OHIO ELDER LAW BLAWG

VA Releases New Medical Forms In the Hopes of Faster Claims

The Department of Veterans Affairs (VA) has promulgated 68 new forms, some of which will hopefully speed processing of Vet’s disability pension claims, among other claims. Pension claims include claims for Aid and Attendance and Homebound benefits, of which many of our clients are able to take advantage.

The forms can be completed by private physicians, eliminating the need for a VA clinic examination in certain circumstances. “VA employees will be able to more quickly process disability claims, since disability benefits questionnaires capture important medical information (which are) needed to accurately evaluate Veterans’ claims,” said Secretary of Veterans Affairs Eric K. Shinseki. “Disability benefits questionnaires are just one of many changes VA is implementing to address the backlog of claims.”

New disability benefits questionnaires (DBQs) are meant to guide physicians’ in their medical findings. Hopefully this will ensure the VA has complete and appropriate medical information needed to make a decision in a reasonable time. These forms are downloadable from the VA website. Additionally, DBQs give veterans and active duty service members the option of visiting a primary care provider in their community instead of completing an evaluation at a VA facility. The streamlined forms use check boxes and standardized language so that the disability rating can be made accurately made.

The reason the forms are so numerous is because there are forms for individual medical conditions a Vet may experience. Some are specific to a sinmost condition while others can be used for several related issues. Click here for a list of the conditions.

Todd W. Bartimole

 

Nicholas Flamel and the Prepaid Funeral

I recently recommended to a client that he prepay his and his wife's funeral.  Not just preplan, but prepay. I was met with great resistance to this idea. Often, as in this case, the resistance generally boils down to one of two issues:

1. prepaying for my funeral is not good financial sense

2. I am not going to preplan my funeral, that's morbid!

Both may be true. However a prepaid funeral plan should still be considered, and even if one decides not to prepay, a preplanned funeral should still be considered.  

First of all, as to the morbidity of the thing, we all must understand and accept that for the last several millennia, everything that was born eventually dies.  I know this is news to everyone, but it's true.  Even Nicholas Flamel, who famously created the the Elixir of Life (a potion that prevented death as long as one continued taking it) in Harry Potter, ends up dying.  As I recall, when Flamel decided to stop taking the elixir of life, he took enough to prepay and preplan his funeral.  (This clearly was what Dumbledore meant when he said Flamel took enough of the elixir to “get his affairs in order.”)

Anyway, a preplanned funeral can be a gift to those who you leave behind, because it saves them the guesswork of what you would have wanted.  A prepaid funeral allows them to not have to worry where the funds are going to come from.  It also allows you to do this planning in a time of relatively low stress, as opposed to the time of high stress immediately after a spouse or parent has died.  Funerals can be expensive, and buying one when under stress may lead to impulsive purchases, and excess spending.  It will even allow you to shop around.  With a married couple's funerals often costing as much as a new car,  shopping around may be a good idea.

The question of whether it is a sound financial decision for you to prepay a funeral is a question that must be answered on a case by case basis.  When spending down to qualify for Medicaid, it is typically a good idea. For some, it is better to have the funds invested and earning some financial return.

There are some resources available if you are considering a prepaid funeral. The Funeral Consumers Alliance is that sells an end-of-life planning kit, "Before I Go: You Should Know." The Consumer’s Alliance is a a nonprofit, educational organization.  The International Cemetery and Funeral Association website has additional information and Federal Trade Commission offers publications that can help when planning a funeral: "Funerals: A Consumer Guide." And "Paying Final Respects: Your Rights When Buying Funeral Goods and Services."

You also can call us if you have other questions.

 

Going To Physician Visits With Older Loved Ones Could Improve Care, Save Costs

Family companions who routinely accompany older adults to physician office visits could be helpful to health care quality improvement efforts, according to a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health.

Because companions of patients were more active in communication by providing information directly to the doctor (70.5%), asking the doctor questions (67.1%) and explaining the doctor's instructions to the patient (54.5%), the study seems to indicate an increased quality of care for the elderly patient.   "Our study documents that the patient-provider relationship often includes a consistently present and actively engaged family member. This work suggests that quality of care improvements may result from more productive communication and education that targets both patients and their companions," said Jennifer L. Wolff, PhD, lead author of the study and an associate professor with the Bloomberg School's Department of Health Policy and Management.

