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A study led by Karolinska Institutet reports for the first time the positive effects of an active vaccine against Alzheimer's disease. The new vaccine, CAD106, can prove a breakthrough in the search for a cure for this seriously debilitating dementia disease. The study is published in the distinguished scientific journal Lancet Neurology.

There is currently no cure for Alzheimer's disease, and the medicines in use can only mitigate the symptoms. In the hunt for a cure, scientists are following several avenues of attack, of which vaccination is currently the most popular. The first human vaccination study, which was done almost a decade ago, revealed too many adverse reactions and was discontinued. The vaccine used in that study activated certain white blood cells (T cells), which started to attack the body's own brain tissue.

The new treatment, which is presented in Lancet Neurology, involves active immunisation, using a type of vaccine designed to trigger the body's immune defence against beta-amyloid. In this second clinical trial on humans, the vaccine was modified to affect only the harmful beta-amyloid. The researchers found that 80 per cent of the patients involved in the trials developed their own protective antibodies against beta-amyloid without suffering any side-effects over the three years of the study. The researchers believe that this suggests that the CAD106 vaccine is a tolerable treatment for patients with mild to moderate Alzheimer's. Larger trials must now be conducted to confirm the CAD106 vaccine's efficacy.

This is a very promising trial!!

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A health care power of attorney (POA) and a health care proxy are two of the most important estate planning documents you can have, but in some instances they may be useless if they don't comply with the federal privacy law.

A POA allows someone you designate (your "agent" or "attorney-in-fact") to make decisions for you if you become incapacitated. A health care proxy specifies who will make medical decisions for you. For these documents to be effective, your agents may need to be able to access your medical information. However, medical information is private. The Health Insurance Portability and Accountability Act (HIPAA) protects health care privacy and prevents disclosure of health care information to unauthorized people. HIPAA authorizes the release of medical information only to a patient's "personal representative."

HIPAA can be a problem especially if you have a "springing" power of attorney. A springing POA doesn't go into effect until you become incapacitated. This means your agent doesn't have any authority until you are declared incompetent, but, under HIPAA, the agent won't be able to get the medical information necessary to determine incompetence until the agent has authority.  

To make sure your agent doesn't get caught in this "Catch-22", your POA and health care proxy should contain a HIPAA clause that explains that the agent is also the personal representative for the purposes of health care disclosures under HIPAA. I have now come to the conclusion you should also sign separate HIPAA release forms that explain what medical information can be disclosed, who can make the disclosure, and to whom the disclosure can be made.

Contact our office to make sure your POA and health care proxy do not conflict with HIPAA.

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Top Ten Red Flags of Elder Financial Abuse


  1. Sudden changes in a senior’s bank account of banking practices
  1. Uncharacteristic and unexplained withdrawals of large sums of money by an elder or someone with a power of attorney for a senior.
  1. Large credit card transactions or checks written to unusual recipients such as salesman, telemarketers, or “cash.”
  1. Abrupt changes in a will or other financial documents; transfer of a senior’s assets to a family member or acquaintance without a reasonable explanation.
  1. Complaints of stolen or misplaced credit cards, valuables, checkbooks or checks form the Social Security Administration, pensions and annuities.
  1. Seniors who appear nervous when accompanied by another individual or give far-fetched explanations of why they need money.
  1. Sudden increases in incurred debt or inexplicable credit card transactions.
  1. A person accompanying a senior who bullies the senior into making a withdrawal or does not allow the senior to speak for him or herself.
  1. New signatories added to a senior’s account or newly formed joint accounts between a senior and another individual.
  1. Possible forged signatures on financial transactions, documents for transfer of assets, or new applications for items such as credit cards.

These came for my good friend Andy Hook's newsletter a few years ago.  They are as pertinent today as they were when Andy posted htme!  This situation can be avoided when you appoint a trusted familiy member, friend or attorney/trust department as your Agent in a well drafted Durable Power of Attorney.  If these red flags sounds familiar or you want to start your own planning to avoid this situation, please give us a call for a consult.

Source: Oast & Hook, Elder Law News, Vol 13 Issue 7, April 28, 2006

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It’s a dangerous situation. Did you ever ask your aging parents how many prescriptions they are taking?

The answer could surprise you.  Sometimes there are so many pill bottles, no one is keeping track of all of them.  Parents’ memory loss, too many drugs to manage without help, lack of money to pay for them and other factors can mess up the best of medical intentions when prescriptions are written.

