Articles Posted in Elder Law

Elderly couples are divorcing at a higher rate than ever before for a surprising reason: soaring medical and long-term care costs. These expenses are being aggravated by longevity and uninsured risk from a lack of long-term care insurance. Although these senior couples still care for each other very much, the cost savings from divorce are inflicting the least amount of damage when compared to other financial options.

Medicare and Medicaid

Seniors are now turning to divorce to stave off financial ruin trying to qualify for Medicare and Medicaid coverage. In terms of Medicare coverage, the program only covers 100 days of nursing care. If you or your spouse needs long-term nursing care you must either pay out of pocket until your assets fall beneath a certain threshold or tap into your long-term care insurance if you have it.

The Centers for Medicare and Medicaid Services says that it reviews more than 100,000 complaints and appeals every year. Beneficiaries of the programs file around 16,000 complaints relating to hospital care and discharge orders as well as 18,000 complaints against nursing homes, home health services, and hospice programs. Another 30,000 complaints and appeals are specifically geared towards the Medicare Advantage programs. How Medicare handles its complaint and appeals process is no trivial matter, and the program has recently revised its complaint process.

Updated Medicare Complaint Process

On August 1, Medicare made a change to its complaint filing system: it added new, toll-free numbers to call to lodge a complaint. The new phone numbers represent a larger change in the Medicare complaint system. Each state used to have a quality improvement organization, or Q.I.O. Up until August 1, these organizations worked with providers on issues like hospital readmissions or preventing infections, reviewed beneficiary complaints, and expedited appeals.

When Medicare was expanded in 2003, the expansion that established prescription drug coverage was called a “promise, a solemn promise, to America’s seniors.” Part D Medicare officially took effect in 2006, but still some seniors were afraid of falling into the infamous “doughnut-hole” coverage gap.

Initial Benefits of Part D

In Part D’s first few years, national data has shown that the program had helped seniors make progress with their prescription drugs. Overall, out of pocket costs decreased for medication, seniors took their medication more regularly, and were less likely to forego basics like food or heat in order to afford for their prescriptions.

The Jewish Home Lifecare nursing home is starting a new program later this month geared towards patients suffering from both elderly ills and addiction issues. This unusual rehabilitation program is the first of its kind in the country. Traditionally, nursing home patients that have the complication of alcohol or prescription pill addiction are considered “undesirable admissions” and have been a population that nursing home communities have shied away from.

Why Elderly Addiction is Dangerous

Elderly adults often have addiction issues that go unnoticed. It can stem from a lifetime of drug and alcohol abuse or come from a recent misuse of doctor prescribed pharmaceutical drugs. Alcohol abuse can be particularly dangerous because as a body ages it metabolizes alcohol differently. In addition, it can cause serious interactions with any medications that a senior may be taking. A general stigma surrounding the subject also prevents people from discussing the mental illness in the elderly that can come with substance abuse.

With the name “nursing home” most people assume that registered nurses are always on the premises. However, some of the time that is not the case and in certain nursing home facilities, most of the time. This is because of an old law from 1987, and lawmakers today are attempting to rectify the situation.

Old Registered Nurses Law

In 1987, a federal law was enacted that required registered nurses to only be on-site at nursing homes for eight hours per day. This rules applied regardless of the size of the facility. Supporters of the law at the time realized that in a building of sick and ailing elders a health crisis could arise at any time, but the legislation required compromises to be passed that included reducing registered nursing hours.

Whether it is moving to a retirement community, nursing home facility, or simply closer to the kids the changes associated with moving an elderly parent or relative can be fraught with stress and logistically challenging. There are few transitions in life more difficult for a person than when a senior needs to give up their home and independence. Giving up a house and friends of many years is an emotional and difficult experience for everyone involved.

Easing the Transition

There are many different ways to ease the transition for your loved one, but the most important is giving the older adult the opportunity to make their own choices about the decision. In addition, planning ahead for this type of transition is also a big help for everyone involved. Making plans early, instead of waiting for an emergency to hit, goes a long way in minimizing the stress for everyone.

The California Supreme Court ruled that people suffering from Alzheimer’s disease are not liable for injuries that they may cause to paid, in-home caregivers. The court ruled in favor of a couple sued by their in-home caregiver when she was hurt by the wife, who suffers from Alzheimer’s disease.

Facts of the Case

In the California case, Gregory v. Cott, the facts were undisputed. In 2005, Bernard Cott hired Ms. Gregory as a paid, in-house nurse to help care for his wife, Lorraine, who was suffering from Alzheimer’s disease. Ms. Gregory had worked with other Alzheimer’s patients in the past and was specifically warned that Ms. Cott could be combative by biting, scratching, flailing, and kicking.

One of the most confusing aspects of the Medicaid program is the look back period for asset transfers and how it can affect the eligibility for applicants to the program. The Medicaid program is different than the Medicare program, although people often think of the two terms as interchangeable. Medicare is an entitlement program paid for through withholdings in paychecks. Medicaid is a social welfare program designed for people who need medical care and cannot afford it. Medicaid is administered by each state, which means that the rules and benefits can vary from place to place.

Medicaid Qualification

The Medicaid program goes into effect once a person no longer has the money to pay for medical care on their own. This means that as long as you have assets that you can sell you are not eligible for the Medicaid program. Long-term planning can protect some portion of savings and assets for a spouse or children while still allowing you to qualify for Medicaid coverage. One way to keep assets and still qualify is to transfer assets to family before applying to the Medicaid program, but you must beware of the Medicaid look back period.

Over 1.4 million seniors are currently living in a nursing home in the United States. While most dislike or fear nursing homes, it is usually the best option for a senior that needs 24-hour care. Nursing homes typically have a reputation for being smelly, unfriendly, and indifferent places where the elderly is left to spend their final years until they die. However, there are plenty of nursing home facilities that can be even better than home care, and good facilities outnumber the bad when it comes to nursing home and long-term care.

Preparing to Choose a Nursing Home

One of the biggest mistakes that can be made when choosing a nursing home facility is waiting until the last minute. Especially when faced with a medical or financial crisis, being forced into an impulsive decision is never the best option. When choosing a nursing home you need to do the research, start looking around, see what services are available, and figure out what will be best for your loved one.

This summer, one nursing home settled a massive class action suit against the facility for using powerful and dangerous drugs on its residents without their informed consent or consent from family members. One member of the suit was a daughter whose mother entered the facility for eighteen days for physical therapy for a broken pelvis. The nursing home had given her heavy medication, including many dangerous antipsychotics, and within a matter of weeks she was dead. This class action lawsuit was the first of its kind in the country, and with a growing issue of drug abuse in nursing homes it will most likely not be the last.

A Growing National Issue

Sadly, this case is not an isolated event. Researchers estimate that as many as one in five elderly patients in nursing homes are given powerful antipsychotics and other drugs that are wholly unnecessary. This growing trend comes from a variety of sources, including but not limited to inadequate training of staff, understaffing of facilities, and aggressive selling by pharmaceutical companies. The Center for Medicare Advocacy has been quoted as saying that “The misuse of antipsychotic drugs as chemical restraints is one of the most common and long-standing, but preventable, practices causing serious harm to nursing home residents today.”

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