Environmental Funerals

Environmentally-friendly burials are gaining in popularity and becoming a viable option without interfering with traditions.

There are so many little, almost imperceptible steps society has taken to lessen our impact on the earth. Recycling has become the norm, hybrid cars aren't the joke they once were, and eating organic and locally produced foods is something most people attempt to include in their lives. (Whether or not we succeed isn't always the case, but at least we try.) So it's only natural for these values to carry over into the choices we make for our final disposition. Because if you had the choice between being buried in a more natural state, as opposed to being loaded with chemicals, which would you choose?

The green burial movement has been active for some time now, and people are interested in green burial and green funerals for a variety of reasons:

·         Green funerals and green burials can be a final eco-friendly act, one last effort to lessen our impact on the earth and reduce our carbon footprint.

·         Green burial can be seen as the traditional way of being buried -- a return to the way people were buried before the industrialization and commercialization of funerals.

·         For people observing religious traditions -- specifically Jewish or Muslim funerals -- green burial can be a way to honor those customs.

·         Consult with a knowledgeable funeral director to learn if they provide or are experienced in green funerals.

Important Facts To Know About Green Burials

Green burial, also called a natural burial, is an environmentally friendly burial that aims to have as little impact on the earth as possible.

How To Choose A Green Funeral Home

Green funeral homes make environmentally friendly goods available to their customers, offer non-toxic body preparation options, and work with green cemeteries or natural burial grounds.

A Guide To Buying Green Burial Products

If you're planning a green burial, you'll need to purchase burial products that are environmentally friendly -- this generally means you'll want a green casket and a green headstone.

 Natural Materials Used To Make Green Caskets

Green caskets are made from natural materials that will easily decompose when buried and will have as little impact on the earth as possible, such as bamboo, pine, recycled cardboard, hemp or other natural materials.

If you're planning a green burial you'll want to mark the grave with natural elements, rather than a commercial headstone.

The Three Different Types Of Green CemeteriesTraditional, Home, and Green

In addition to traditional cemeteries, there are a number of other options for where you can be buried, such as at a “green” or “eco-friendly” cemetery.

Pre-Planning A Home Funeral Service

Home funerals take place at a family home, rather than a cemetery chapel, religious place of worship, or a funeral home.  In the Denver Metro Area, the burial will then take place at a cemetery.

How To Have A Home Burial

If you live in a rural area you may be allowed to bury a body on your own property. For many families, home burial is a more intimate, economical, environmentally friendly, and personal method of burial.   Home Burial is not allowed in the Denver Metro Area.

Also called a natural funeral, a “green” funeral is an environmentally friendly funeral that aims to have as little impact on the earth as possible.

Finding A Green Cemetery

Many conventional cemeteries are now offering green burial options.  There is a fairly new cemetery in Denver called Seven Stones that specializes in such burials.

Purchasing A Green Casket

Green caskets are commonly made from materials such as bamboo, cork, teak, willow, rattan, banana leaf, seagrass, and recycled cardboard, as well as hemp, organic wool and felt, and organic cotton.

Presidential Executive Order could affect your Retirement plan

Earlier this year, Donald Trump ordered the Department of Labor to reconsider the Obama administration’s retirement savings protections due to begin taking effect in April, with an eye toward revising or completely eliminating them.

This protective ruling is based on two core ideas. First, if you are an individual investing for retirement, your best interests should come first. Your financial interests should not take a back seat to the financial interests of your financial adviser. And, the second idea of the ruling maintains that how your adviser gets paid cannot conflict with your best interests.

What Eliminating These Protections Could Mean For You

You may lose hard-earned retirement money.

The Labor Department created the new retirement investor protections because lots of evidence showed working people and retirees were paying a huge price for conflicted investment advice through higher fees and worse returns. If you continue to live with that conflicted advice, you could end up with about 25% less in retirement money over 35 years of investing than if you were getting recommendations from someone who is paid to work in your best interest. This easily could amount to tens, if not hundreds, of thousands of dollars less for you when you retire. Or, you might have to work longer to make up for it.

You won’t automatically be able to trust your retirement investment adviser.

Trusting the wrong person to help you make good decisions about your retirement investments can cause you deep and permanent financial harm. If the Trump administration gets rid of or weakens the retirement investor protections, it will continue to be your job to figure out whom you can trust—that is, who is a “fiduciary” legally required to act in your best interest versus who is just a salesperson getting paid with commissions and kickbacks.

AFL-CIO President, Richard Trumka had this to say after the initial Fiduciary protection ruling. “We know that financial industry opponents of the rule will continue their efforts to prevent it from being enacted. The AFL-CIO will be watching to see how members of Congress respond to their entreaties. This rule is critical to promoting retirement security for working men and women. It means we will have more of our hard-earned funds available for a secure and dignified retirement.”

Always Work With a Respected Fiduciary Financial Adviser

Even though a U.S. federal judge upheld the Obama-era rule, the case could still be appealed to a higher court. So, for now, the protective ruling is alive. However, the case is not closed. In the meantime, whether the ruling is ultimately done away with or not, you don’t have to be the one to suffer. If you have a plan stick with it. If you don’t have one, find a respected fiduciary investment adviser to work with immediately. Working with a fiduciary financial adviser can at least assure you that your interests are above theirs.

How You can Compare Replacement Plans

This week, the Congress is preparing to Repeal the Affordable Care Act and, perhaps, replace it with another plan.  The Kaiser Family Foundation has provided comparisons of the most prominent plans to date in terms of coverage, costs, pre-existing conditions. and other factors.   You can see these comparisons of Rep. Paul Ryan, Sen. Rand Paul, Rep. Tom Price, and Sen. Bill Cassidy to the current law by going to http://kff.org/interactive/proposals-to-replace-the-affordable-care-act/.

As I stated in my post on Linked in, the Op-Ed on the replacement of the Affordable care act, the proposals for block grants to fund Medicaid and/or Medicare would mean the end of these programs.  As of June, 2016, 1,356,251 Colorado citizens were enrolled in Medicaid.  Many of these are in long term care facilities.  Perhaps you did not know that Medicaid is the only government program that assists in paying for long term care for the elderly and disabled.  Perhaps you did not know that the average cost of care in a facility in Denver is over $8,000.00 per month.  But you do now.  Even for those who have saved $200,000, the cost of such care will wipe out these savings within two years whereas the average stay for a person in care is three years.  Home care for these people is not an option unless a family member quits working.  That results in loss of tax income and an increase in emergency room admissions for people who cannot pay for health care.

