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Monday, June 26, 2017

The Four Most Important Legal Documents You Will Need to Manage Your Aging Parent's Affairs

To help your parents get their affairs in order, you should first make sure that you or someone trustworthy has the legal ability to manage your parent’s affairs.  This article is a guide to the four fundamental legal documents you and your parent may need in order to get financial affairs in order.



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Monday, January 23, 2017

Help, I’m Lost in the Medicare Alphabet Maze!


 

Recently, I had to help a relative reinstate her Medicare Part D insurance coverage after she forgot to pay the premiums for several months.  The insurance company sent many notices advising that they would terminate coverage if the past-due premiums were not paid, but she either ignored the notices or could not comprehend what they said and eventually lost coverage.

After spending hours on the phone first with the insurance company and then with Medicare, I realized that Medicare is somewhat of a mystery to me.  Medicare is not yet my health insurance provider, so other than knowing that most of my clients are covered by Medicare and pay a monthly premium for the health insurance, I really had little idea of how Medicare works.  This blog post is a general guide to Medicare, while the next four posts will explore the alphabet of Medicare in more depth.
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Thursday, November 12, 2015

UNDERSTANDING THE BASICS OF MEDICARE PART A

 

Medicare Part A is known as hospital insurance.  That term may be misleading, however, because services provided in the hospital by doctors, anesthetists, and surgeons are covered by Medicare Part B.  Part A covers nursing care, such as care provided by professional nurses, a semi-private room, meals, lab tests, prescription drugs, medical appliances and supplies, rehabilitation therapy.  Services provided for home health care, when you qualify, or hospice care are also covered under Part A.

Generally, the Part A premiums are paid for by the Medicare taxes withheld from your paycheck if you or your spouse has worked enough to qualify for 40 or more work credits.  If you have not worked long enough to earn the 40 credits, you may pay up to $407/month based on the number of credits earned during your employment.

You can qualify for Medicare Part A if you are age 65 or if you are disabled and qualified for Social Security Disability Insurance for 24 months. 

Most people assume that Medicare will cover the cost of all health care once you reach 65.  That is not truly accurate.  Although the premiums for Part A may be “free” because you or your spouse paid through the payroll deductions from your paycheck while you were working, in most circumstances you will be required to pay a co-pay or co-insurance.  In addition, you will be required to meet a deductible of $1,260 for each hospital benefit period in 2015.  What is a hospital benefit period?  That is the period from when you are admitted to a hospital and ends when you have been out of the hospital for 60 days in a row.  After the deductible is met, Medicare will pay for the full cost of the hospital care for 60 days.  If you go home from the hospital before the 60 days are up, but are readmitted during that 60 days, the costs of the stay will be covered.  After 60 days and before day 90, you will pay $315 for each day of the benefit period.  After 91 days, you will pay $630 per day.  (These are the 2015 costs.  The 2016 rates will most likely be higher.)

What about admission to a Skilled Nursing Facility (SNF)?  Medicare will pay the full cost of Days 1 through 20 in a SNF.  From Day 21 through 100, you must pay a daily co-pay of  $157.00 (These are 2015 costs.)  and from Days 101 on you must pay all of the costs. Before Medicare will pay for your stay in the SNF, however, you must be admitted to the hospital for a 3-day inpatient stay.

You can buy a Medigap policy to cover some of the Part A deductibles and co-pays.  If you are admitted to a SNF, long-term care insurance may cover some of the costs of your care.

Open enrollment for Medicare plans is October 15 through December 7th, 2015.  At that time, you can compare Medicare Advantage (Part C)  plans to regular Medicare plans to determine which option is the best one for you.

 

 

 

 


Thursday, August 6, 2015

Five Questions to Ask Loved Ones About End of Life Treatment

How do we decide how we want to be treated at the end of life?

What would a good day look like if you were suffering from a terminal illness?

This is one of the questions Dr. Atul Gawande asks in Being Mortal, Medicine and What Matters in the End, New York: Metropolitan Books, Henry Holt and Company, 2014, his book exploring medical treatment at the end of life.

Dr. Gawande looks at how this one question, along with a series of questions most physicians are not asking their patients, might shape the course of medical treatment and care of those who are terminally ill, as well as those frail elderly who are in need of long term care.