Wolff and her colleagues at the Johns Hopkins schools of Public Health, Nursing and Medicine, and Weill Cornell Medical College analyzed a national survey of Medicare beneficiaries ages 65 years or older. The researchers studied the influence of socio-demographic characteristics, health status and physical function in regard to consistent accompaniment to physician visits. They also examined the activities performed by older adults' family companions during medical visits.

The researchers found that 75 percent of the 9.5 million older adults who attended routine physician visits with a family companion were consistently accompanied at 12 months follow-up. Nearly 9 in 10 (87.9%) beneficiaries who were consistently accompanied over time were accompanied by the same companion. Patients who were older, less educated and diagnosed with multiple chronic conditions were more likely to be consistently accompanied at one year follow-up. Nearly 35.5 percent of accompanied beneficiaries were physically disabled and received help with daily activities from their family companion.

Companions of these patients were more active in visit communication by providing information directly to the doctor (70.5%), asking the doctor questions (67.1%) and explaining the doctor's instructions to the patient (54.5%). "Initiatives to improve older adults' quality of chronic illness care have typically focused on improving health care professional and patient competencies, and have ignored the fact that Medicare beneficiaries often manage their health conditions and attend routine physician visits with a family member, predominantly a spouse or an adult child," said Wolff. "Results from this study may help inform health reform initiatives that seek to improve care quality and lower costs, such as the Patient Centered Medical Home."

Previous studies have shown that Medicare beneficiaries who attend routine physician visits with a family companion are disproportionately vulnerable by age, education and health, and that their Medicare expenditures are twice as high as those beneficiaries who are not accompanied by a companion.

Article URL: http://www.medicalnewstoday.com/releases/240712.php

Some Signs of Dementia may be B-12 Deficiency Instead

The NY Times today had a piece which described a woman's cognitive declines.  Her daughter noticed her becoming more and more confused.  When Aricept (a common Alzheimers' disease treatment) was prescribed, the woman became more confused. 

When blood work was done her B-12 level was well below normal.  When she recieved B-12 injections, she recovered. Now 87, the woman still lives alone in Manhattan and feels well enough to refuse outside assistance.

The link to the article is below.  It discusses not only the story, but information about B-12. 

http://www.nytimes.com/2011/11/29/health/vitamin-b12-deficiency-can-cause-symptoms-that-mimic-aging.html?src=me&ref=general

Beware Special "Senior Accreditation" Designations

The Financial Industry Regulatory Authority Inc. (FINRA) issued a warning, along with the results of a survey of 157 member firms, which questioned the approval process and oversight of "senior" or "retirement-related" designations.

Finra's notice is one in a long-running dispute over the use of "senior" accreditations and designations. A few years ago regulators became concerned about the growing number of free seminars given by insurance agents and others who sported impressive-sounding designations targeted at retirees, and who offerred a free lunch or dinner as a marketing draw.

Some financial planners have a great deal of experience with issues of retirement and the elderly, and others do not.  Taking a course for an accreditation may or may not indicate a substantial level of knowledge.  

An article further discussion this issue is an article from Investment News which is referenced below. 

-Todd

http://www.investmentnews.com/article/20111120/REG/311209989/-1/INIssueAlert01

Careful, Medicare's Annual Open Enrollment ends Dec. 7, not Dec. 31

Every year, people with Medicare should look into whether they should change the health and drug plans in which they are currently enrolled. This year, this Open Enrollment period is starting earlier than in prior years, (on October 15).  However, in what may catch people unaware,  it is ending sooner than usual.  This year open enrollment closes December 7.  This may be confusing to people who are used to seeing a December 31 end date for open enrollment. 

"Part D" plans help Medicare Beneficiaries pay for prescription drugs.  

"Part C" is the Medicare "Advantage" plans, which are managed care organizations [Medicare PPO (preferred provider organizations) and HMO's (Health Maintenance Organizations)]. Beneficiares may stay with their current plans, chnage plans, or go back to the Original Medicare program.

Its important to review your current plan to determine whether switching makes sense. Plans can and do make changes from year to year, so it is important to review your current Medicare choices, and decide what is best for you. 

Its also important to do this by December 7th, 2011.  