 

GOP to protect pre-existing conditions?

http://thehill.com/policy/healthcare/316416-gop-chairman-to-introduce-bill-to-insure-people-with-pre-existing

There are many bills that are in the process of introduction in the House of Representatives to repeal and replace the Affordable Care Act, also known as Obamacare.  Many of us are anxious about the future of the program and how it will affect our Seniors and the disabled community.  Many of the bills propose the repeal of the ACA without any replacement, which would leave approximately 20 million Americans without health insurance. 

The main sticking point for many of the Representatives and Senators seems to be the cost of insuring those with pre-existing conditions or severe illnesses. 

"A Democratic aide familiar with a version of the bill said that the measure would provide for an enrollment period during which people with pre-existing conditions could get coverage. However, the aide said under the current language, insurers could charge a client any price if they have had a period of no coverage."  The Hill

In other words, if a person is discontinued from their previous insurance for any reason, the insurance company could charge any amount to re-insure the person. "The biggest problem? Both premiums and other costs remained too high for many people with health conditions to afford. The federal program ran out of money almost a year before it was scheduled to end. Sometimes the pools got so expensive for states that they had to impose waiting lists for coverage. And often, to keep costs down, risk pools set up waiting periods before they started paying bills for the very illness that made people high risk."  Kaiser Health News.

The other problem with the proposals is that, under the ACA, the Congress was supposed to provide block grants to the states to support the Act.  Instead, of the grants, most states were provided with "loans" to support the program and less than one-half of the money that was supposed to fund the program was allocated.

"But the GOP plan also would likely make insurance more expensive for older people by proposing a broader range for premiums based on age. Current premiums can vary only three-fold based on age, which is “driving out younger and healthier patients” who can’t afford them, the GOP aide said.
Under the plan, insurance companies could not charge higher rates to people with pre-existing conditions so long as they maintain continuous coverage, whether from an employer or in a policy they purchase themselves. The new high-risk pools would be available for those who have a break in coverage, or who fail to purchase during a one-time open enrollment under the plan.
The plan would get rid of most of the coverage requirements under the Medicaid program for the poor, so states could make them more or less generous than they are currently. It would also limit funding. States could opt for either a per-person cap or a block grant to spend much as they wish."  Kaiser Health News

The plans to replace the Affordable Care Act are not affordable for our Seniors and would limit benefits for the most vulnerable in our society.  If an elderly person were to need surgery to prolong life, would they get it?  Maybe not under managed care proposals.  We have all had experience with denials of care because a clerk somewhere decided it was not reasonable or necessary.  I had to defend an ambulance to transport my 90 year old aunt to the hospital because Medicare said she could have taken a cab.

Be care what you wish for.

Rose Mary Zapor

 

Financial Exploitation of Incapacitated Adults

By Clinical Law Professor Kate Mewhinney

Provided to you by Rose Mary Zapor, Esq.

Lakewood Legal Center

New laws in most states provide an easy way to prevent impaired elders from being financially exploited. The impaired elder's credit cannot be increased and new credit lines cannot be opened. This type of "credit freeze" can be handled by someone acting on behalf of the elder, such as an agent under a POA. Clinical Law Professor Kate Mewhinney, CELA, discusses the North Carolina "protected consumer credit freeze" law, a 2016 statute that is similar to new laws passed in other states. She examines the benefits and ambiguities of the law and gives practice tips on how to use it to help prevent elder exploitation.

Sometimes an older person’s most valuable asset is a strong credit rating. Unfortunately, like any other asset, credit is often the target of financial exploitation. Predatory actors aren’t the only risk. Every elder law attorney knows of clients who get carried away with online shopping or investment trading. The temptations of the internet have been the financial undoing of many well-educated, savvy older people -- particularly those who are lonely or bored.
In recognition of these dangers, North Carolina has taken recent steps to protect the assets of incapacitated adults by broadening the availability of credit security freezes. This article covers the basics of the new “protected consumer credit freeze” statute, discusses its ambiguities, and proposes practice tips for attorneys working with older clients and their families
In our field, we probably don’t need a lot of data to know that financial matters often go awry when mild cognitive impairment hits. See, e.g., Tara Siegel Bernard, “As Cognition Slips, Financial Skills Are Often the First to Go,” N.Y. Times, Apr. 25, 2015. Now we have a new tool to address it.

What Is a Security Freeze?
An easy way for any adult of any age or health status to get protection from identity theft is to put a “security freeze” on his or her credit report. Placing a security freeze prevents someone else from stealing the person’s identity by opening a new account or increasing a credit line. Visit the National Conference of State Legislatures for the security freeze laws in 50 states and the District of Columbia. The three credit reporting agencies are Equifax, Experian, and TransUnion. A freeze can be put into place at any or all of these agencies. It is also fairly easy to remove the freeze if a person decides to open a new credit card or alter an existing account, but not so easy that they’ll be buying a huge flat screen TV on impulse.
In North Carolina, effective January 1, 2016, a guardian or an agent under a power of attorney (POA) can put a credit freeze in place for the principal if the principal is “incapacitated.” N.C.G.S. §§ 75-61, 75-63.1 (2015). Twenty-seven states have enacted these “protected consumer” laws in recent years and others are considering them now. For a list of these states, see Heather Morton, “Consumer Report Security Freeze State Laws,” National Conference of State Legislatures, October 12, 2016. The protected consumer statutes also allow parents and guardians to protect minor children from being the victims of identity theft, so “protected consumer” also applies to those age 16 or 18 and younger, depending on the state.
Who Is an “Incapacitated Person”?
The new statute in North Carolina sets out the procedures for creating and for removing a security freeze on what is termed a “protected person.” A “protected person” is defined as someone who is “incapacitated,” under age 16, or for whom a guardian or guardian ad litem (g/a/l) has been appointed. N.C.G.S. 75-61(11a) (2015).
North Carolina’s new statute does not define “incapacitated” and, unlike some elder abuse statutes, is not triggered by the person having reached a certain age. Unlike states requiring the consumer first to be found incompetent, such as Florida, Indiana, and Tennessee, by not requiring a finding of incompetency in guardianship before a person can be a “protected consumer,” North Carolina opted for a broad application of the law. Fla. Stat. § 501.005 and 501.0051; Ind. Code § 24-5-24-1 et seq. and Ind. Code § 24-5-24.5-1 et seq.; Tenn. Code § 47-18-2101 et seq.  
Besides the statute’s failure to define “incapacitated,” it also fails to include any requirement as to the evidence needed to establish incapacity. It may be that a verbal or written assertion by the representative will suffice. And what if the consumer simply disagrees with the allegations made by the representative that the consumer/principal is “incapacitated?” Sound like a familiar story? Is using a wheelchair or suffering from arthritis sufficient to meet the criteria for incapacity? The credit reporting agency seems to be put in the position to adjudicate what it means to be “incapacitated” -- with no set criteria to guide that decision. The only guidance is a provision that the freeze can be lifted if the consumer or his or her representative made a material misrepresentation of fact that caused the freeze to be put into effect. N.C.G.S. 75-63.1(c)(2) (2015).