In the book, one patient says that he is willing to have medical treatment for his terminal illness so long as the treatment will allow him to eat ice cream and watch football on television.  However, if at the end of the treatment he can’t have that ice cream and television, he does not want the treatment.

Another patient says a great day for her would be to take her grandchildren to Disneyworld.  Unfortunately, by the time she tells her doctor this she has undergone months of aggressive treatment that leaves her tired and weak and no longer able to go to Disneyworld.  The question then might be, if your idea of one good day is to go to Disneyworld, should physicians forgo treatment that will not cure you in order for you to have at least that one good day at Disneyworld with those people you love?

In our office, we spend lots of time helping clients fill out their Advance Directives for Healthcare, a document that allows a person to nominate an agent to make healthcare decisions for them if they are not able to make or communicate those decisions.  We talk about whether the client wants extraordinary medical treatment if they have a terminal illness that will likely end in death and they are not aware of their surroundings.  Most people say that they don’t want aggressive treatment under those circumstances.  However, we don’t have a good way for clients to really communicate their wishes to their loved ones when the question may be quality of life versus quantity of life.  What decisions should a healthcare agent make if treatment will prolong life but may leave that life not worth living for the person for whom the agent is deciding?

Dr. Gawande suggests a series of questions that should be asked while a person is still able to give answers. These questions would also be appropriate to ask someone who is aging and becoming frail :

  1. What is your understanding of where you are and your illness?
  2. What are your fears and worries for the future?
  3. What are your goals and priorities?
  4. What outcomes are unacceptable to you?  What are you willing to sacrifice and not willing to sacrifice?
  5. What does a good day look like for you?

Here is a link to an article about the author, along with a video discussing the five questions:

http://www.nextavenue.org/atul-gawandes-5-questions-ask-lifes-end/

Of course, the answers to these questions will change over time and as diseases progress.  For instance, a young mother facing terminal cancer will have very different goals, fears and worries from the frail 90-year old great-grandmother facing admission to a nursing home.

How would the answers to these questions help if you were the person who has to make or communicate these decisions for someone else?  If you knew a good day for your father was for him to be able to sit and eat ice cream while watching football on T.V., would you make decisions for his care that would allow him to do that?

I know how difficult conversations about end of life can be, but perhaps asking these five questions can at least open up a dialogue that will ultimately lead to better decisions about end of life care.

 

 

 

 

 

 

 

 

 

 

 

 


Thursday, July 23, 2015

Four Ways to Pay for Long-Term Care

Concerned about how your parents will pay for their long-term care?  Here are the four basic ways to pay for care.


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Thursday, July 16, 2015

The Zen of a Family Meeting: The Five Things You Must Cover When Planning for Your Aging Parents’ Care

 

 

July is Sandwich Generation Awareness Month.  The Sandwich Generation refers to those people, mostly in their mid-40’s to late 50’s, who are caring for aging parents as well as caring for young children or dependent young adult children.  If you are the meat or peanut butter in that sandwich, you might be looking for help from your siblings or other family members.  One of the best ways to plan the care for an aging or disabled family member is by holding a family meeting.  The meeting is designed to do many things:  get information from the aging or disabled person about their needs, figure out what kind of care is needed and brainstorm about ways to find that care, gauge the financial resources available for care, and assign duties to various family members so that one caregiver does not get burned out.

Who should attend the meeting?  I recommend that all of the parents and siblings attend a meeting, preferably where they can meet face to face to talk about the issues facing the aging parent now, and those issues that may come up in the future.  If grandchildren, aunts and uncles or friends will be responsible for some of the care, invite them along.    The parent or person with a disability should be in attendance so long as they are physically able to be there. 

It is usually best to hold the meeting in a neutral place, such as a meeting room in a hotel or community center.  I also recommend there be a fairly impartial facilitator to keep the meeting on track, if possible.  And, there should be plenty of snacks and drinks so people won’t want to leave before you’ve discussed all the important points.

With so many families spread out over the world, it can be difficult to get everyone together.  If the family has a regular family reunion, perhaps the reunion time can be extended to allow the family to get together for this meeting.  If there is no regularly scheduled reunion, you can use scheduling programs such as www.doodle.com to find out when the most attendees will be available. If some family members absolutely cannot meet in person, you can use tools such as Skype www.skype.com or Google Hangouts www.google.com/hangouts‎ to bring those other family members in by video.

