Does Your Power of Attorney Include a HIPAA Release?

Seniors and family caregivers often find it difficult to discuss plans of action for when the elderly family member is incapacitated or no longer able to speak for themselves. It’s a challenging subject, but one worth tackling before it’s needed. If you don’t, the circumstances can be dire.

The Health Insurance Portability and Accountability Act of 1996, better known as HIPAA, was designed to protect a patient’s right to privacy by penalizing doctors and other healthcare providers who disclose "protected health information" about their patients. Whenever you go to the doctor, you’ll be prompted to fill out a federally-mandated form that reads, "HIPAA Notice of Privacy Practices." Patient confidentiality is generally a good thing. No one has the right to know my medical prognoses, see my prescriptions, or discuss my medical treatments unless they have my written approval. But what if a person can’t give that approval?

There are plenty of HIPAA horror stories out there. Imagine the story of the woman whose mother wound up in the ER after suffering a stroke. She approaches the nurse’s station, frantic about her mother’s condition and is met with a sympathetic shrug of the shoulders and, "I am sorry, I am not authorized to give you that information." By law, unless the woman and her mother had a Power of Attorney for HIPAA release, no one in that hospital can discuss her medical condition with outside parties—even the woman’s own daughter.

Caregiverlist®, in it’s ongoing mission to care for the caregiver and make life just a little easier for seniors and their families, has worked with Law Depot to provide you access to senior care legal documents to help facilitate elder care.

In the case of Power of Attorney for HIPAA Release, it is imperative to have all legal documents in place as, in most cases, the patient is not a position to give their verbal instructions. Do it in order to lessen the burden on family members during an already stressful time. In addition to the providing all medical professionals the “release of information” paperwork, it’s also important for the senior and their proxy to discuss and fill out a Last Will and Testament and a Living Will for end-of-life medical treatment requests.

Learn more about HIPAA at the Department of Health and Human Services’ Office for Civil Rights website at www.hhs.gov/ocr/hipaa.

Long Term Care Scorecard: Best and Worst States

When I was a kid, Florida and Arizona were the retirement states of choice. My parents and their friends decided that, after decades of Midwestern winters, the promise of warmth and sunshine, coupled with the notion of never picking up a snow shovel again proved too enticing to pass up. At their first opportunity, many of the “snowbirds” declared permanent residency in those sunshine states. Did they make the wrong move?

This week, AARP in conjunction with the Commonwealth Fund and the SCAN Foundation, released the 2014 State Long-Term Services and Supports (LTSS) Scorecard. In it, they rate states based on long-term services and support for the elderly, people with physical disabilities, and family caregivers. State performance was measured across five categories:

  • affordability and access,
  • choice of setting and provider,
  • quality of life and quality of care,
  • support for family caregivers, and
  • effective transitions

The report shows that in terms of quality of long-term care, Florida ranks in the bottom quartile compared to other states, although it fares better than Kentucky, Alabama, Mississippi, and Tennessee in affordability and transitions from nursing home care back to the community. This interactive map shows each state’s ranking:

The top-ranking states for long-term care and services are Minnesota, Washington, Oregon, Colorado, and Alaska; perhaps it’s not quite time to put those snow shovels on eBay.

It’s a well-known fact that few of us prepare for long-term care, although about 70% of people age 65 and up will need some sort of assistance with the activities of daily living. While most people would prefer to age at home, Medicare doesn’t cover the cost of home care provided by a Home Care Agency. Few of those in their 40s, 50s and 60s carry long-term care insurance and Medicaid is available only for low-income seniors with few assets. And before we all decide to retire to Minnesota or Washington, it’s important to note that long-term care is unaffordable for most middle-income seniors in all states.

The authors of the study see the need for a guide at the federal level to establish minimum long-term care performance standards below which no state should fall. No one anywhere in the U.S. should fear that their state cannot provide the needed level of assistance. Susan Reinhard, one of the study’s authors and senior vice president of Public Policy at AARP told Forbes magazine that she is optimistic in the incremental improvements she’s seen since a similar study was published in 2011, but admits all states can do better.

Caregiverlist® champions the need for change in the long-term care arena and urges you to contact your state legislature or your state’s Department on Aging and let them know how important it is to improve services in providing high-quality, well-coordinated, affordable long-term care.