Who Can Request a Security Freeze?
In addition to an agent under a POA, the statute also authorizes a “guardian” to request a freeze for a protected consumer. The statute does not specify whether it be a guardian of the estate or a general guardian. However, as we know, a guardian of the person has no authority over financial matters. N.C.G.S. 35A-1241 (2015). It makes sense that POA agents and court-appointed guardians should have the authority to ask for a security freeze because they have statutory authority to make financial decisions. The third category of authorized persons, though, does raise some questions.
The new statute provides that when a g/a/l has been appointed, a credit freeze can be requested. But, interestingly, a g/a/l is not listed in the statute as an entity with the authority to make such a request. The new statute only requires a consumer reporting agency to place a freeze if the “protected consumer’s representative” makes the request N.C.G.S. 75-63.1(a)(1) (2015).
The “representative” of an incapacitated person is defined as a person who provides “sufficient proof of authority to act on behalf of a protected consumer.” N.C.G.S. 75-61(13a) (2015). “Sufficient proof of authority” to act on behalf of a protected consumer is defined as including:

1.     An order issued by a court of law.

2.     A valid power of attorney.

3.     A written, notarized statement signed by the person that expressly describes the authority of the representative to act on behalf of the protected consumer. N.C.G.S. 75-61(16) (2015).

The statute does not make clear whether “person” is referring to the consumer or the representative. In at least a few states, the definition of “sufficient proof of authority” is clear in that the written, notarized statement is to be signed by the representative.  What “authority to act” the person has, without a POA or guardianship, is hard to imagine.  Perhaps family members who are Social Security representative payees will use that status to assert this authority?
If “person” is referring to the consumer, then it seems possible for a guardianship respondent, prior to any adjudication of incompetency, to authorize the g/a/l to make a security freeze request on the respondent’s behalf. However, in my experience, most respondents are in no shape to do so. With this in mind, where appropriate, the g/a/l should ask the Clerk of Court to issue an order authorizing the g/a/l to request a security freeze for a guardianship respondent.
Additionally, the statute allows the request to be made by first-class mail, phone call, or secure website or secure electronic mail, but the statute doesn’t address how the proof of one’s authority is established when the credit freeze request is made by phone. TransUnion, and perhaps the other agencies, currently only accepts written requests for protected consumer security freezes.

Doesn’t a POA Already Allow an Agent to Request a Freeze?
It seems that a broad, general power of attorney should already be legally adequate to request a security freeze without waiting until the principal becomes “incapacitated.” As we know, it is not always clear when a person has reached that point. Also, if the POA is adequate to buy and sell real estate, file tax returns, and handle all financial affairs, why wouldn’t it suffice to simply freeze the principal’s credit?

Should the Agent Under a Springing POA Be Able to Request a Freeze?
Consider the adult who has a springing POA that is triggered only by a doctor’s determination of the principal’s incapacity. Will consumer credit agencies notice if the springing POA hasn’t yet technically “sprung” (since there is no doctor’s letter) and the agent isn’t yet authorized to handle financial issues?

Contesting or Removing the Security Freeze (and Could an Impaired Person Figure This Out?)
The process for a “protected consumer security freeze” is more focused on providing protection from identity theft and improvident spending than on giving impaired individuals a chance to keep taking out credit. At the outset, when a security freeze is put in place for most consumers, the agency must send a written confirmation to those consumers within three business days of placing the freeze. N.C.G.S. 75-63(c) (2015). Also, the “regular” consumer is provided a personal identification number or password to be used when the consumer wants to lift the freeze for a specific party, for a specific time period, or permanently. Id.

This statutory provision is not referenced in the new statute on security freezes for protected consumers, so it is not clear how an incapacitated person would know that a freeze had been put into place or how to request that it be removed. Frankly, the process for an incapacitated person to remove or lift the freeze is such that an impaired elder would probably not be able to figure it out or get it done. This is especially true if the person is not provided notice that the freeze was put in place or an explanation of how to contest it or ask to lift it.

To remove the freeze, the statute allows the protected consumer to submit proof that the “authority for the […] representative is no longer valid.” N.C.G.S. 75-63.1(c)(1)(b) (2015). Presumably, this would include revocation of the POA by the consumer, dismissal of a guardianship petition concerning the consumer, or the consumer’s restoration to capacity in the guardianship context. The protected consumer must submit a request to remove the freeze to the consumer reporting agency in the manner specified by the agency. N.C.G.S. 75-63.1(c) (2015).

The protected consumer may have to pay a fee to have the freeze removed. Unless the consumer is over age 62 (or under 16), the agency may require payment of up to $5. N.C.G.S. 75-63.1(d) (2015). This fee is also waived if a report of identity theft was made to law enforcement. Id.

The statute seems to contemplate that the process for lifting (and placing) a freeze on a protected consumer’s credit will work slowly. The agency has up to 30 days to process the request to lift (and place) the freeze. N.C.G.S. 75-63.1(c) (2015). For unprotected consumers, however, the lift must occur within 15 minutes of an electronic request or within 3 days of receiving a written or telephonic request. N.C.G.S. 75-63(j) (2015).