 

Alzheimer's: Earlier Diagnosis Creates Reform of Definition of the Disease

The definition of Alzheimer's disease is being updated and reformed in new medical guidelines that reflect fast-mounting evidence that the disease begins damaging the brain well before, perhaps years before, the symptoms begin to become apparent. 

The new guidelines by the National Institute on Aging and the Alzheimer’s Association, divide the disease into three stages, listed here in reverse in time:

1. A phase when dementia has developed;

2. A phase in which mild problems emerge but daily functions can still be performed; and

3. A phase, most recently discovered, in which there are no symptoms but changes are brewing in the brain.

Early diagnosis may become more prevelant and Medicare regulations may be updated to reflect the need for earlier discovery and intervention which hopefully can result in better planning and care. Edward Markey, Representative from Massachusetts has sponsored a bill to increase medicare reimbursement for such diagnosis.

For a more thorough review, please see the full article in the NY Times.

Long Term Care Insurance Premium Deductability for the Self Employed

Qualified long-term care insurance premiums can be claimed as a self-employed health insurance deduction in 2010, subject to the following limits:

 

Age of Covered Person	2010 Limit
40 or younger	$330
41 to 50	$620
51 to 60	$1,230
61 to 70	$3,290
Over 70	$4,110

Medicare part B health premiums deductable in some circumstances

Sole proprietors, partners, LLC members, and S corporation employee-owners can deduct qualified health insurance premiums paid to cover themselves and family members. In order to qualify, the owner must own over 2% of the stock in the business. The health insurance costs can be deducted on a 1040 "above the line"  meaning that the deduction can be taken whether or not you itemize. ("The line" refers to the last line on the first page of the 1040 which indicates your adjusted gross income).

Medicare Part B premiums have not been a deductable qualified health insurance premium for the self-employed. Small business owners who were enrolled in Part B Medicare were unable to deduct from between about $1,100 to $4,500 a year (the amount paid depends on the income level of the Medicare beneficiary).   However the IRS recently reversed itself on the Medicare Part B premium deductability, as the 2010 instructions explicitly Medicare Part B premiums to be included in health insurance costs for the deduction.

A person can also deduct self-employed health insurance premiums from self-employment income when calculating self-employment taxes in 2010. Review these rules for 2011 returns, as they may expire after 2010. 

 

Micky Rooney: the tip of the iceberg in elder abuse and exploitation

Micky Rooney recently testified at a congressional hearing regarding his own experience with abuse and exploitation of the elderly.

Rooney testified that he felt trapped and scared.  For years, he said he was controlled by a stepchild who took his identification, awards, and took control of his finances.  Rooney waited several years to act, feeling like he was a prisoner.  Finally he sought legal intervention when he obtained a restraining order over his alleged abuser. (CNN story)

This problem is not necessarily rare.  With the downturn in the economy, children who are not making ends meet because of their own financial problems are relying on parents for financial assistance.  Sometimes those needs take over the relationship and sometimes the relationship becomes physically abusive.

A recent national study showed that about 14% of older americans were neglected, abused, or exploited.

In one case our firm worked on, a caregiver working for a home health care agency worked for an elderly woman who began to rely on the caregiver.  Exploiting the elderly woman's dependence on her, the caregiver got a power of attorney from the elderly woman, and used hundreds of thousands of the client's funds for herself and friends.  A concerned child living out of town alerted attorneys and the police. An intervention occurred, and we filed suit to recover the funds from the caregiver and the agency. The woman was sent to prison and funds were recovered from the home health agency after a suit was filed.

Financial abuse can be overt or subtle.  When subtle, the elderly person may think that he or she is being nice by providing funds to someone who is in need.  When a closer look is taken, the transaction involves an abuse of the relationship.  Often the elderly person is dependent on the person exploiting the elder, and the power in that relationship creates the opportunity for abuse.  Sometimes it is not about money, but about mental or actual physical abuse, or neglect of a loved one.   

Unfortunately in our current political climate, funding for protecting vulnerable elderly is limited, and often falling.  Sentaor Herb Kohl of Wisconsin sponsored a bill that will create an office on elder justice.  The hope is that the office would tighten standards for reporting and defining elder abuse, coordinate the patchwork of services available to address elder abuse, and assist states in investigation of abuse, neglect, and exploitation cases.

If you believe someone is being abused, neglected or exploited, please call us for information and advice as to how to remedy the problem.