10 Elder Care Tips to Make Senior Care Easier

Elder Law "Super Lawyer" Ben Neiburger shares 10 Elder Care Tips

May is Elder Law Month and when I hear “Elder Law,” I think of Caregiverlist® Elder Law Expert, Ben Neiberger. Since 1994, Ben has been giving legal and lay audiences a reprieve from some of the most complex and boring topics in the legal field (specifically, ERISA, Medicaid, and Eldercare). His delivery style helps you understand the important aspects of these topics in a way that gives you the ability to understand the legal issues you must know. Here, Ben shares his 10 Tips for surviving elder care to help you through the caregiving process and ensure you provide the best care possible for your loved one

Oh, and the moniker "Super-Lawyer" is real. Mr. Neiburger was named a “Super Lawyer” in Elder Law by Thompson Reuters and the publishers of Chicago magazine. Only three other attorneys in the state of Illinois were recognized this way in 2013. He also received this honor in 2007 and 2009 through 2014.

For Caregiverlist readers only, Ben is offering letting us give away his new ebook Brighter Skies: Your Blueprint to Navigating Elder Care. It’s a simple to understand guide that was written to make the process of Elder Care more bearable and less stressful for families. Follow these tips and you will spare yourself and your loved ones unnecessary pain in both the long and short terms.

Having practiced elder law for as long as I have, I've observed a number of issues that recur for families trying to negotiate the complex matters that come to the fore when assisting loved ones in the final stages of their life.

To that end, I’ve identified 10 principles that you need to pay attention to. Using these principles as a guide, you can develop strategies to help you and your family negotiate this very complex and emotional time.

Tip one – Put no one else before you and your family. You have a moral obligation to care for your parents, spouse and children. To do so well, you need to be informed, plan ahead, and take care of yourself first; the earlier the better.

Tip two – Let others help you. Find a trusted team of experts to help you through the health, legal and financial issues of end- of-life healthcare and planning. Geriatricians, care managers, elder law attorneys, accountants and financial planners are key advisors during this time.

Tip three – Act only with legal authority. There will come a time when you must make health-care and financial decisions for your elder when they cannot make decisions for themselves. Protect your loved one’s dignity and privacy by having them sign powers of attorney for property and health care before it’s too late.

Tip four – Rest. You are only human. Sometimes, the caregiving process requires an incredible amount of time, effort, blood, sweat, and tears. Even the strongest of us only last a matter of weeks or months before the stress of caregiving overwhelms our human capacity to provide that care. Hire caregivers, seek respite care, or let other family members, friends, or social agencies assist in providing care. You need rest and time to work and enjoy your own life, spouse and children. And only in doing so, will you be able to provide the best care for your loved one(s).

Tip five – Honor your loved one and preserve their independence as long as medically advisable. No one really wants to live in a nursing home. Most people want to live a dignified and independent life in their own home as long as possible. If it can be done safely, try to enable your loved one to live at home or in a non-nursing home community setting. If you want to support your parent in his or her home, but require additional funds for caregivers, reverse mortgages (including private family mortgages) can be a viable option.

Tip six –Make a financial plan. Assisted living and long-term care can be quite expensive. You need to take steps to ensure that your loved one’s funds last as long as possible. The longer his or her funds last, the more care options there are and the more independence they can have. Encourage your loved one to create a financial plan (including long-term care insurance, if possible) to generate enough income to cover long-term care at home, in an assisted living facility, or a nursing home when the time comes. Such a plan should be set up sooner than later.

Tip seven – Respect your loved one’s end-of-life wishes. As the last chapter of somebody’s life begins to close, the only thing many people have left is their family and personal dignity. It is your job as caregiver to do all you can to honor that dignity, as well as the wishes that preserve it. There will come a time when your loved one cannot tell you what they want. Take time to have a discussion with them beforehand on issues such as life-sustaining medical treatment and hospice, last rites, and their final resting place. Communicate these wishes to the entire family to ensure that such plans will be honored without familial strife when the time comes.

Tip eight – You can’t always control a progressive disease or sudden illness. There are some health conditions that improve with, and respond to treatment. There are others that do not, no matter what you do. Understand the condition or ailment that your loved one has, and do not expect miracles to occur as a result of treatment. Manage from that point forward. Many times, people do not recover from dementia, Alzheimer’s disease, or major strokes.

Tip nine – A nursing home placement isn't a death sentence. No one wants to go to a nursing home for their twilight years. Thirty or 40 years ago, families cared for loved ones at home until they died. Back then, people typically didn’t last longer than a few months, but with advances in medicine, the elderly now live on for years. Families need to rethink their objections to nursing homes because of the increase in end-of- life lifespans.