Conclusion
North Carolina’s new statute allowing a security freeze for protected consumers provides an easy process for preventing and addressing identity theft and profligate spending that might result from cognitive impairments. While it won’t prevent an impaired elder from “giving away the farm,” it might keep them from mortgaging it!

What You Need - as POA Agent - to Freeze the Principal’s Credit
First, it is probably easiest to simply help the principal put a security freeze in effect without using the new protected consumer statute. The agent should be sure to keep track of the PIN or password provided, in case the freeze on the principal’s credit needs to be lifted for a new account or simply for a credit check.

If, however, the agent uses the new “protected consumer security freeze law,” the agent must assemble and send to each credit-reporting agency:

  • The complete name and address of the principal and the agent.
  • The POA.
  • Social Security card of the principal and the agent.
  • A government issued I.D., such as a driver’s license, for the principal and the agent.
  • A letter enclosing a copy of these items, saying the principal is incapacitated.
  • Note that Experian also requires a copy of the following items for both the agent and the principal: a birth certificate plus one of these: a utility bill, bank statement, or insurance statement.

The process is free if the principal is older than 62. Read each site carefully, because they vary slightly. Some only allow submission of documents via U.S. mail, at this time. For more details, see:

About the Author
Clinical Professor Kate Mewhinney manages the Elder Law Clinic at Wake Forest University School of Law. She is a Certified Specialist in Elder Law by the N.C. State Bar and the National Elder Law Foundation, and a former chair of the NCBA Elder Law and Special Needs Section. She thanks Rebecca Daddino, third-year law student, for her research assistance on this article. If you use your state's protected consumer statute, please share your experiences with her at mewhinka@wfu.edu.

IF YOU HAVE ANY QUESTIONS ABOUT CREDIT FREEZE IN COLORADO, FEEL FREE TO CONTACT MY OFFICE.

The Lakewood Legal Center

7475 W. 5th Ave., #202

Lakewood, CO80226

303-866-0990

 

Affordable Care Act is hard to repeal and replace

http://khn.org/news/repealing-the-affordable-care-act-could-be-more-complicated-than-it-looks/

Kaiser Health News has reported that keeping Americans healthy is going to be harder than just a catch phrase like Repeal and Replace.  First, repeal of the law would take 60 votes in the Senate, whereas Democrats now hold 48 of those seats and Republicans now only 51.  Second, both President Elect Trump and Vice President Elect Pence have made statements regarding maintaining parts of the ACA that provide coverage to those already dependent on the program. Third, there is no plan yet to repeal and replace the coverage for 20 million people at this time.  Even the base of the Republican party will not allow their representatives to just erase a program that has become more popular in the last few years.

I am not so naive as to believe that the ACA will never be repealed, but the replacement plan will have to be part of the plan in order for the GOP to retain their base of hard working Americans.  The repeal will not be in one big swoop, but will take little bites from the plan through tax amendments like the one vetoed by President Obama earlier this year.  But the replacement will have to be a one piece legislative effort, open to scrutiny by the public and by the insurance industry.

This is not the time to panic, but it is the time to keep vigilant.

Estate Planning As Part of Your Long Term Care Plan

September 22, 2016 | by The NCPC

A key deficiency in the process of planning for long term care occurs when seniors fail to provide for the orderly distribution of assets after death or fail to let their family know what to do when the senior can no longer handle his or her own affairs.

Estate planning from a qualified estate planning attorney, a financial adviser who specializes in estate planning or a CPA planner is the design of documents to provide the orderly transfer of assets and property to the next generation. Wills, living trusts and a myriad of other trust documents or business arrangements to avoid estate taxes are some of the principal planning strategies used. Other planning might center around income tax and real estate capitol gains. Estate planning also concerns issues of business succession and consideration of eligibility for government sponsored benefits.

Estate planners need to become more involved in the planning process for long term care by helping in the production of a written long term care plan. This should include meetings with potential family caregivers and instructions or checklists for these people. This important part of the planning process is often overlooked.

Because long term care planning is often overlooked, elders or their families who are assisting them should insist on more careful planning for long term care issues when doing an estate plan. Some advisers have recognized this need for care planning and have put together a team of experts such as attorneys, care managers and financial planners who provide a more complete and comprehensive approach to estate planning, long term care and end-of-life issues.

Estate planning attorneys can also help draw up legal documents and provide additional legal input that might be necessary. As an example an estate planning attorney will help you with the following:

  • Give tax advice pertaining to estate issues
  • Perform probate services
  • Draw up wills and trusts
  • Design powers of attorney and other consent documents
  • Design special trusts or partnership programs to save estate or gift taxes
  • Design charitable gifting programs
  • Design programs to pay for estate taxes
Source: https://www.longtermcarelink.net/article-2...

Be Sure to Have Your Eyes Checked!

New research shows that an early detection of Alzheimer's may be available through tests of our senses, especially eyes and smell.  While this may seem strange, it is actually logical.  The senses of sight and smell are directly connected to the brain.  Unlike our sense of touch that is routed through our spinal column, the sense of sight is directly connected to the brain through the optic nerve. 

Four studies being presented at the Alzheimer’s Association International Conference in Copenhagen, Denmark, strengthen earlier evidence that the earliest signs of Alzheimer’s disease might show up in the eyes and nose.

That could mean earlier treatment, and could give people a chance to plan, said Maria Carrillo, vice president of medical and scientific relations at the Alzheimer’s Association.

Two used fluorescent compounds to detect deposits of the protein amyloid in the eye.

The authors of these studies believe the amount of amyloid found is a good indicator of how much is present in the brain, where it forms sticky clumps in those with Alzheimer’s.

Two other studies suggest a loss in the ability to detect odors could be an early sign of the disease.

Dr Simon Ridley, of Alzheimer’s Research UK, said: “It is difficult to diagnose Alzheimer’s disease accurately and, in many cases, by the time the symptoms have developed, damage has already been going on in the brain for a number of years.

“A quick, cheap, non-invasive test to detect Alzheimer’s would be an important step in helping people to receive an early diagnosis .

“This research is promising but it is too soon to determine whether these types of tests will be useful for diagnosis of dementia .”

More research is reported in the Journal of the Alzheimer's Association that discusses a possible blood test for Alzheimer's. 

A BLOOD test which will be a “major step forward” in fighting Alzheimer’s could be available in just two years, scientists say today.

