been a lot of stories in the news about how families need to talk with loved ones about their final wishes. This is partly to do with the fact that when everyone gets together at the holidays, the opportunity is there for everyone to be part of a conversation about it.
Americans don’t do this conversation well. It’s a bit like we believe that if we talk about something it will happen except in this case it will happen whether we talk about it or not. ABC News ran a special about “the conversation” that gives pointers about the kinds of questions to ask and how it’s a conversation for every member of the family. Remember to make your decision, once you’ve made, it a legal decision. Get your power of attorney drawn up (both the medical and financial) and your will as the bare minimum. Then you can get on with the rest of your life.
Eating healthy has major cardiovascular benefits
There are a lot of things you can do to preserve your health but one of the biggest steps you can take to avoid health risks such as heart attacks, diabetes or Alzheimer’s disease is to watch your diet. Heart attacks and diabetes are largely preventable diseases (and there is a strong correlation between diabetes and/or cardiovascular problems and Alzheimer’s).
Heart disease is the number one killer of men and women in America, and is a major threat to the health of seniors. About 84 percent of Americans 65 and up will die from heart disease. Many seniors take medication of one form or another to lower their blood pressure and cholesterol, but once they get those numbers under control they don’t believe they need to follow a healthy diet or exercise to keep their condition under control. However, new data from a five year study done at the Population Health Research Institute; McMaster University in Hamilton, Ontario, Canada indicates that eating a heart healthy diet can reduce the risk of cardiovascular death by as much as 35 percent. The study looked at 31,546 adults with cardiovascular disease or end organ damage. Read the article here.
Staying healthy is a major part of living retirement on your own terms. Avoiding skilled nursing care or other expensive long term care solutions will help to preserve your assets and keep you from becoming a burden on your loved ones.
Research indicates there may be a clinical reason older adults experience more fraud
Statistics show that financial exploitation of older people is on the rise. New research suggests that older people don’t respond to the visual cues that would tell them if a person is trustworthy or not. The research is the first to suggest that there may be an underlying neurological reason that older individuals become vulnerable to fraud. Read the New York Times article here. How can this be useful to you? Being forewarned is forearmed. Take time making important decisions. Get a second opinion. Check references thoroughly.
Planning for your special needs child
If you are the parent of a child with special needs, you already know that there are many things to consider for your child as you age. Here are five planning tips for parents with children having disabilities.
For the article, go here.
While end of life planning is a family concern it’s especially true if one or more of the children has disabilities that will require a handoff of responsibilities when neither parent is able to continue care. It’s also important that everyone understand how a legacy can negatively impact someone who needs expensive care options that are currently handled through public agencies so that those benefits aren’t jeopardized. An elder law attorney can help avoid these pitfalls and make transitions easier.
Why you should have a Caregiver Contract
Last week on the radio show, Rajiv talked about an individual who cared for her mother for several years and took compensation for her work. While there aren’t enough details about the case to know whether the daughter’s compensation was something her mother wanted her to have or not, it’s possible to clear up the confusion in your own family by planning for just such an occasion with a Caregiver Contract. Why would you need compensation for caring for someone you love? Caregiving costs the caregiver in time, energy and even health and can impact the caregiver’s future earning potential and their Social Security benefits. Read the article here.
Court affirms judgment against daughter for misappropriating funds
A Tennessee couple (Garnette and William Kidd) moved into the daughter’s mother’s home in order to care for her. The mother (Lola Lee Duggan) eventually moved into a nursing home and received Medicaid benefits. After Duggan died the state of Tennessee filed a claim against her estate to recover Medicaid expenses. See article here about Medicaid liens. The estate’s administrator (Duggan’s brother) sued the couple for misappropriating Duggan’s funds. The trial court issued a judgment and the Kidds appealed. The court affirmed the judgment against Garnette Kidd but reversed the judgment against William Kidd. Read the court document here.
Idaho attorney files a petition to review whether or not state can recover assets transferred before a recipient’s death
Martha and George Perry owned property together which Martha Perry transferred to her husband when she entered a nursing home. She then began receiving Medicaid benefits. George Perry died before Martha Perry and the property was sold. Idaho filed a claim against his estate seeking recovery of Medicaid benefits that it had already paid out for Martha Perry’s care.