Once you have set the time and place, have everyone agree to an agenda.  Appoint someone to come up with a proposed agenda in advance of the meeting, and then circulate that proposed agenda for comments, additions and changes.

Here are the five basic items that should be covered in the meeting:

 

  1. The Health and Safety of the aging parent or person with a disability

     

    How do they feel about their own healthcare and safety and what are they concerned about?

    Are there any disease or illness diagnoses?

    Are they paying attention to personal hygiene?

    Have there been any instances where the safety of the parent has been compromised, such as falling, leaving the stove on, wandering, etc.?

    Who are their physicians, dentists, therapists, professional and volunteer caregivers?

    What medications are they taking and are they remembering to take them regularly? 

     

    What health insurance do they have?  If they are on Medicare, is there supplemental insurance or prescription medication coverage?

    How are the premiums paid and is there someone who will be informed if the premiums are not paid?

     

    How are their finances? 

    What financial resources do they have? 

    What are their regular bills and how do those bills get paid?  How will you know if they forget to pay the bills?

     

  2. The current living and care arrangements, whether those arrangements are working, and a plan for future living arrangements

 

 If the parent’s condition is changing, what living and care arrangements will be necessary in the future?

How will you find appropriate housing and care?

 

  1. The legal documents do they have and the legal documents they need

     

    Who is their lawyer and when was the last time they saw a lawyer?  Where are the legal documents stored?

    Who is named as Agent, Personal Representative, etc. in those documents?

    Who are their beneficiaries on their IRA’s, 401(k)’s, life insurance policies and annuities?

     

  2. A plan to pay for long-term care

    Is there long-term insurance available?  If so, what are the terms?  Where is the policy and how are the premiums paid for? 

    If there is no long-term care insurance, can the parent or person with disability afford to pay for care by him or herself?  Are there any government programs, such as Veterans benefits or Medicaid, that can help pay for long-term care?

     

  3. The family caregivers – who will do what and when

Sometimes family members volunteer to perform the tasks for which they have talent.  The brother who is a nurse may be the natural fit for the person to oversee the parent’s healthcare and the sister who is the CPA will take over the finances.  What if it isn’t so clear or if no one wants to take on the tasks?  Can people be hired to perform some of the tasks such as paying the bills? 

Can the family agree that it may not be fair to one of the children to take on all of the responsibility for care?

If one family member is taking on the bulk of the care, can the others agree to take a turn to provide relief to the primary caregiver? 

 

The topics may vary from family to family, and for those families who may find it especially hard to discuss these items you might consider having a professional or a mediator to assist in these discussions.

 

 

 

 


Friday, June 28, 2013

GUEST BLOGGER: Jeannie Pickard of Project Walk Atlanta... It's Personal.

It was two weeks before our oldest son Chris' graduation from Lambert High School and the night before prom...an exciting time of year for a senior. On Friday evening May 13, 2011 at 10:20pm we received a phone call and learned he had possibly been in an automobile accident. We arrived to the scene of police cars, fire trucks and ambulances, and were relieved as we did not see his truck. Within seconds, through the flashing lights, we caught a glimpse of our son lying on a stretcher and found out that he was a passenger in an automobile that had crashed into the nearby brick sign. He had sustained a burst fracture to his c6 vertebrae and would need surgery right away to relieve pressure on his spinal cord.

All of a sudden, our world was turned upside down and, after spending a week in ICU at North Fulton Regional Hospital, we were on our way to the Shepherd Center in Atlanta. Our son was a quadriplegic and we would find out over the next three months, exactly what that meant. We were bombarded with the reality that there is much more to a spinal cord injury than being paralyzed and in a wheelchair.

While at the Shepherd Center our son learned how to function in a wheelchair, and we were educated on how to live with a spinal cord injury. All the while, we were wondering, "Where do we go next?" as our goal was for him to walk again. After much prayer, hours of research and the discovery of a friend, we believe God led us to Project Walk in Carlsbad, California. We had visited several facilities while researching our options and, without a doubt, we knew Project Walk was where he needed to be.             

For the first time since his accident, we were filled with hope. It felt like the ball was finally in our court, and our son would have the opportunity to work toward gaining optimum recovery and the arduous goal of walking again someday.


Through God's provision and the generous support of family, friends, and even strangers in our community, Chris' dad Paul, and Chris, spent seven weeks at Project Walk in California. Project Walk exceeded ALL of our expectations. We were very encouraged as Paul and Chris met people who had been told in traditional therapy that they would never walk again, but after being at Project Walk, they were proving them wrong.

