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While many fear the use of Medicaid compliant annuities are under attack, a U.S. district court holds that Connecticut cannot treat the income stream from an annuity as an available asset for the purposes of Medicaid eligibility. Lopes v. Starkowski (U.S. Dist. Ct., Dist. Conn., No. 3:10-CV-307, August 11, 2010).

After John Lopes moved to a nursing home, his wife, Amelia, purchased an annuity. She received a letter from the annuity company saying that no part of the annuity was assignable, including periodic payments. Mr. Lopes applied for Medicaid. The state identified a potential buyer of the annuity's income stream and directed Mrs. Lopes to attempt to sell the annuity. Mrs. Lopes refused, and the state denied Medicaid benefits to Mr. Lopes.

Mr. Lopes appealed, arguing Mrs. Lopes was not legally obligated to sell the annuity's income stream. The state ruled that Mrs. Lopes' annuity was an available asset, and Mr. Lopes appealed to the court.

The U.S. District Court for the District of Connecticut grants Mr. Lopes's motion for summary judgment. The court holds that the annuity company did not permit Mrs. Lopes to assign the income stream from her annuity, so it could not be characterized as an asset. The court further finds that even if the income stream were assignable, "it would be incongruent with the principles of [Medicaid law] to permit a state to characterize even an assignable income stream as an asset." The court also notes that the Deficit Reduction Act does not require that states treat annuities as assets.

The key to this case was the "Medicaid compliant" nature of the annuity.  It must meet the strict requirements as set out in the Medicaid Manual.  Before you buy an annuity, please check with a Certified Elder Law Attorney (CELA).

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More than half of seniors resist asking for help, even from their adult children, fearing it signals a neediness that could land them in a nursing home, a new study shows.  That fierce resistance is playing out in so many family squabbles — from the silent treatment to bitter turf wars between aging parents and their grown kids — that the home-care agency Home Instead Senior Care has just launched a series of online self-help videos, one of them focusing on communication.  “This is a big problem for family caregivers,” says Bruce Mahony, owner of Home Instead’s Toronto office. “If seniors admit they need help, they think their independence is in question. They worry about losing control of their affairs.”  Fifty-one per cent of 24,147 adult caregivers surveyed across Canada and the U.S. by Home Instead Senior Care from 2004 to 2009 say their aging relatives can be so reluctant to accept help, they fear for their safety. Some worry their elderly parents are forgetting to eat meals or take medications in a misguided bid to maintain their independence.  Others are managing to hobble along with considerable help from elderly partners who are getting sick struggling to keep up appearances that all is well, elder-care experts say.

 Source:  Healthzone Canada (September 3, 2010)
Full story:  
http://www.healthzone.ca/health/yourhealth/agingwell/article/856361--seniors-resist-help-at-home

It is precisely this type of situation that prompted me to look into the growing field of Life Care Planning.  Soon, an Elder Care Coordinator will join my staff to offer these badly needed services to elders and their families in our area.   Life Care Planning is a holistic, elder-centered approach to the practice of law that helps families respond to every challenge caused by chronic illness or disability of an elderly loved one. The goal of Life Care Planning is to promote and maintain the good health, safety, well-being, and quality of life of elders and their families. Elders and their families get access to a wider variety of options for care as well as knowledgeable guidance from a team of compassionate advisors who help them make the right choices about every aspect of their loved one's well-being.

Watch this blog and the Martinsville Bulletin for an announcement on Life Care Planning soon!

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 People who retire at or near age 62 receive a welcome but somewhat surprising benefit — a greater relative increase in physical and emotional well-being than those who retire at earlier or later ages, Esteban Calvo of Boston College reported August 15 at the annual meeting of the American Sociological Association.  Intriguingly, that’s the age at which U.S. citizens become eligible to receive partial Social Security benefits, Calvo noted. Retirements that occur at culturally and institutionally expected ages yield large dividends in well-being, he suggested.  “This isn’t good news for the Social Security Administration,” Calvo said. Officials there would prefer aging baby boomers to pay into Social Security until at least age 67, when full benefits kick in, he noted.  Calvo and his colleagues analyzed survey data from a national sample of 5,395 individuals tracked from their 50's into their late 60's. A majority retired during a narrow window around age 62.


Source:  U.S News and World Reports (August 17, 2010)
Full story:  http://www.usnews.com/science/articles/2010/08/17/retirement-at-62-boosts-well-being.html

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 Preventive health care is important at any age, but never more so than as we get older. Many of the major cancers that can be screened for - such as breast and colorectal cancer - are typically diagnosed at about age 70. After age 55, people have a 90 percent chance of developing high blood pressure, putting them at higher risk for heart disease and stroke.  "The payoff in terms of prevention in geriatrics is more upfront and more immediate," says geriatrician Peter Hollmann, chairman of the public policy committee for the American Geriatrics Society.  Starting in January, the new health-care law will make it easier and cheaper for seniors to get preventive care. Medicare beneficiaries will be able to receive for free all preventive services and screenings that receive an A or B recommendation for seniors from the U.S. Preventive Services Task Force. That includes mammograms and colorectal cancer screening, bone mass measurement and nutritional counseling for people at risk for diet-related chronic diseases such as diabetes.  Medicare beneficiaries will also get a free annual wellness visit under the new law. The visit will cover a number of services, including a health risk assessment and a review of the person's functional and cognitive abilities.


