Archive for October, 2015

Medicare to Pay for Advance Care Planning come January

Posted on: October 28th, 2015 by Mark R. Friedman

Medicare as of January 1, 2016 will start paying for patients to have conversations with their doctors about how they would like to die.

In a thought-provoking New York Times article, Pulitzer Prize-winning journalist Tina Rosenberg makes a powerful argument for why people should take advantage of this new provision.

I’ve written about advance care planning before, and it bears repeating. We all have to die eventually, and most people say they want to do it at home, in their own bed surrounded by friends and family. Yet in reality, most Americans die in a hospital bed surrounded by doctors and nurses, often being poked and prodded with machines.

One of the most intimate decisions in life is how it should end, yet far too many people never get the chance to make it.

The law does offer all of us the chance to have some input into how we die, by creating an advance directive for health care. A healthcare directive is a legal document in which you can appoint an agent to make health care decisions when you’re unable to. You can also set forth your wishes regarding medical treatment, including end of life care, which healthcare providers must follow.

However, Rosenberg argues that creating a healthcare directive is only the start of advance care planning, and I agree with her. People on Medicare should take advantage of the new program and talk to their doctors about what end-of-life care really entails. (Insurers will probably start paying for these conversations as well, so soon everyone will be able to talk to their doctors about end-of-life care.)

Most importantly, everyone should talk to their family about their wishes regarding end-of-life care. The conversation may be daunting or seem morbid, but if your family has to make a decision for you, it will be vastly easier for them to make peace with that decision if they can follow your wishes, instead of wondering ever after what your wishes were.

What to Do if your Spouse needs Long Term Care

Posted on: October 21st, 2015 by Mark R. Friedman

If your spouse is losing the ability to care for himself / herself and needs long term care, in a nursing home, assisted living facility or with home care aides, there are a lot of steps to take, like Medicaid planning and changing your estate plan.  We’ve written extensively about those steps on this blog, and today I want to focus on one particular and often overlooked step:  changing title to joint property.

For many people, the only way to pay for the high costs of long term care is through Medicaid.  If your spouse is on Medicaid and you are not, it’s very important that you don’t own assets jointly with your spouse, for two reasons.

First, when someone is on Medicaid, they can’t have more than $2,000 worth of assets (Resources).  If they have more than $2,000 in any month, they lose Medicaid.  If you own property jointly with your spouse, and you die, the property passes entirely to your spouse, and he will lose Medicaid.  Instead, in many cases that property could go to your children or other family members without causing your spouse to lose Medicaid.

Second, people over age 55 who receive Medicaid (called “beneficiaries”) are subject to Medicaid estate recovery.  That means that when a Medicaid beneficiary dies, any property they own goes to the government, in order to repay the government for the Medicaid assistance it provided to the beneficiary.  If you own property jointly with your spouse (or parent, child, sibling, etc.) on Medicaid, and your spouse dies, that joint property may become subject to Medicaid estate recovery and may have to be sold to repay the government.

If your spouse needs long term care and will go on Medicaid, it may be wise to change title to joint property.  That may involve doing a new deed to your house, changing bank account ownership, designating new beneficiaries for life insurance or retirement accounts, etc.

To learn more about what to do if your spouse is going on Medicaid, call or email FriedmanLaw.

Women Bear Majority of Costs for Alzheimer’s, Study Finds

Posted on: October 9th, 2015 by Mark R. Friedman

Women bear the majority of costs for Alzheimer’s disease, according to a new study from researchers at Emory University.  As reported by Pacific Standard, women bear six times as much of the cost for caring for Alzheimer’s patients.

The study’s authors look at direct costs – spending money on fees for home care aides or long-term care facilities – as well as indirect costs, like lost productivity due to serving as caretaker for a spouse or parent with Alzheimer’s disease.

Women bear so much more of the costs for a variety of reasons.  First, women are likely to contract Alzheimer’s disease, both because women live longer, and because women appear more susceptible to the disease for reasons unknown.  Second, women are more likely than men to serve as a caretaker for a loved one who has Alzheimer’s.

As the baby boomer generation ages and more people suffer from Alzheimer’s, lost productivity of caretakers could become a significant drain on the economy.  This is particularly true when caretakers are adult children taking care of their parents.  These caretakers are often in their working years, and may also be taking care of their own children.  Taking care of an Alzheimer’s patient is a draining role to which family-caretakers often devote more than twenty unpaid hours per week.  If more women are forced to shoulder this burden during their peak working years, it could have an impact on the economy.

The study raises an interesting and provocative question:  If men bore as much of the cost of Alzheimer’s as women, would there be more effort and resources put into finding a cure?  Alzheimer’s is the sixth leading cause of death in the United States, according to the CDC.  At any given time, there are five million people in the country suffering from Alzheimer’s.  Yet research efforts on the disease receive a fraction of the resources of other diseases, and much less than researchers say is needed to make meaningful progress towards a cure.

In any event, it’s certainly true that Alzheimer’s disease imposes significant costs on patients and their families, but government programs are available to help, including the Medicaid long term care benefit.  For more information on coping with the costs of Alzheimer’s, call or email FriedmanLaw today.

Hearing Loss Affects Longevity for Seniors

Posted on: October 7th, 2015 by Lawrence A. Friedman

On Oct.1, 2015, Reuters reported that a recent study involving researchers at Johns Hopkins University School of Medicine in Baltimore, Maryland shows that older people with significant hearing loss are at risk to die sooner than people with normal hearing.  While researchers haven’t determined the cause of the connection, the study points to hearing impairment as at least a warning sign and maybe even a contributor to lowered survival odds.

“In the simplest terms, the worse the patient’s hearing loss, the greater the risk of death,” lead author Kevin Contrera said of the study’s findings. While prior research has linked hearing problems to negative health effects, few studies have addressed mortality risk, Contrera and his colleagues write in JAMA Otolaryngology-Head and Neck Surgery.

Reuters notes that a hearing loss researcher who teaches at the University of Manchester in the U.K. and had no connection to the study wasn’t surprised by the results because seniors with hearing loss tend to have more difficulty with communication, are more socially isolated, and are less able to care for their own long-term health conditions. However, it isn’t clear whether increased mortality risk arises from hearing loss itself or these related conditions.  Since most older people have some hearing impairment, hearing loss could just be a marker of being older and sicker in general.

The study involved data on 1,666 adults from a nationally representative survey conducted in 2005-2006 and 2009-2010, as well as death records through the end of 2011. The study group were all over age 70 and had undergone hearing testing. Using World Health Organization definitions of hearing impairment in light of age, the researchers found that people with moderate or severe hearing impairment had a 54 percent greater risk of dying than those with normal hearing. In contrast, participants with mild hearing impairment had a 27 percent greater risk of mortality. Meanwhile, even after injecting other potential mortality indicators into the mix, people with moderately or severely impaired hearing had a 39 percent higher risk of death than those without hearing problems, and those with mild hearing impairment had a 21 percent greater risk.

Since two thirds of adults over 70 experience some hearing impairment, every hearing impairment alone doesn’t automatically indicate a major health issue. Still, in light of the links shown in the study, seniors with noticeable hearing loss would do well to discuss the study with their health providers.

While this study is outside the typical topics we discuss on this blog, at FriedmanLaw, we think it’s important to take a broad approach to solving legal issues. Thus, we hope you have found this post useful.


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Homepage photo: Cows grazing at Meadowbrook Farm, Bernardsville, NJ by Siddharth Mallya. October 23, 2012.
Interior photo: Somerset hills pastoral scene by Lawrence Friedman.