The trial court held that federal Medicaid law did not permit the state to recover funds from property divested before death but the Idaho Supreme Court disagreed saying that federal law does not preempt the state from recovering assets from both spouse’s estates.
Elder law attorney Peter Sisson filed a petition asking the U.S. Supreme Court to review the decision in order to address the conflict between that case and a 2008 Minnesota case in which the Minnesota Supreme Court ruled that Medicaid may not recover from the estate of a recipient’s surviving spouse if, at the time of the recipient’s death, he or she did not possess a legal interest in the property being claimed.
Increase your gray matter by increasing your activity
If you want to avoid Alzheimer’s disease, get out and exercise. That’s the latest report anyway. A study on older adults concluded that an active lifestyle helps preserve gray matter and could reduce the burden of dementia and Alzheimer’s disease. The study examined how an active lifestyle influenced the brain structure in 876 adults with an average age of 78 years. By using an MR image and building a mathematical model, researchers were able to examine the relationship between gray matter volume and an active lifestyle. The study found a high degree of correlation between high energy output and greater gray matter volume. Dr. Raji, a researcher on the study said the study suggests that an active lifestyle probably increases brain health because of improved vascular health. Read the report on the study here.
Court affirms caregiver not liable for nursing home care
In 2006, an Armenian home health aide, Araxie Symeonidis agreed to allow Eugenia Baboudjian, also an Armenian to move in with her so that Symeonidis could provide care for her. As part of the move in, Baboudijian’s lawyer drew up documents including a medical power of attorney and a financial power of attorney. When Baboudjian fell and ended up being hospitalized, her doctor released her to a nursing home rather than to Symeonidis. Symeonidis was not consulted about the move. Baboudjian refused to sign the nursing home’s admissions agreement and so the home required Symeonidis to sign the document even though she had limited ability to read or write English. While in the home, Symeonidis applied for Medicaid benefits twice for her client and the home also applied for benefits. Baboudjian racked up over $272,000 worth of services which the home then tried to get from Symeonidis. The home lost the court case and appealed.
Medicare providers and beneficiaries may appeal decisions related to claims for health care services and items but according to a report out by the U.S. Department of Health and Human Services, health care providers who appealed at the third level (the first two levels are decided by contractors, the third level includes a hearing before a judge) won more often than patients did. Providers included physicians, suppliers and hospitals. They are also far more likely to file an appeal than beneficiaries, making up 85 percent of the cases with a small number (96) accounting for nearly one-third of all appeals even though they represented only two percent of all providers. One provider filed 1,046 appeals. Several staff indicated that some providers appeal every payment denial as the cost is minimal and a favorable decision was likely. Beneficiaries on the other hand made up 11 percent. The report made 10 recommendations for CMS (the Centers for Medicare & Medicaid Services) and the Office of Medicare Hearings and Appeals (OMHA) included developing and providing training on policies, clarifying policies that are unclear and standardizing case files. You can read the rest of the story here or if you want to exercise your heart and really get the blood flowing read the report here.
In an AARP survey of individuals 50+, researchers found that older Americans wanted a separate public debate about the future of Medicare and Social Security rather than tying changes into whatever deal is found to avoid the “fiscal cliff”. Americans across party lines did not want Congress to make last minute deals that would impact Medicare and Social Security, they also wanted decisions to be made based on the needs of the people rather than the impact these two programs would have on the budget and wanted a say in the process. If you want your voice to be heard, it’s time to reach out and touch your representatives. Here’s the website for their information. Read about the AARP survey here.
Confused about what’s entailed in an advance directive? You’re not alone. According to an article on amednews.com, an online version of American Medical News, doctors and emergency room personnel have many of the same misunderstandings about living wills, advance directives and do-not-resuscitate orders as the rest of us, a situation that could be the life or death of the patient. QuantiaMD, an online physician learning collaborative found in a series of surveys that nearly half of health professionals misunderstood the components of living wills. Ninety percent of the individuals surveyed were doctors. A similar study in May by the Journal of Emergency Medicine, found that 78 percent of physicians misinterpreted living wills as DNRs. Doctors may attempt to interpret DNRs but receive little to no training on how to follow directives. Adding to the confusion, each state has its own laws on when directives apply and what content is required.
