Good Medical Care for the Elderly and How to Get It

Social Security & SSI Payments Protected from Creditors

The National Consumer Law Center® (NCLC®) is a non-profit organization specializing in consumer issues on behalf of low-income and other vulnerable people. Since 1969, NCLC has worked with legal services and nonprofit organizations as well as government and private attorneys across the United States, to create sound public policy for low-income and elderly individuals on consumer issues. The NCLC has just sent out a press release explaining how recipients of social security and SSI payments will be protected from seizures from bank accounts by creditors because of a recent change in the law. Effective March 1, 2013, both new applicants and current recipients who do not choose another option (and have not been granted a wavier) will automatically receive their payments on the federal government’s Direct Express card.

Current benefits recipients have until March 1, 2013 to choose an electronic payment option. After that date, no payments will be issued via check, unless the person qualifies and is approved for an exemption.

To continue receiving paper checks, recipients must be approved by the US Treasury for one of the following exemptions:

•       Aged 90 years or older, as of May 1, 2011 (no wavier required)
•       Mentally impaired
•       Live in a remote geographic area lacking the capability to support an electronic financial transaction

Here are more details from the press release:

Making Decisions about When to Stop Driving

Jane Gross wrote in the New York Times recently about the angst primary care doctors face when   confronting a patient and family about whether an aging patient should still be driving. Questions raised are:

When is it time for someone with physical or cognitive problems to give up the car keys?

Who makes that decision?

How can it safely and compassionately be enforced?

Gross provided a link to a comprehensive and thoughtful handbook published by the American Medical Association in collaboration with the National Highway Traffic Safety Administration. Recently updated, the “A.M.A. Physician’s Guide to Assessing and Counseling Older Drivers” can be accessed by doctors and also family caregivers.

Internet resources for seniors & others seeking affordable medical insurance

Reported in a newsletter by MoveOn.org, here is some valuable information about Internet resources to assist seniors (and others) trying to assess and access affordable health care.

• Yesterday, www.HealthCare.gov, a new online portal where anyone can go to find insurance options in their state, went live. It's a very handy resource for information that used to be difficult to find. It's available to help millions who need insurance find it, and as a resource for those who want to shop around for new options or find out their new benefits under the new law.

What it means to be a health care proxy

I just watched Keith Olbermann's Special Comment -- MSNBC -- February 24, 2010. Olbermann spoke  movingly about what it means to be a patient advocate for a loved one and about the importance of end-of-life planning, both for the patient and for the loved one(s) who may be chosen to make health care decisions when a patient is no longer able to do so. Olbermann also spoke passionately how important it is for our Congress to make health care accessible to all Americans.

I have to say that, having acted as a health care proxy for my parents at the end of their lives, I wept throughout Olbermann's extremely moving plea.

Exploitation of the elderly

There's been a lot of focus lately on how to avoid exploitation of the elderly and also domestic violence perpetrated by caregivers and/or family members.

Josh Ard, a noted elder law attorney who practices in Williamston, Michigan called to my attention an interesting case involving aspects of both issues (if one counts financial exploitation as a form of domestic abuse. I believe that financial exploitation is a form of abuse. See the Power and Control Wheel). In this case, the adultery and perjury of the elderly nursing home resident's husband trumped the lack of notice (and a false statement about notice) required by a guardianship petition filed by a granddaughter. The case occurred in Mississippi, but the concepts are equally applicable under Michigan law. These are the facts:

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Ruby Chism Ellis, married to Bobbie Ellis since July, 2000, entered a nursing home in June, 2006. In 2008, Ruby’s granddaughter, Stephanie Chism Turner, filed a petition to be appointed as Ruby’s conservator. Stephanie represented to the court that she served the petition on Bobbie although she had not.

The court appointed Stephanie as conservator and, according to Bobbie, his first notice of the proceeding was when Stephanie showed up at the home with the conservatorship papers, demanding that he vacate the premises. Bobbie, for his part, had been carrying on an affair over the previous eighteen months, even moving his paramour into Ruby’s home.