Source:  Kaiser Health News (August 10, 2010)
Full story:  http://www.kaiserhealthnews.org/Features/Insuring-Your-Health/health-law-expands-medicare-preventive-care-coverage.aspx

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A national survey of adults aged 65 and older for the National Council on Aging (NCOA) finds that most seniors are still confused or unaware of important aspects of health reform, or the Affordable Care Act, including its impact on their own Medicare coverage, the growth of Medicare, and the budget deficit.  NCOA identified the top 12 facts that every senior should know about the health reform law. The “Straight Talk” poll reveals that only 17% of seniors knew the correct answers to more than half the factual questions posed about these key aspects of new law, and only 9% knew the correct answers to at least two-thirds of the questions. None of the 636 older adults interviewed for the poll knew the correct answers to all 12 of the factual questions.  Speaking at a town hall meeting at Iona Senior Service Center in Washington, DC, James Firman, President and CEO of NCOA, announced the launch of NCOA’s “Straight Talk for Seniors on Health Reform” campaign, aimed at helping seniors get the facts they need about health reform and changes to Medicare. “Seniors need to know the key facts about health reform so that they can be informed consumers and educated citizens,” Firman said. The campaign will continue through the fall with additional town hall and educational events, a series of “Straight Talk” educational materials (available at http://www.NCOA.org/StraightTalk), an interactive online “Straight Talk” quiz for people to test their knowledge of the law and learn more about it, detailed poll results, and Webinars to prepare aging services professionals to give “Straight Talk” presentations in their own communities.

Source:  National Council on Aging (July 26, 2010)
Full story: http://www.ncoa.org/press-room/press-release/most-seniors-misinformed.html

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Reverse mortgages have gone mainstream – no longer sold as something for seniors who are house rich and cash poor and need money to make ends meet. Today, they’re marketed as a way for homeowners 62 or older to crack open a giant piggy bank. The pitch is working. The market for reverse mortgages has more than doubled from 2005 to 2008. Last year, more than 100,000 seniors took out these loans. Some consumer advocates think that’s a dangerous trend.  Some unscrupulous brokers aggressively market reverse mortgages as a way for seniors to get money to invest with them in annuities or other financial products. 

“They try to convince you that you have all this money tied up in your house, here’s a way to take it and make a bigger nest egg for yourself,” says John Gannon, senior vice president for investor education with the Financial Industry Regulatory Authority. “And what we’ve tried to do is alert people that they’re putting their home equity at risk in investments; that while they have a promise of paying off, they may not.”  “While reverse mortgages can be a valuable last resort for some seniors under specific conditions, they are being advertised in a way that can lead to real trouble – urging seniors to use the equity in their home like an ATM or credit card,” explains Andrea Rock, a senior editor with Consumer Reports. “That’s a recipe for disaster.”  The truth is reverse mortgages are costly and complicated. Clearly, they’re a godsend to some seniors who have no other way to pay their bills. But they can be a nightmare for people who don’t understand how they work. 

“We are asking the industry to admit there are downsides to these loans and these downsides can lead to a lot of horrible situations for a lot of very good and decent people,” says Prescott Cole, a senior staff attorney with California Advocates for Nursing Home Reform.

Source:  MSNBC (July 21, 2010)

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A small Virginia firm hoping to revolutionize the way Americans care for aging family members has unveiled its first prototype of a portable, high-tech dwelling that would provide temporary shelter for a sick or elderly relative in their family's back yard.  On Monday, N2Care, a company formed by a Methodist minister in Salem, Va., showed off its first MedCottage, a 12-by-24-foot prototype filled with biometric technology that would allow a family and health-care providers to monitor the condition of an aging or disabled relative. The cottage contains air-filtration systems, video links, devices that allow the remote monitoring of vital signs and sensors that could detect an occupant's fall.  Until now, the MedCottage had been an idea on paper only. Even before the prototype was trotted out, however, the company's concept had received an important endorsement: the Virginia General Assembly this year passed legislation, HB1307, that supersedes local zoning laws and allows families to install such a dwelling on their property with a doctor's order. 

AARP, the lobbying group for aging Americans, has said local zoning laws pose one of the biggest obstacles to making such dwellings a practical solution to caring for aging family members in what it calls "accessory dwelling units." Although the bill passed almost unanimously and was signed into law by Virginia Gov. Robert F. McDonnell (R), detractors have dubbed the concept the "granny pod" and predicted that it could create conflicts between neighbors who find the dwellings unsightly. Some critics also worry that the setup could lead to cases of neglect involving elderly or disabled occupants of the dwellings.

