OHIO ELDER LAW BLAWG

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.

 

Tsunami has Especially Severe Consequences for the Elderly and Ill

 

I spent a little time this morning wondering how the elderly and disabled were doing after the Tsunami.  It appears as though hospitals were in its path, one hospital's first floor was ruined, and unfortunately the first floor kept all of the food and many supplies.

One article I read noted that "Much of the concern is focusing on of the elderly. At Shintona, about 90% of the victims were described as old, suggesting this might become a defining characteristic of the disaster."  The article noted that some elderly in nursing homes were dead or missing.  The care manager, Kiyoko Kawanami, of one of Miyagi Japan's first old people's homes she was able to confirm only 20 of the 90 residents were safe. "We don't know what happened to them. The tsunami hit while we were trying to organize an evacuation," she said.

There are already a number of articles engaging in hand-wringing over what could have been learned and was not in the aftermath of the the 2004 Tsunami, which hit Thailand with incredible devistation.  I guess there is always room for improvement, but it is hard to see how much of this devastation could have been fully avoided after such an incredible natural disaster.

Among a few interesting ways people can donate, Apple is accepting Red Cross donations through iTunes.  

A few links to articles:

http://www.newser.com/article/d9lutaro0/sick-elderly-face-double-misery-after-japanese-tsunami-destroys-hospitals-along-the-coast.html

http://www.guardian.co.uk/world/2011/mar/13/japan-earthquake-tsunami-survivors-grief

 

Options for Estates of 2010 Decedents

    The new law regarding Estate taxes signed by President Obama makes two different options for the beneficiaries of estates of those dying last year (2010). 

   Congress reinstated the estate tax (which had been repealed in 2010) with a $5 million exemption and a 35 percent tax rate for 2010. Executors must decide whether to  elect out of the tax for 2010. 

     If the personal representative elects to opt out, there will be carryover basis rules which apply to the estate beneficiaries for income tax basis purposes. Beneficiaries of large estates (sorry Steinbrenner kids) can be forced to pay capital gains taxes on appreciation of assets from purchase through the time of the decedent's date of death.  In other words, there will be an income tax bill, but no estate taxes. If no election is made the $5 million exemption and 35 percent rates will apply for 2010 decedent's estates. In this case the basis of the  inherited property will be the fair market value of the property at the date of death. 

    For estates worth less than $5 million, electing to pay estate taxes may be advisable, as the tax will be zero and you will get a step up in basis on the stock.  On the other hand, estates with significantly more than 5 million may want to elect out of the estate tax, and either pay or postpone events which would cause capital gains. 

Talk to us or your tax adviser for information about your particular situation.

Elder Law Office of Todd W. Bartimole