Tip ten – Try to mitigate family conflict. Family conflict at the end of a parent’s life is sometimes inevitable. However, an often unspoken wish for any person in the twilight of their life is the hope their children will get along after they pass on. A third-party is sometimes needed to assist in the decision making process. Sometimes transparency and disclosure will help. Other times, with a little more guidance and understanding, the children can make it through the process and keep their focus on ensuring their parents maintain their dignity as well as crucial family harmony.

I’ve create a series of short videos to further flush out these concepts. The goal is simple. Help you and your family make the best of a tough situation.

Ben is an active m

ember of the National Academy of Elder Law Attorneys (NAELA) and a member of the Executive Committee and Board of Directors for the Illinois Institute of Continuing Legal Education and through frequent speaking engagements and ongoing course work both locally and nationally, is in continuous pursuit of knowledge and insight to the laws and finances that affect our families and senior citizens. He brings this wealth of knowledge, his clear and common sense explanations, his patience, gentle humor and sensitivity to each of his legal consultations.To read more on each of these ten principles, go to generationlaw.com.

Caregiverlist's® Nursing Home Star-Ratings take the top criteria from the government inspection reports to help you choose the right and best nursing home for you or your loved one, if you should need one.

Senior Housing Building Boom: Too Much Too Soon?

I am part of a very substantial population of the United States known as Baby Boomers. According to the U.S. Census Bureau, 76.4 million American children were born post-World War II, between the years 1945 and 1964, making up almost 40% of the American population. As much as we would love to age in place, the fact is that if we see 80+ years old, we will need some sort of help with Activities of Daily Living, and the cold, hard truth is that a lot of us will receive that help in some sort of assisted living community.

It’s no wonder that many real estate developers are banking on building for a significant niche market. Home and commercial real estate building in 2014 point to a post-recession recovery. However, are those developing housing for the elderly building too much too soon?

Analysts say that a glut in the supply of senior housing is destined to hurt hurt health-care real estate investment trusts (REITs). Bloomberg News reported that the jump in supply is forecast to cut growth in senior-housing net operating income to 1.8 percent in 2015 and 1.4 percent in 2016 from 3.3 percent this year, according to Green Street Advisors Inc. These projections have translated into a 17 percent fall in the Bloomberg health-care REIT index during the last 12 months.

Brookdale Senior Living Inc. (BKD:US), is buying competitor Emeritus Corp. (ESC:US) for about $1.4 billion, Green Street Advisors told Bloomberg, making it the biggest owner of senior properties, with 1,161 senior care facilities in 46 states.

While the supply of senior care communities is increasing, the over-85 population is projected to increase to just 7 million by 2020. Senior housing won’t be in full swing for a few more years, when the nation’s “oldest old” could number as many as 31 million in 2050, although Jacob Gehl, managing director and founding partner of Blueprint Healthcare Real Estate Advisors, a brokerage and advisory firm in Chicago, told Bloomberg that peak demand is projected to be 15 to 20 years away.

It will be interesting to see how these new properties compete by way of staff, amenities, and senior housing costs. It will also be interesting to see if the trend in preferring to age at home with the assistance of quality home care continues. A lot can happen to the senior care landscape in 20 years.

Caregiverlist® would love to know about you and your family's projected needs. Where do you see yourself living when you are in need of assistance? Are you hoping your family will care for you? Do you see yourself moving into some sort of assisted living well before you absolutely need it?

Medicare Open Enrollment Deadline on the Horizon

If you or someone you know receives Medicare benefits, now is the time to review that coverage. Open enrollment for supplemental Medicare insurance, also known as Medigap, started on October 15 and ends on December 7. Seniors can change their Medicare supplemental health and drug coverage only during this open enrollment period.

Medicare is the government-sponsored healthcare coverage for Americans over 65 years of age. However, Medicare does not cover all healthcare costs. That’s why, during this open enrollment period, the elderly and senior caregivers can shop around for Medigap insurance.

Medicare supplemental insurance helps pay the "gap" between what Original Medicare (Medicare Parts A and B) pays for your health care and what you pay out of your own pocket, including deductibles, copayments and coinsurance. There are four parts to Medigap insurance:

  • Part A: hospital insurance
  • Part B: medical insurance
  • Part C: Medicare Advantage (offered by private companies approved by Medicare, like an HMO)
  • Part D: prescription drug coverage

If a senior already has a Medicare Advantage plan or a stand-alone Part D plan, they will have received an Annual Notice of Change (ANOC) and/or Evidence of Coverage (EOC) from their plan. This is the time to review the plan's costs, benefits and rules for the upcoming year. Changes made to coverage will take effect January 1 of the next year.