After Stephanie moved money from Ruby and Bobbie’s joint account, placing it in a conservatorship account, Bobbie sought to have the conservatorship set aside or, in the alternative, to replace Stephanie as conservator. Bobbie argued that he was Ruby’s appointed agent under a power of attorney. It was at this point when Stephanie’s perjury became apparent.

A guardian ad litem was appointed who prepared a detailed report quoted at length in the appellate opinion. Significantly, the guardian ad litem found that Bobbie’s loyalties had been transferred to someone else and may once again. The trial court declined to dissolve the conservatorship, but ordered Stephanie to submit an accounting. The court noted that Mississippi law does not give a spouse preference in a guardianship proceeding and that any procedural deficiency in Stephanie’s appointment was resolved by later hearings. On appeal, the judgment was affirmed. The presence of a power of attorney does not deprive the court of jurisdiction and, although the court was displeased with the conduct of each party, the determining factor appeared to be Bobbie’s shifted loyalty.

You can read the appellate court's opinion (and the GAL's accounting) here. In re Conservatorship of Ellis, 2009 Miss. App. LEXIS 873, Appeal No. 2008-CA-01993-COA (December 8, 2009)

The opinion gives you the understanding about what types of conduct may fit into the pattern that will be helpful for the court in making an informed decision.

Care coordination | A life-extender for seniors

Earlier this year, Anne Underwood wrote about a program called Guided Care in Caring and Coping, a "New Old Age Blog" featured by the New York Times. The Guided Care program provides services from a registered nurse to help seniors get coordinated care. Research shows that repeat hospital re-admissions caused by often life-threatening complications are significantly reduced when care is carefully transitioned between the hospital and another care setting (home, assisted living, rehab, etc.)

Can you imagine spending two weeks in the hospital after suffering a seizure, being cared for by nurses, seen by doctors, having medications prescribed, being transferred for "rehab" to a nursing home, then arriving home to find that most of your care wasn't covered by Medicare?

That's exactly what is happening to some patients. The Chicago Tribune published an article on March 10th explaining a little known category of hospital care called "observation stay."

Lack of communication in ER results in post-discharge complications

The New York Times reports on September 16, 2008 that most ("a vast majority") of emergency room patients are discharged without understanding the treatment they received or how to care for themselves once they get home. As borne out by earlier studies, and in particular, by the research of Dr. Eric Coleman who is the director of the Care Transitions program at the University of Colorado, the lack of communication when patients are discharged from one care setting to another can lead to medication errors and serious complications that can send them right back to the hospital.

You can read the entire New York Times article here. E.R. Patients Often Left Confused After Visits

For more information see Dr. Coleman's website caretransitions.org. Be sure to look at the intervention section and also to access a Caregiver's Tool kit for caregivers and patients. This toolkit will help you safety negotiate not only safe care in the emergency department, but also to handle successfully transitions between hospital and home or hospital and another care facility such as a rehab center.

Is online medical record storage safe?

As I have earlier written on Aging in Place, companies like Microsoft and Google are getting into the medical record storage business.  Last week, however, the New England Journal of Medicine raised important questions about whether medical privacy rules should be extended to these private firms. Steve Lohr wrote in the New York Times that the authors of The New England Journal article say there are still more questions than answers about the new “personalized health information economy.'’

Reducing incidence of bedsores using teamwork

Bedsores can be a serious complication of aging. The clinical name is pressure ulcers. These ulcers occur when skin breaks down because blood circulation is cut off by sustained pressure. Bedsores can be so difficult to heal that prevention is the recommended approach. A recent study shows that a teamwork approach can reduce the incidence of bedsores by 69%.

Patients who are confined to beds and wheelchairs in hospitals and nursing homes are most at risk for bedsores. Other complications, such as dehydration and poor nutrition, can put the elderly at greater risk to develop bedsores. Incontinence also can lead to bedsores.