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Medicare is the federal health insurance program for people 65 and older, and for some younger adults with permanent disabilities and medical conditions. Prior to 1965, the year in which the Medicare program was established, about half of all seniors lacked health insurance. Today, virtually all people 65 and older have coverage under Medicare, and are eligible for this coverage without regard to their income or medical history. Medicare currently provides health insurance coverage for nearly 50 million Americans. Even with Medicare, people face many choices when they enroll in the program, and each year thereafter. "Talking About Medicare" is intended to provide answers to some basic questions related to Medicare coverage, as well as information to help you make decisions on a range of topics related to enrollment, plan choices, and prescription drug coverage. The guide also provides a state-by-state list of key agencies that can answer specific questions about Medicare, Medicaid, supplemental health insurance, the Medicare prescription drug benefit, and long-term care.

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The Medicaid Compliant Annuity has been a staple of protecting assets for the community spouse for years.  It enables a spouse who is already reeling from having to place their husband or wife in a long term care facility, to have some peace of mind knowing they will have a level of resources to o forward.   Now, in this age of shrinking government resources and austerity, it appears states are aggressively challenging asset protection techniques.

An Ohio District Court held that an annuity, even though it met all the criteria as a Medicaid Compliant Annuity, was a countable asset because it was purchased after the spouse entered the long term care facility:

"The U.S. District Court for the Northern District of Ohio grants the motion to dismiss, holding that a transfer to a community spouse in excess of the spouse's CSRA is an improper transfer. The court rules that while the Deficit Reduction Act of 2005 allows the purchase of an annuity in certain circumstances, that law applies only to the institutionalized spouse. According to the court, the community spouses "transferred resources above their CSRA and turned it into income after the date of institutionalization, which is the date the CSRA is established. It is irrelevant what form the resources took after the transfer, [the state] penalized the transfers themselves."

While this decision does not affect Virginia, I take it as a sign of things to come.  This makes advance planning even more important and illustrates the crucial impact timing is.  If you want to discuss your current situation to see if advance planning is right for you, please call us at 276 629 5381 for a consultation.

Hughes v. Colbert (U.S. Dist. Ct., N.D. Ohio, No 5:10CV1781, May 29, 2012)

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We all receive them, the mailing from the Social Security Administration that shows what our social security retirement benefit would be id we retired at age 62, 65 or 70.  Is the delay really worth foregoing that check at 62 or 65?  According the the Center of Retirement Research at Boston College, that answer is the delay is worth it!  They describe it as "Buying an Annuity form Social Security:"

monthly benefits would be 7.1 percent higher if claimed at age 66, not age 65, and 41.4 percent higher if claimed at 70.  If monthly benefits would be $1,000 a month if claimed at 65, they would be $1,071 if claimed at 66 and $1,410 if claimed at 70
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The 2012 Genworth Cost of Care Survey has been released and it continues to document the increasing cost of long-term care. The survey divides Virginia by its metropolitan statistical areas (MSA) with Roanoke and Danville being the MSA's closeest to us.  

In the Danville area, one can expect to pay over $43,000 annually for an assisted living facility, an increasde of 28%.  Nursing home long term care for a semi-private room is on average almost $75,000 a year and a private room can cost over $83,000!!! That is an 11% increase over last year.

In the Roanoke area, an assisted living facility averages $38,100 while a semi-private room in a nursing home averages just over $72,000 and a private room just over $79,000.

Thinking about in-home care?  Those costs are increasing as well, with the average cost for a caretaker running $14 to $18 an hour.

These rising costs make the process of estate planning and asset protection even more important!  Don't keep putting it off until it's too late.  Call Brandy to schedule a free consultation today!

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It's Saturday June 2nd 2012 and I am finally back to update this blog!  I seem to always have the best on intentions but when the days I plan to blog,  Wednesday and Friday, there always seems to be a fire to put out here at the office!  I have resolved to do better from now on.  

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Medicare average prescription drug premiums will not increase in 2012. The recent announcement from the Department of Health and Human Services (HHS) comes as more people with Medicare are receiving discounts on prescription drug costs and no-cost preventive services.

The national and regional premium data in the announcement can be found here.

For state-by-state information on the number of Medicare beneficiaries who have seen lower out-of-pocket costs in the donut hole, please click here.

Source: AoA Aging News Update (August 15, 2011)

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The average consumer knows more about cars, cell phones or renting an apartment than they do about nursing homes. This guide spotlights some of the most common illegal practices and explains strategies that residents and family members can use to avoid or reverse illegal procedures.

The National Senior Citizen Law Center (NSCLC) has published a guide the spotlights some of the most common illegal practices and explains strategies that residents and family members can use to avoid or reverse illegal procedures.

Did You Know That...

--A nursing home resident or family member must be allowed to participate in planning care?

--A resident has the right to choose when to wake up or go to bed?

--A resident's family cannot be restricted to specific visiting hours?

 Order your guide today:

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