Good Medical Care for the Elderly and How to Get It

Seniors cautioned about reverse mortgages

Some seniors struggle financially while trying to age in place. The Financial Industry Regulatory Authority (FINRA) recently advised senior homeowners to proceed with caution before using reverse mortgages to access their home equity. The group warned that a reverse loan--meaning that a bank makes payments to a homeowner instead of the homeowner making payments to a bank--can be a risky financial move.

Aging in Place | A change in the tax law may help

On January 30, 2008 the Wall Street journal reported an important change to the tax code. A cherished tax break is the exclusion of as much as $500,000 of gain from gross income when, as a one-time event, a couple sells their principal residence as long as they file their tax returns jointly. (The exclusion is $250,00 for a single person). Yes, there are some conditions. You aren’t entitled to the exclusion unless you owned the home -- and lived in it as your primary residence -- for at least two of the five years prior to the sale.

Speak up and prevent health care errors

Caring at Home has published a valuable article about how seniors can help prevent serious medical errors by paying attention and speaking up when they have questions about their care or the medications prescribed for them.

You can read and reprint this article here.

"To Prevent Health Care Errors, Patients are Urged to SPEAK UP"

Do not resuscitate orders | A family's dilemma

The Boston Globe today (December 3, 2007) explores the complicated subject to DNR orders -- do not resuscitate orders. When are they appropriate? What if the elderly patient waits too long? What decisions must be made and how can they be made?

The problem is, says the Globe's writer Patricia Wen, many families aren't sure about how to discuss this difficult subject. Often they wait too long, and by the time it's obvious that this decision needs to be made, the elderly loved one is not mentally competent to execute the required documents.

My book Taking Charge: Good Medical Care for the Elderly and How to Get It, discusses end-of-life decisions, the Five Wishes (called by the Miami Herald "the Living Will with a Heart"), and how and when to have this difficult conversation with your elderly loved one.

The Boston Globe article, by Patricia Wen may be read here:

For many, 'Do Not Resuscitate' too painful to discuss
Relatives, doctors often delay in offering patients the option

Baby Boomers ambivalent about longevity in parents

Today, it's not unusual for Americans to live to be 90 or even 100. Problems occur when the elderly outlive their savings. Sometimes elderly parents own their own home and a reverse mortgage can help them stay there.

And now about the Baby Boomers -- one quarter of the US population. These folks are accustomed to the idea that their parents might bail them out from time to time, contribute to a down payment on a home, etc. And last, but not least, leave them an inheritance.

Well, it's not happening. Longevity means eating into capital. Not everyone is a Rockefeller. How do baby boomers feel about their parents spending what they'd counted on as an inheritance.\?

Read Hey Folks, You're Spending My Inheritance in the Fall 2007 issue of Dissent Magazine.

Choosing a good nursing home for your loved one

Charles Duhigg reports in the New York Times Health section on September 23, 2007 that private investors have purchased groups of nursing homes, reduced staff (often below minimum requirements), and cut other expenses. As a result, profits for the owners have increased, but quality of care is down, mobility and health of nursing home residents is compromised, and complaints to regulatory agencies are higher.

Families of patients who have died as a result of alleged negligence in such nursing homes increasingly find that complex corporate structures are like mazes and act to insulate the real owners of the facilities from any negligence that might be proven.

Read More Profit and Less Nursing at Many Homes

For help in choosing a safe nursing home for your loved one, see the resources in Appendix A of Good Medical Care for the Elderly and How to Get It. This and other appendices are online and yours to use without charge.

New report criticizes government oversight of nursing homes

The New York Times revealed on April 21, 2007 that the Government Accountability Office (GAO) will release a report this week about the failure of federal health officials charged with oversight of nursing home regulations to impose penalties upon nursing homes repeatedly cited for “poor quality of care.” The net result is that nursing homes that should have been closed remain open and residents of those nursing homes continue to be abused.

The report notes that federal investigators found that a Michigan nursing home (unidentified) was still open even though it had repeatedly been cited for “poor quality care,” poor nutrition services, medication errors and employing people who had been convicted of abusing patients.

The US has about 16,400 nursing homes in which about 1.5 million people live on any given day. Annually, more than 3 million people receive nursing-home care. Medicaid and Medicare pay for more than two-thirds of this care. The cost is significant. In 2005, the most recent year for which figures are available, $122 billion was spent on nursing home care. 60% of that was paid for by Medicaid and Medicare.

I’ll be watching for this report and will post a link to it when it is released.

Read the NY Times article Oversight of Nursing Homes is Criticized

Technorati tags: caregiving, caregiver, family caregiver, nursing homes, nursing home, GAO, Government Accountability Office,

State of Aging and Health in America 2007

The State of Aging and Health in America 2007 was released by the Centers for Disease Control and Prevention (CDC) and The Merck Company Foundation at the 2007 Joint Conference of the American Society on Aging and the National Council on Aging in March 2007.

The report will be a useful resource for a variety of audiences committed to improving and preserving the health of older adults, including public health and aging professionals, policymakers, and researchers. This report addresses prevention of cognitive decline and prevention of falls among other critical issues in a straightforward, easy-to-read format.

The doctor makes house calls

According to the Washington Post, In New York City, doctors make house calls. Driving a Beemer, carrying the traditional black bag, and wearing black scrubs, the doc is available when and where the patient wants to see him. [New Yorkers Feel Right at Home With House Calls: Convenience Appeals To City's Professionals, Wednesday, March 14, 2007; A03]

The cost? $500 for the first visit and $400 thereafter. The doctor keeps patient records in a laptop computer. If necessary, he can send a crew with a portable Xray machine and have the diagnostics done prior to his visit.

An aging population, increasingly portable medical devices and lab tests, and changes in Medicare in the late 1990s that allowed for higher reimbursement rates for doctors' visits to homes mean that changes have occurred in the way that medicine is practiced. In fact, an American Medical Association study showed that more than 2 million house calls are made each year for the elderly homebound patient.

Read the entire article here.

Technorati tags: Aging in place

Medicaid eligibility and estate planning/gifting

Members of the State Bar of Michigan Elder Law and Disabilities Rights Section recently participated in a meeting with the Medicaid Policy Directors They advise that there are some of the immediate changes to the Medicaid rules as well as anticipated changes effective July 1, 2007. These changes relate to Medicaid eligibility for people in nursing homes, or who are in their homes but who are receiving assistance through the MI Choice Waiver program. Many of these rule changes are the result of the passage of the Deficit Reduction Act of 2005 (the "DRA").

Although these new rules dramatically alter the "Medicaid Planning" landscape, it is important to understand that there remain many viable planning techniques for people seeking to "protect assets" and still qualify for Medicaid assistance. Specifically, there are still ways to preserve assets by gifting appropriately and entering into certain type of care and home contracts.

SUMMARY:

1. Big Changes to the Medicaid "Divestment" Rules. As a result, as of 7-1-07 the Medicaid "lookback" period (the period during which asset transfers must be reported) will be extended from three to five years prior to the date of application. More importantly the date on which the transfer penalty will start will change from the date of transfer to the date when the individual transferring the assets enters a nursing home and would otherwise be eligible for Medicaid coverage. In other words, the penalty period does not begin running until the Medicaid applicant is in the nursing home and out of funds.