Scientists have identified a unique combination of protein molecules in the blood which give an early warning that a patient is likely to develop dementia. This finding will help them devise a test to diagnose people quicker and could lead to new treatments, they say.

A spokesman for the Alzheimer’s Society in the United Kingdom hailed the study, saying: “Finding a way to detect dementia before symptoms develop would revolutionise research.”

The test, likely to cost between £100 ($171.00 U.S.) and £300 ($514.00 U.S.), can show with almost 90 per cent accuracy which individuals suffering from mild memory loss will develop Alzheimer’s within a year.

Professor Simon Lovestone said drugs trials currently fail because they take place too late when Alzheimer’s is too far advanced.  “If we could detect people earlier, it  might be that the drugs which are developed are more effective,” he said. “If we could treat the disease during the phase where there are no symptoms we could have a preventative therapy.”

Prof Lovestone, of Oxford University, said it could be between two and five years before a blood test could replace brain scans and lumbar punctures. He said: “At the moment all I can say to someone with signs of memory loss is, ‘Come back in a year and we’ll see if it has progressed’ and that is grim, that’s horrible.”

A blood test could pave the way for more breakthroughs in treating dementia

In the largest study of its kind, researchers analysed 26 proteins previously linked to dementia in 1,000 patients. They found 16 molecules present in people with mild cognitive impairment. A specific combination of 10 molecules were identified in patients who developed Alzheimer’s within a year.

An Alzheimer’s Society (UK) spokesman said the test has so far shown just 87 per cent accuracy, meaning that one in 10 people would get an incorrect result. “Only through further research will we find answers, so we will watch the progress of this with interest,” he said.

For more information on clinical trials in the United States, go to  www.alzfdn.org for a list of ongoing trials.

 

MEDICARE MUST COVER SKILLED NURSING CARE

Improvement Standard Update: CMS Revises Medicare Policy to Ensure Coverage for Skilled Maintenance Care

 

December 9, 2013 – The Center for Medicare Advocacy is pleased to announce that the Medicare Policy Manuals have been revised pursuant to the Jimmo vs. Sebelius Settlement. The Manual revisions, which clarify that improvement is not required to obtain Medicare coverage, were published by the Centers for Medicare &Medicaid Services (CMS) on Friday December 6, 2013. They pertain to care in Inpatient Rehabilitation Facilities(IRF), Skilled Nursing Facilities (SNF), Home Health care (HH), and Outpatient Therapies (OPT ). The CMS Transmittal for the Medicare Manual revisions, with a link to the revisions themselves, is posted on the CMS website. The CMS MLN Matters article is also available on the CMS site under “Downloads ”

 

As CMS states in the Transmittal announcing the Jimmo Manual revisions :No “Improvement Standard” is to be applied in determining Medicare coverage for maintenance claims that require skilled care . Medicare has long recognized that even in situations where no improvement is possible, skilled care may nevertheless be needed for maintenance purposes (i.e., to prevent or slow a decline in condition). The Medicare statute and regulations have never supported the imposition of an “Improvement Standard” rule- of - thumb in determining whether skilled care is required to prevent or slow deterioration in a patient’s condition. Thus, such coverage depends not on the beneficiary’s restoration potential, but on whether skilled care is required, along with the underlying reasonableness and necessity of the services themselves . The manual revisions now being is sued will serve to reflect and articulate this basic principle more clearly. [Emphasis in original.]

 

Per the Jimmo Settlement, CMS will now implement an Education Campaign to ensure that Medicare determinations for SNF, Home Health, and Outpatient Therapy turn on the need for skilled care – not on the ability of an individual to improve. For IRF patients,  the Manual revisions and CMS Education Campaign clarify t hat coverage should never be denied because a patient cannot be expected to achieve complete independence in self - care or to return to his /her prior level of functioning.

 

“As with all components of settlement agreements, the Jimmo revisions are not perfect,” says Judith Stein, Executive Director of the Center for Medicare Advocacy. “But they do make it absolutely clear that skilled care is covered by Medicare for therapy and nursing to maintain a patient’s condition or slow decline – not just for improvement .”

 

Plaintiffs in Jimmo vs. Sebelius are represented by the Center for Medicare Advocacy and Vermont Legal Aid. Jimmo is a certified national class action lawsuit brought by individual Medicare beneficiaries and national organizations. It was formally settled by the Plaintiffs and Secretary Sebelius on January 24, 2013, when federal Judge Christina Reiss approved the settlement Agreement .

 

Changes to Medicare could cost claimants for Home care

New CMS Proposed Homebound Policy Would Leave Medicare Beneficiaries Without Coverage

 Medicare only covers home health care if, among other requirements, the beneficiary is homebound. As of November 19, 2013, the Centers for Medicare & Medicaid Services (CMS) will require new criteria for purposes of meeting the homebound requirement . These new requirements will leave many Medicare beneficiaries without access to the medically reasonable and necessary home care coverage to which they are legally entitled.

 The Law

 The Medicare statue indicates that a beneficiary is homebound if the individual is confined to home because of:

  a condition, due to an illness or injury, that restricts the ability of the individual to leave his or her home except with the assistance of another individual or the aid of a supportive device (such as crutches, a cane, a wheelchair, or a walker), or if the individual has a condition such that leaving his or her home is medically contraindicated.  While an individual does not have to be bedridden to be considered "confined to his home", the condition of the individual should be such that there exists a normal inability to leave home and that leaving home requires a considerable and taxing effort by the individual. Any absence of an individual from the home attributable to the need to receive healthcare treatment, including regular absences for the purpose of participating in therapeutic, psychosocial, or medical treatment in an adult day-care program that is licensed or certified by a State, or accredited, to furnish adult day-care services in the State shall not be disqualify an individual from being considered to be "confined to his home". Any other absence of an individual from the home shall not so disqualify an individual if the absence is of infrequent or of relatively short duration.  For purposes of the preceding sentence, any absence for the purpose of attending a religious service shall be deemed to be an absence of infrequent or short duration."[1] [Emphasis added.]