At Project Walk we found a very different philosophy. We saw with our own eyes the success of the clients at Project Walk and we knew our son needed to continue this therapy, which our insurance would not pay for.

Once again, God moved in a big way, and we signed a deal to bring Project Walk to Atlanta! The motto we have inscribed on our hearts is: "Project Walk Atlanta... it's personal." It's personal because we understand firsthand what families are going through after experiencing the devastation of a spinal cord injury. We strongly believe that EVERY person affected by a spinal cord injury deserves the opportunity to receive this kind of therapy. 

Not only does this intense activity-based therapy give them the best chance for recovery, but it also helps prevent secondary health issues such as pressure sores, blood clots, poor circulation, blood pressure issues, loss in bone density and pneumonia. Sitting in a wheelchair promotes poor health, reducing the quality of life and the hope of gaining independence.

That is why a major portion of our time will be focused on raising awareness for the needs of spinal cord injury patients in order to raise funds to help those whose insurance will not pay for this kind of therapy.
We are humbled and honored to be the Founders of Project Walk Atlanta. We need your help, to step up and scholarship clients who have been put in a position where they cannot help themselves. A spinal cord injury can happen to anyone...a daughter, a son, a spouse...anyone. Please partner with us as we help those who have been affected by this traumatic injury. With your help we can change lives!

Project Walk Atlanta is a 501c-3 non-profit company. We need your help in supporting the many friends with SCI to get the recovery that they deserve. Please donate through our web site or Facebook at Project Walk Atlanta. Thank You.

(Pictured aboveChris, Paul and Jeannie Pickard) 


Wednesday, April 3, 2013

What are Advance Directives?

Are you prepared if a tragedy strikes making you or a loved one go to the hospital?

Fortunately we have the right to make our own decisions when it comes to our healthcare, but what if that ability was taken away? How will you and your loved ones wishes be protected? The solution: Advance Directives.

Advance Directives are legal documents stating your wishes for the doctors and rest of your healthcare team to follow when you are unable to make decisions for yourself. During critical times, these documents can make a world a difference.

In recognition of Advance Directive Day on April 16th, our firm will be hosting a Lunch and Learn.

Lunch will be provided and we are honored to have guest speakers Reverend Ed Hampton and Community Outreach Representative for EverCare Hospice Carol Mullen. We invite anyone to join to learn useful information, resources and receive answers to your questions on the importance of Advance Directives.    

See attached flyer for more details. Lunch provided. RSVP REQUIRED!


Tuesday, March 12, 2013

March is Social Work Month!

Featured Article by Thom Corrigan, MSW, CMC

Each March we are asked to celebrate Social Work month. For some, this means sending a note or an e-mail to a social worker we may know. For others, it may be treating a social work colleague to lunch or bringing them a plant or some flowers to show our appreciation for them.

But this year, I invite you all to celebrate what social workers do, in addition to who they are. Social workers possess many traits and skills. These include being trained to serve as advocates and brokers for our clients. Social workers have developed skills in the areas of empowerment, resourcefulness, problem solving and helping people with transition. They help people to learn new skills while at the same time, helping them to regain confidence, self-esteem, self-determination and resilience. Social workers do this in part by modeling, teaching, empowering, counseling and developing in a person the traits and characteristics that will lead to better outcomes and create a heightened sense of accomplishment and independence.

Each year, the National Association of Social Workers (NASW) creates a theme as part of its celebration for social work. This year's theme is "Weaving Threads of Resilience and Advocacy: The Power of Social Work."   Lastly, did you know that Social Work is the only profession that has the word "WORK" in its name? I find that interesting-

Happy Social Work Month to all my professional peers and colleagues and thanks for all that you do to help people with their everyday needs and challenges!

Thom Corrigan, MSW, CMC
Certified Care Manager


Wednesday, February 20, 2013

Caregiver Appreciation

Expressing appreciation for the assistance received from caregivers is something that not many think about, but is certainly needed. Now some may say, “Why should I be grateful for help from someone I am paying?” Or in the case of family caregivers, “Aren’t family members supposed to take care of each other?” Research shows, however, that not only does expressing appreciation make the caregiver feel better about what they do, but also that the people expressing gratitude have a greater sense of well-being.