Click here to read the article.
A Metlife Market Survey found that the cost of long-term care for nursing homes and assisted living facilities increased significantly across the board over the past year. The average cost of a private room in a nursing home rose 3.8 percent to $90,520 a year; a semi-private room increased 3.7 percent to $81,030 a year and assisted living facility costs rose 2.1 percent to $42,600 per year.
The cost of companions rose 5.3 percent to $20 an hour. The one bright spot is that the cost of adult day care services remained the same at $70 a day and home health aides remained at $21 per hour.
For more details on the MetLife Survey go here.
A New Jersey retired firefighter, Saccone, requested the Division of Pensions and Benefits change his beneficiary from his wife and disabled son to his wife and a special needs trust in his son’s name. A special needs trust would have safeguarded his son’s ability to receive public assistance. However, the Division of Pensions and Benefits declined the request, stating that a survivor benefit was payable only to a qualified survivor (in this case, the son and wife) and could not fund a third party trust with money that belonged to a first person trust beneficiary. On appeal, the court concluded that the legislature intended to limit a member’s ability to select his or her own beneficiary but that the benefit was not Saccone’s property to bequest and was therefore not assignable. Read more about the case here.
No, this article isn’t to tell you that you should trust scams, instead it is to warn you that scammers are out there who are telling people they need to set up a living trust plan to avoid or lessen estate taxes, avoid probate and protect themselves in the event of incapacity. Number one, most people will not be impacted by estate taxes, number two probate generally isn’t as expensive as the cost of the trust package they’re trying to sell you and finally in the event of incapacity, you’ll need something more complex than a one-size fits all package. You can read the rest of the article here but if you get nothing else out of this brief, here’s your takeaway: never sign anything you don’t understand, be wary of pressure sales and review documents with a lawyer.
A Gallup Poll of nearly 600,000 adults in the U.S. showed an increase in the number of people rated obese since a similar study four years ago. The highest jump in obesity rates occurred in individuals in their 40s, 70s and 80s.
According to the study authors, obesity among middle-aged adults is particularly troubling because these older adults face health risks associated with that weight such as lower quality of life, more health problems and a shorter lifespan.
Experts at Gallup recommended that more effort be made to encourage and help seniors stay active and informed about nutrition. Read the article here
If you were born between 1945 and 1965, you need a one-time blood test for Hepatitis C. The viral infection can cause serious damage to the liver but prompt treatment can help stop the infection. Boomers (that’s all those folks born between 1945 and 1965) are five times more likely to be infected with the virus than individuals born in other years. Three out of every four people that test positive for Hepatitis C were born during Boomer years. It’s not understood why. Read the article here.
The American Hospital Association and four institutions sued the U.S. government over repayments of Medicare bills months and sometimes years after the fact. At issue is that a private auditor the government hired to crack down on improper Medicare payments is forcing hospitals to repay Medicare for the cost of in-patient services because the auditor determined the patients should have been treated as outpatients instead of being admitted. You may remember that hospitals are catching some flak for treating clients as out-patients rather than admitting them for care. Read that story here and an older posting here. Read about the suit here.
Two items you must pay attention to if or when you have occasion to sign a nursing home admission agreement for someone else are: who is the responsible party and an arbitration provision. There are other terms such as private pay required, eviction procedures and waiver of rights but let’s go back to the first two items. According to this article, don’t agree to sign anything that makes you the responsible party. In a recent court case, Judy Andrien signed an admission agreement on behalf of her mother as the responsible relative agreeing to ensure that the nursing home would be paid either from her mother’s assets or by Medicaid. That facility sued Andrien claiming she did not live up to her responsibility. The Superior Court of Connecticut ruled in the facility’s favor ensuring that the case will continue on to trial. Here’s the full article here.