 Current Policy

 CMS currently effectively captures the intent of the Statute in its policy manual, stating:

 An individual does not have to be bedridden to be considered confined to the home.  However, the condition of these patients should be such that there exists a normal inability to leave home and, consequently, leaving home would require a considerable and taxing effort.[2]

 The current policy then quotes the Statute, followed by:

It is expected that in most instances, absences from the home that occur will be for the purpose of receiving health care treatment.  However, occasional absences from the home for nonmedical purposes, e.g., an occasional trip to the barber, a walk around the block or a drive, attendance at a family reunion, funeral, graduation, or other infrequent or unique event would not necessitate a finding that the patient is not homebound if the absences are undertaken on an infrequent basis or are of relatively short duration and do not indicate that the patient has the capacity to obtain health care provided outside rather than in the home.[3]

 The current policy goes ontostate:

 Generally speaking, a patient will be considered to be homebound if they have a condition due to an illness or injury that restricts their ability to leave their place of residence except with the aid of: supportive devices such as crutches, canes, wheelchairs, and walkers; the use of special transportation; or the assistance of another person; or if leaving home is medically contraindicated.[4]

 In other words, the current policy clarifies that a person will be considered homebound if her ability to leave home is restricted and the policy provides a number of ways in which to demonstrate this is the case. If a beneficiary requires the aid of supportive devices, the assistance of another person, or if leaving home is medically contraindicated, it establishes the requisite restriction on the ability to leave home even without a taxing effort. Under the Statute and current CMS policy, there is no specific requirement that the person must require the assistance of another, require an assistive device, or special transportation to leave home or that it is medically contraindicated for the person to leave home. Indeed the statute states that the individual's condition "should be such that there exists a normal inability to leave home and that leaving home requires a considerable and taxing ef f o rt "

 CMS' New Home bound Policy

 As of November 19, 2013, however, CMS will require Medicare beneficiaries to meet two sets of criteria before their home health agency even considers whether they have an ordinary inability to leave home. The new policy states :

 For purposes of the statute, an individual shall be considered "confined to the home" (homebound) if the following two criteria are met :

1. Criteria- One:

 The patient must either:

 Because of illness or injury, need the aid of supportive devices such as crutches, canes, wheelchairs, and walkers; the use of special transportation; or the assistance of another person in order to leave their place of residence

 OR

Have a condition such that leaving his or her home is medically contraindicated.

 If the patient meets one of the criteria in Criteria- One, then the patient must ALSO meet two additional requirements defined in Criteria- Two below.

2. Criteria- Two :

 There must exist a normal inability to leave home;

 AND

 Leaving home must require a considerable and taxing effort .[5] [Emphasis added.]

Two years ago, on November 4, 2011, CMS published this new proposed policy as "Clarification to Benefit Policy Manual Language on 'Confined to the Home' Definition."  Unfortunately, the proposed policy change was included with unrelated materials and went unnoticed by beneficiary and consumer advocates until November 1, 2013. The 2011 explanation for the po licy change was s t at ed as :

 To address the recommended changes of the Office of Inspector General (OIG) to the home health benefit policy manual, CMS proposed to clarify its "confined to the home" definition to more accurately reflect the definition as articulated in the Act…These changes present the requirements first and more closely align our policy manual with the Act to prevent confusion and promote a clearer enforcement of the statute and more definitive guidance to HHAs for compliance[6]

 Regrettably, CMS did not indicate to which OIG report it is responding. Nonetheless, in a more recent report the OIG defined homebound more clearly than, and mostly consistent with, the Statute and the current CMS policy manual:

 Medicare considers beneficiaries homebound, if, because of illness or injury, they have conditions that restrict their ability to leave their places of residence.  Homebound beneficiaries do not have to be bedridden, but should be able to leave their residences only infrequently with "considerable and taxing effort" for short durations or for health care treatment.[7]

This March 2012 OIG statement is far more akin to the relatively flexible "confined to home" standards set out in t he Medicare Act . Similarly, the current policy is closer to the statute than the proposed policy. Where the statute and current policy indicate what should usually be present to meet the homebound definition, the proposed policy states what must be present . Further, the proposed policy deletes the introductory language of the current policy, which includes a sense that an individual's circumstances as a whole should be looked at to determine whether he/she is homebound.

 Conclusion

 The intent of the Medicare statute is to provide health care in the home to beneficiaries who lack an ordinary ability to leave home. Beneficiaries who need the assistance of another or an assistive device or who require special transportation to leave home or people who should not leave home because it is medically contraindicated are examples of people who lack an ordinary ability to leave home, and thus need the health services to come to them. However, they are not the only beneficiaries who are homebound  for purposes of Medicare coverage of home health care.

For example, an individual with chronic obstructive pulmonary disease may not have an assistive device, may not need another person to help her leave her home, and may not need specialized transportation. Nonetheless, she may still have an ordinary inability to leave home for multiple reasons including shortness of breath, dizziness upon exertion, or inability to climb stairs . Under the Statute and current CMS policy, this individual would be eligible for home health coverage, but under CMS's new definition of homebound, she and many like her, will not be considered homebound and will lose access to Medicare coverage for home health care. This is an illegal and unaccept able result .

 CMS should not implement its new home bound policy. It is inconsistent with, and more restrictive than, the Medicare law. It will undermine the intent of the Medicare statute.  Furthermore , it will result in many older and disabled Americans losing home health care the very care that allows them to live at home and to stay out of costly institutions.

1] 42 U.S.C. § 1395n(a)(2), as amended by t he Medicare, Medicaid, and SCHIP Benef it s Impro vement and

Pro t ect io n Act o f 2000 (BIPA), Pub. L. No . 106- 554(Dec. 21, 2000).

[2] Medicare Benef it Po licy Manual, Pub. 100- 02, Ch. 7, § 30.1.1

4 [5] Rev, 172, Is s ued: 10- 18- 13, Ef f ect ive: 11- 19- 13, Implement at io n: 11- 19- 13, No t yet available o n t he o nline vers io n o f t he Medicare Benef it Po licy Manual, Pub. 100- 02, Ch. 7, § 30.1.1.

[6] 76 Fed. Reg. 68526, 68599 (No v. 4, 2011).

[7] Of f ice o f Ins pect o r General (OIG), Documentation of Coverage Requirements for Medicare Home Health

Claims, OEI- 01- 08- 00390 (March 2012).

Seniors Find Ways to Enter the Work Force

Posted on Sun, Nov. 03, 2013

Senior citizens find ways to enter the workforce again through innovative jobs program

CW Griffin / Miamin Herald Staff

Gail Willingham, works with Jessica Bras on advanced math as she tutors children at Miami Beach Senior High School through a program called AVID.