Expressing appreciation for something your caregiver has done for you does not require the eloquence of a public speaker, only a few words are all that it takes. Examples of some things to say thank you for are : “Your gentleness when helping me change positions really minimizes my pain. Thank you.” “The way you talk to me as a person, rather than a patient, really makes me feel good.”  By giving sincere words of affirmation  will not only allow the caregiver to feel appreciated, but will help them to have a know how you liked to be cared for.

Expressing gratitude is a choice. This month, show some appreciation to someone who helps care for those in need.


Monday, February 11, 2013

Helpful News for Trustees and Beneficiaries for Special Needs Trusts

Last fall the Social Security Administration quietly released the text of changes to the Program Operations Manual System -- the POMS. Though described as "clarifications" by Social Security, they were actually far-reaching changes that would have driven up the cost of trust administration, complicated the lives of beneficiaries and provided no additional protection for anyone involved.

Lawyers, trustees and advocates raised objections, and thankfully Social Security listened. Last week another set of changes were announced and the news is entirely good for everyone.

First, a word about POMS. This not very well known set of rules has far-reaching effect. It is a manual of instructions for Social Security eligibility workers, explaining how to treat all manner of documents, transactions and information obtained in the course of eligibility applications and reviews. You can look at the POMS online, but you will quickly see that it is a complicated, detailed and tightly-written set of rules.

The POMS is not law. It is not even a set of regulations governing Social Security eligibility. It has no legal force, and so one might think it is not important. Actually, it is more important than the law, at least in day-to-day decision-making. It is the document Social Security eligibility workers look to when faced with any wrinkle, confusion or question.

The changes last fall addressed several sections of the POMS dealing with how to treat expenditures from special needs trusts. Some of the changes focused on just "self-settled" special needs trusts, others included expenditures by "third-party" special needs trusts and perhaps even payments by family members or others who try to help recipients of Supplemental Security Income (SSI).

Among the changes posted last fall:

  • When family members paid for items for a trust beneficiary -- like medical supplies, clothing, transportation or pretty much anything else -- reimbursement from a trust would be treated as income to the beneficiary, even though nothing ever went through the beneficiary's hands or account. The same would have been true for trust payments to the family member's credit card.
  • Payments for caregiving could not be made to a family member unless the family member was certified in some way. (This change actually wouldn't have made much difference in Arizona, since a variation of this rule is already in place for Arizona Medicaid -- AHCCCS/ALTCS -- recipients.)
  • Travel expenditures for third persons to visit a trust beneficiary would have been prohibited in pretty much all circumstances.

What changed? Social Security initially removed the change governing travel, and then indicated that the others were under review. Reportedly the high-level reconsideration included senior staff and even out-going Social Security Commissioner Michael J. Astrue (who had already submitted his resignation from that post, to be effective February 13, 2013). Commissioner Astrue wanted the reconsideration completed before the end of his tenure, so Social Security moved very quickly to make changes.

Last week one of the reviews got completed, and the reimbursement policy changed. Not only did it change -- it actually changed to make good sense. Now POMS section SI 01120.200 E.1.d, "Reimbursements to a third party," reads:

"Reimbursements made from the trust to a third party for funds expended on behalf of the trust beneficiary are not income.

"Existing income and resource rules apply to items a trust beneficiary receives from a third party. If a trust beneficiary receives a non-cash item (other than food or shelter), it is in-kind income if the item would not be a partially or totally excluded non-liquid resource if retained into the month after the month of receipt. If a trust beneficiary receives food or shelter, it is income in the form of in-kind support and maintenance (ISM)."

Similar changes have been made in another, related section, SI 01120.201 I.1.f.

What does it mean?

  •  It means that an arrangement used by trustees all over the country, though without any specific authorization, has now been formally blessed by Social Security.
  • It means that the trustees of special needs trusts can reimburse family members who buy clothing, bedding, diapers, supplements, medical devices, transportation services, furniture -- all manner of items -- without risking loss of benefits from Social Security.
  • It means that all of those things can be done without limiting or losing benefits from AHCCCS and ALTCS (Arizona's version of Medicaid). It means that a system that worked well, was responsible and cost-effective, is now available again to trustees, beneficiaries and family members.

Word is that the other changes are in the works for release this week. Here's hoping all the changes will be as thoughtful and responsive to practical realities.


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