It is recommended that you compare prices for all of your supplemental insurance. Caregiverlist has partnered with eHealth Medicare to provide Medicare Supplemental Insurance plan quotes outside “the Marketplace”. We invite you to shop around by going through this trusted Medicare Supplemental site or by calling 888-353-4215.

Understand the difference between the Fall Open Enrollment Period and Open Enrollment for the Health Insurance Marketplaces. The Health Insurance Marketplaces (also known as Exchanges) open enrollment for uninsured or underinsured Americans that began on October 1, 2013 has nothing to do with Medigap or Medicare supplemental coverage. The Marketplaces are not meant for people with Medicare. People with Medicare do not change their Medicare supplemental insurance through the government's HealthCare.gov.

Seven Caregiver Trends

China's rapidly aging population (estimated to grow 35% by 2053), along with its urban single-child mandate, has forced the government to urge adult children to provide more emotional support to their elderly parents. Here, guest blogger Charlotte Bishop discusses the recent steps taken in China to encourage more active long-distance caregiving and it's international implications.

You may not have been following the news in China this past week, but China has enacted what may be the first law governing caregiving to older adults.  In a law called the "Protection of the Rights and Interests of Elderly People"  enacted this month caregivers are called to task.  The law states "Family members living apart from the elderly should visit or send greetings to the elderly persons."  This is not what I would consider a very enforceable statute, but it is a sober statement about what caregivers and their older loved ones around the world are increasingly seeing. 

AARP and a group called the National Alliance for Caregiving (NAC) have been surveying caregivers since 1997 and an analysis across the years show some interesting trends:

  1. the average age of caregivers has been steadily increasing from 46 years old in 1997 to now 50 years;
  2. the percentage of caregivers who are women still outnumber men, but the numbers have declined from 73% women in 1997 to the most recent figure of 67% women; (this has been generally consistent across caregivers of all ages)
  3. the average percentage of older recipients of care is growing - 24% of recipients 85 years of age and older to now 30% being that old or older;
  4. the proportion of caregivers who also hold a day job has been quite consistent during the years of these surveys;(from roughly three in four to four in five caregivers employed)
  5. across all ages of caregivers there is an increasing incidence of leaves of absence from their jobs reported by caregivers
  6. "burden of care" measured in hours of caregiving as well as actual activities was measured only in the most recent survey, but it was the older caregivers reporting the greatest burdens;
  7. as a counterpoint to this "burden," the older caregivers also were those most likely to use outside services to help in the caring; (older caregivers also were less likely to report help from friends)

Getting back to our China example, the law does say "should."  But it just may be that the authorities were seeing some of the same trends as we see here in the United States.  And what our surveys report pretty much squares with what I see as a geriatric care manager; older caregivers taking care of older friends or spouses shoulder a larger burden, and it ultimately takes its toll on the caregiver.  If you know an older caregiver, help them to find resources to take some of the load off; remember also that a large portion of that "load" may be guilt about not going it alone...so be supportive. 

Charlotte Bishop is a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago.  Charlotte's blog is also the winner of the 2013 ALTY Award for "Best Senior Healthcare Article."  Please email your questions to ccbishop@creativecasemanagement.com.

If you need help caring for a beloved senior, Caregiverlist is here to help. Request Senior Home Care Agency and Assisted Living Rates and Services Near You: Submit Request. You can also read our recent news story about Chinese elderly and poverty here.

Caregiver Stress Relief Photo of the Week

Caregivers employed with senior care companies know the realities of caregiver stress. Caregiverlist invites all family caregivers and professional caregivers to take a moment for relaxation with our photo of the week and inspirational quote. This week's photo features tulips that may bring color into your life as a caregiver. Thank you for caring for our seniors and please refer your friends to apply for part-time and full-time job positions on Caregiverlist.com and visit our career center for additional career tools.

Caregiver Stress Relief Photo of the Week Tulips

"Opportunities are never lost. The other fellow takes those you miss."

Anonymous

 

End-of-Life Care Ethics: NYC Hospital Made Home for Heiress for Twenty Years

Posted By: Julie Northcutt

End-of-Life care sparks opinions and contemplation for everyone, especially for those of us working in the senior care industry who have witnessed a variety of scenarios.  Hospice care was established to help families navigate through the details and emotions of saying goodbye to a lifetime of friends and family and.....assets.  It seems that time after time it is the assets that can cause problems for everyone for many years after someone has deceased.