Source:  Washington Post (July 20, 2010)
Full story:  http://www.washingtonpost.com/wp-dyn/content/article/2010/07/19/AR2010071903132.html

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File this entry in the "tell us something we don't know" file:

Battered by high unemployment and record home foreclosures, most Americans seem to have lost faith in another fundamental part of their personal finances: Social Security.  A USA TODAY/Gallup Poll finds that a majority of retirees say they expect their current benefits to be cut, a dramatic increase in the number who hold that view. And a record six of 10 non-retirees predict Social Security won't be able to pay them benefits when they stop working.  Skepticism is highest among the youngest workers: Three-fourths of those 18 to 34 don't expect to get a Social Security check when they retire.
The public's views are far more dire than the calculations of Social Security's trustees. Last year, they projected the system would begin running in the red in 2016, as the Baby Boom generation retired, and the trust fund would be exhausted in 2037.  Then, Social Security — which celebrates its 75th anniversary next month — could finance about three-fourths of current benefits through the payroll tax.

Source:  USA Today (July 20, 2010)

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Seniors need to become better educated on sex as a new study shows the rates of sexually transmitted infections are rising rapidly in people over 50 who are popping erectile dysfunction drugs, according to the executive director of AIDS Moncton.  A recent study in the Annals of Internal Medicine shows that the number of people over 50 who are being diagnosed with a sexually transmitted infection is rising in an alarming fashion.  Debby Warren, executive director of SIDA/AIDS Moncton, said a lack of education geared to that age demographic is helping to fuel a silent epidemic.  While no one wants to talk about sex in their 50s, Warren said people are aging healthier and taking on new partners after a death or divorce.  Further fuelling the problem, she said, is the increase in popularity of erectile dysfunction medication, such as Viagra.  "Older people are doing it, having sex, and because they don't receive the education and knowledge, while they may not get pregnant, they're certainly opening themselves up to sexually transmitted infections," Warren said.  "And that's starting to be reflected in the data that's being collected, not just in Canada, but the U.K. and in the United States."

Source:  CBC News (July 9, 2010)
Full story:  http://www.cbc.ca/canada/new-brunswick/story/2010/07/09/nb-seniors-sex-education-stds-558.html

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At UCLA Medical Center, which prides itself on caring for critically ill patients, a recent study showed room for improvement in the way doctors manage dying patients -- and the findings likely apply to other hospitals as well, the researchers say.  While doctors excelled at pain control, they did less well at talking to patients and families about prognosis and goals of care. They were good about ordering comfort care, but not about follow-up to make sure the care was effective.  Lead author Dr. Anne Walling, of the University of California, Los Angeles, and colleagues analyzed the charts of 496 adults who were hospitalized at least three days before dying. The researchers assessed the patients' end-of-life care based on 13 quality indicators in three domains: eliciting goals of care, pain assessment and management, and assessment and management of dyspnea (difficulty breathing).  More than half of the patients were admitted to the hospital with end-stage disease, one-third required removal from mechanical ventilation before death and 15 percent died while receiving CPR.  Records showed that 85 percent of the patients were likely to die during the hospitalization, and 47 percent had "expected death" documented in their charts. One-third had mechanical ventilation discontinued before death, and 15 percent died during cardiopulmonary resuscitation. Eighty-four percent had do-not-resuscitate orders, which were written on the day of death in 28 percent of cases and two days before in half of cases. Only 18 percent had advance directives prepared.  For 70 percent of the quality indicators studied, patients received recommended care.

Source:  Reuters Health (July 7, 2010)
Full story:  http://www.reutershealth.com/archive/2010/07/08/eline/links
/20100708elin022.html

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The Life Care Planning Law Firms Association, (LCPLFA), a national network of holistic elder law practices, has announced that Bassett attorney Robert W. Haley has completed The Elder-Centered Law Practice—Life Care Planning for the Elderly, a workshop that equips attorneys to offer Life Care Planning services. 

Life Care Planning is an innovative approach to elder law that helps families respond to the wide variety of challenges created by the long-term illness or disability of an elderly loved one. The focus is on using the elder’s money to maximize quality of life and independence—often well before the nursing home care is needed—while preserving family wealth to the greatest extent possible.

Firms offering Life Care Planning services rely on an inter-disciplinary team of elder law attorneys, care coordinators and others who work together to identify current and potential future care needs, locate appropriate care, coordinate private and public resources to pay for care, and ensure high-quality care.  Life Care Planning gives families access to a wider variety of options for care as well as expert guidance from a team of compassionate experts who help them make the right choices about every aspect of their loved one’s well-being.

I am excited about Life Care Planning.  In the weeks and months ahead I will keep you all updated on our implementation of Life Care Planning services for our clients.  In a nutshell, the firm will be able to help more elders find, get and pay for the care they need, whether that care is in a nursing home or just soem help they may need to stay in their own homes!  I hope to soon announce the addition of an Elder Care Coordinator (ECC) to my staff.  The ECC will be able to help assess an elders needs, and then help them plan to meet those needs.

If you have any questions about life care planning, please drop me an email at This email address is being protected from spambots. You need JavaScript enabled to view it.

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