As the U.S. economy continues to recover from the recession, more senior citizens are entering the workforce today compared to 2010, according to a new Gallup poll released in October. Senior Americans aged 65 and older in the workforce increased from 22 percent in 2010 to 25 percent in 2013.

Clyde Fleming is one of them. After spending more than 30 years working for Jackson Health System as an administrator, he recently joined the workforce again after having been retired for five years.

But the former healthcare executive wasn’t pounding the pavement answering help wanted ads when he decided to join the professional ranks. Instead, a friend told Fleming about ReServe, a nonprofit program that matches seniors aged 55 and older with jobs.

“I enjoyed being retired. But after a while, I began to miss the work environment that I had spent decades in at Jackson,” said Fleming. “I wanted to find a way to give back to my community in at a place where my skills and experience would be of value.”

Fleming considered trying to find a job through traditional means.

“Before I talked to friends about my desire to go back to work, I thought about going online and browsing help wanted ads,” said Fleming. “But I knew I would be competing with people half my age and that’s something that many seniors face on their search for a job.”

Seniors face very real barriers to entering the workforce, according to Christine McMahon, president and CEO of Fedcap, the organization that operates ReServe.

Fedcap was founded in 1935 to help people who, at the time, weren’t often considered for gainful employment including the disabled and the elderly. Based in New York, Fedcap operates seven ReServe chapters in the United States including Boston, Newark and Miami.

In addition to ReServe, Fedcap, a not-for-profit, also runs several other programs to help youth and veterans, primarily in New York, New Jersey and Washington, D.C. find meaningful employment. FedCap operates ReServe and receives funding for the program from foundations like the United Way and the MetLife Foundation, among a host of others.

“The recession has taken its toll on the nation as a whole, but for seniors, it has been particularly tough,” said McMahon. “While they have a tremendous experience and skill, it is hard for them to join the workforce again because there are many misperceptions out there about them, like they can’t work as hard as their younger counterparts because of their age, and that, unfortunately, creates a barrier to hiring for them.”

Since its inception in 2005, ReServe has matched 3,000 seniors to jobs around the nation. The Miami chapter was launched in 2012. And to date, 37 seniors have been matched through the program with positions, primarily in the not-for-profit sector.

“We have recruiters in each city that operates a chapter,” said McMahon. “They work to actively engage employers in both sectors to partner with ReServe and hire program participants.”

To participate in the ReServe program, seniors begin by filling out an application online. They attend a session with ReServe staff to evaluate their skills for a possible employment match. From there, seniors who are accepted into the program are given access to the Opportunity Board, a Web-based tool that allows them to browse current job opportunities available exclusively through ReServe. “Through Opportunity Board, program participants can then find opportunities that match their particular skill set and begin the process of being matched for a position,” said McMahon. “Available job opportunities range from short-term and longer term assignments to permanent hires.”

ReServe works directly with employers to present the best candidates for a position.

“We charge employers $15 per hour of which the employee receives $10 per hour. Participants are on the ReServe payroll, so we take care of taxes and other costs associated with bringing on a new employee, so we eliminate those costs for the employer,” McMahon said. Fleming, who joined ReServe earlier this year, is a manager for the Alliance for Aging, where he is working on a yearlong assignment to develop a program that educates seniors about how to avoid being exploited financially.

“It’s the perfect job for me,” said Fleming. “I’m giving back by building a consortium that includes agencies, financial institutions, law enforcement and others to launch a program that is going to tackle a major public issue affecting seniors.”

For Gail Willingham, a native Miamian, ReServe offered flexibility: She was able to give back to children and earn money, and she also had time to pursue her love of acting.

“After joining ReServe in 2012, I was matched with a position as a tutor for the Advancement via Individual Determination (AVID) program at Brownsville High School,” said Willingham. “AVID is a college-readiness program that helps get students on the path to higher education. I get to work part time and still pursue the activities I love.”

For many seniors in the ReServe program, earning a paycheck is secondary to helping the community through their work.

Kelsey Dorsett, a former entrepreneur who lives in Overtown, was looking for volunteer opportunities online when he came across the ReServe program.

“I owned and sold a business before I retired,” said Dorsett, who also works for AVID at Booker T. Washington High School. “I thought volunteering would be a great way to give back. Then I found ReServe. It’s an innovative way to get seniors who have excellent experience back into the workforce to share their knowledge with others.”

Virginia Aponte enjoys sharing her career experiences seniors on the hunt for employment.

A New York resident who worked in publishing for Random House and in television for NBC before moving to Miami, Aponte worked in human resources for the Coconut Grove Playhouse until it closed in 2006. Today, she is a program manager at ReServe in Miami helping other seniors like her find work.

“Senior citizens are repurposing themselves through ReServe to address issues in their communities and make life better for the people who live and work there,” said Aponte. “And employers are getting very talented people to work for them whose expertise is worth well beyond what they are being paid. It’s a win-win situation for everyone involved.”

There are plans in the works to reach beyond the Miami area with ReServe, according to McMahon, the head of Fedcap.

“We have had a great deal of interest from Fort Lauderdale and West Palm Beach to start chapters there,” said McMahon. “We see Florida as an ideal market for program expansion, and it’s very exciting to think about the seniors that we can put to work changing their communities for the better.”


Read more here: http://www.miamiherald.com/2013/11/03/v-print/3726220/senior-citizens-find-ways-to-enter.html#storylink=cpy

 

Long Term Care Commission Fails to Address Finances

Long-Term Care Commission Identifies Issues Facing America's Growing Need for Long-Term Services and Supports

By Morris Klein

Congress mandated the federal Long-Term Care Commission to address a very complex subject in an impossibly short time. As events turned out, the Commission had only three months to conduct hearings and make recommendations once it was fully organized. By comparison, a federal advisory commission created around the same time to review rules on the use of electronic devices on airplanes needed nine months (including a three-month extension) to report its recommendations.  

Identifying the Issues
We commend the Commission for what it did accomplish in this short time. It did a good job identifying many of the issues our nation needs to consider in shaping policies on long-term services and supports (LTSS) – policies more urgent as the baby boomers reach retirement age and the phase in their lives where long-term services and supports may be required. Among the recommendations made in their report, the Commission:

  • Proposed an improved focus on quality across settings of LTSS – with particular attention to home and community-based services. It suggested the promotion of services for persons with functional limitations in the least restrictive setting appropriate to their needs – building a system, including Medicaid, with options for people who would prefer to live in the community.
  • Advocated for new models of public payment that pay for post-acute and long-term services and supports on the basis of the service rather than the setting.
  • Suggested integration of LTSS with health care services in a person- and family-centered approach.
  • Proposed non-specific improvements in the working conditions for care workers.

These recommendations can serve as a basis to educate the public and policy makers.

Most Americans Unprepared to Pay for Long-Term Care Needs
Yet, the Commission fell short in one key area. As pointed out in a report written by five dissenting commissioners, it failed to recommend a clear path to finance LTSS. This report offers two alternatives:

  • Enhanced private financing and
  • Strengthening of a public support program.

It is undisputed that most Americans are unprepared for paying for long-term services and supports if such care is needed. It is also undisputed that many people either cannot afford or are medically unqualified for long-term care insurance. The Commission did not advance the discussion on this vital topic far enough. It should have provided more direction in this critical area.

America Needs Consensus on the Issue of Financing Long-Term Care Needs
Finally, the Commission proposed a national advisory committee to continue its work. We support this. Although the Commission provided a template for public dialogue, it was unable to come to a consensus on the most important issues of financing and the balance between public and private roles. The momentum it has created should continue for this issue to be resolved so the elderly and disabled can receive long-term services and supports with dignity and financial security.

 

Veterans Missing Out on Benefits

Scott A. Makuakane, Esq., CFP
Hawaii State Coordinator, ElderCareMatters.com

Many Veterans believe that they have to have suffered an in-service disability to qualify for monetary benefits from the Veterans Administration. This is a common misconception. Depending on their health status, their income, and their assets, many senior Veterans and their dependent or surviving spouses can qualify for not only basic “Improved Pensions” based on low income, but also supplemental benefits of up to $2053 per month as of 2013. The supplemental benefits are called “Housebound Benefits” and “Aid & Attendance Benefits.”

In order to qualify for any of these pension benefits, the Veteran (or surviving spouse, based on the Veteran’s military service record), must satisfy the following general criteria:

  • · The Veteran must have served at least 90 days of active duty.
  • · At least one day out of the 90 days of active duty must have been during war time (there are defined dates for the beginning and end of World War II, the Korean War, and the Vietnam Conflict; the Gulf War, which began on August 2, 1990, is not concluded yet, and its ending date will be set by Presidential Proclamation at the appropriate time).
  • · The Veteran must have received a discharge other than dishonorable.
  • · The claimant and household must have limited income and assets.
  • · The claimant must have a permanent and total disability at the time of application (note that a surviving spouse can qualify for a basic low income pension without being disabled, but the Veteran must be disabled—although the disability does not have to be related to war time or military service).
  • · The disability must have been caused without the willful misconduct of the claimant and must not have been due to the abuse of alcohol or drugs.

As the name implies, Housebound Benefits are payable where the claimant is substantially confined to his or her home because of permanent disability. In order to qualify for Aid & Attendance benefits, the claimant must:

  • · Require the aid of another person in order to perform personal functions required for everyday living (such as bathing, feeding, dressing, toileting, transferring from bed to a wheelchair, or dealing with incontinence) OR
  • · Be bedridden, in that he or she must remain in bed apart from any prescribed course of convalescence or treatment OR
  • · Be a patient in a nursing home due to mental or physical capacity OR
  • · Be blind or have very poor vision.

Applying for these supplemental benefits is not a quick or simple process, and if you decide to apply, you may want to enlist the help of a Veterans’ assistance organization or a specially-trained individual. Note that whoever assists with the application cannot charge a fee for that service. However, if the individual or organization performs other services, fees may be chargeable for those other services.

To find professionals across America who can help you plan for and/or deal with your family’s elder care matters, go to: ElderCareMatters.com – America’s National Directory of Elder Care / Senior Care Resources for Families.

- See more at: http://www.eldercarematters.com/eldercarearticles/#sthash.vCASW6Zt.dpuf

 

Book on Medicaid in Colorado Released

Rose Mary Zapor has released her newly published guide to Medicaid in Colorado. 

Medicaid Myths and Mistakes is a booklet designed for the public to understand the ins and outs of applying for Medicaid.  There are so many stories out there about what will and will not work in protecting the assets of their family - most of which are wrong.  This guide is written to expose the wrong way to go about protecting our loved ones.

The book also includes a short summary of the new Medicaid Expansion program in Colorado.  The new program under the Affordable Care Act allows low income families and individuals to qualify for Medicaid even if they have no health issues.  In the past, a person had to qualify both medically and financially.  Now, only the financial eligibility will be examined, allowing a family of four with an income of less than $36,639.00 per year to get health insurance through the Medicaid program.

The Colorado Health Care Policy and Finance Department maintains a complete list of all doctors, hospitals, and clinics that accept Medicaid and provide services to Colorado residents. 

For a copy of Medicaid Myths and Mistakes, you can contact the Zapor Law Office, P.C. at 303-866-0990 or go to our web site and send an email.  The cost of the booklet is $7.50 plus tax and shipping. 

What does Medicare Part A cover?

What is covered?

Medicare covers services (like lab tests, surgeries, and doctor visits) and supplies (like wheelchairs and walkers) considered medically necessary to treat a disease or condition.

If you're in a Medicare Advantage Plan or other Medicare plan, you may have different rules, but your plan must give you at least the same coverage as Original Medicare. Some services may only be covered in certain settings or for patients with certain conditions.

In general, Part A covers: 

2 ways to find out if Medicare covers what you need

153_Fotolia_1355450_X.jpg
  1. Talk to your doctor or other health care provider about why you need certain services or supplies, and ask if Medicare will cover them. If you need something that's usually covered and your provider thinks that Medicare won't cover it in your situation, you'll have to read and sign a notice saying that you may have to pay for the item, service, or supply.
  2. Find out if Medicare covers your item, service, or supply.

Medicare coverage is based on 3 main factors 

  1. Federal and state laws.
  2. National coverage decisions made by Medicare about whether something is covered.
  3. Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.