Following estates and how they are divided and contested makes for fascinating reading.  The dramas can be better than the best movies and even become the material for movies.  Even when everyone thinks the estate has been firmly settled and legally structured, the heirs can bust a move to contest an issue.  Remember Lady Astor?  Her son seemingly (and a court agreed) convinced her to sign a new will after her memory loss had begun.  

Huguette Clark is the most recent heiress who has some relatives wanting more money from her estate.  A reclusive copper heiress, she collected dolls and found solace in playing with dolls as an adult and lived her last 20 years at Beth Israel Medical Center in New York.  She had no children, but her distant relatives did inherit some of her money and now they are digging for more dollars, filing documents in Manhattan Surrogate court that seem to show the hospital also begged Mrs. Clark for dollars.

In one e-mail, the CEO of Beth israel joked that a Manet painting Mrs. Clark donated the hospital did not bring as much as they would have liked at auction and joked that Mrs. Clark "didn't take the bait and offer a half dozen more."  Mrs. Clark gave the hospital more than $4 million dollars and stayed at the hospital until her death at age 104, in addition to the millions she privately paid to stay at the hospital.  She also donated another $1 million in her final, contested, will.

The fact that a hospital allowed someone who perhaps was depressed, but did not need acute medical care, to remain as a patient for 20 years raises ethical questions.  Might have there been a better environment for Mrs. Clarke to live in to address her emotional needs? The fact that the hospital did keep her for so many years and continued to ask her for donations is alarming.  The New York Times reports some of the more disturbing facts, such as the hospital sending staff out to research the Clarke family in order to better understand her wealth.  Mrs. Clarke paid the hospital $1,200 a day for her room.

Sometimes it seems, doing the right thing simply because it is the right thing to do, should take precedence.  A grown woman who watches the Smurfs cartoon and plays with dolls all day probably is not in the state of mind to make donations in the millions to a hospital and to decide she should stay indefinitely in a hospital -  it does not take a degree in medicine to know that.  It takes everyone to be a watchdog for ethics, including senior caregivers.  The Inspector General's office can be one place to report senior abuse and instances of Medicare of Medicaid fraud.  It will be interesting to see how Mrs. Clark's heirs are able to gain some restitution from Beth Israel Hospital.

However, this scenario also begs the question:  where the heck were Mrs. Clarke's heirs during the 20 years she was staying at the hospital?

Research your senior care options ahead of time and plan for the costs of senior care and rehabilitation which often takes place in a nursing home.  This way, if you happen to have an uncle who was a copper baron from Montana, you may better be prepared for how to plan.  

Senior Tax Deductions 2012

Tax filing season for fiscal year 2012 is drawing to a close. Senior care expenses for the year quickly become apparent. Family caregivers often ask if Uncle Sam offers a tax deduction similar to the tax deduction for child care when you file each year. The answer is, yes.

You can claim the elderly relative as a dependent. Your parent does not have to live with you but you must be providing for more than half of their financial support, which includes food and transportation. If you and your parent meet the Internal Revenue Service's criteria, you will be able to deduct up to $3,700.00 from your taxable income . Social Security benefits are not counted in most cases.

In addition, the Internal Revenue Service lets you deduct medical costs as long as they are more than 7.5 percent of your adjusted gross income. This may include the medical (and dental) expenses of everyone listed on your tax return, including your spouse and dependents.

Caregiver expenses incurred may be eligible for deduction as well. Keep in mind medical expenses include travel expenses to and from medical treatments, along with uninsured treatments, such as hearing aides and false teeth.

Siblings participates in the financial support of the parent, some families rotate the deduction to a different child each year. Please do consult your accountant and review the specifics on the IRS publication guides (IRS Publication 502 covers medical expense deductions and IRS Publication 554 covers dependent care deductions).

Quartet is Latest Nursing Home Movie

Maggie Smith, our favorite dowager countess on PBS’ Downton Abbey, is on the big screen this month in Quartet, a film set in a home for retired performers, musicians, and especially opera singers.

Dustin Hoffman’s directorial debut is the movie version of a British play of the same name that follows the residents of Beecham House as they prepare for their annual gala concert to celebrate Verdi’s birthday. Ms. Smith plays a diva (what else?) with a caustic tongue and oversized ego, whose arrival at the home reunites her with her former colleagues.



Retirement home movies, if not trending, are proving to be very fashionable at present. Quartet comes on the heels of the wildly popular The Best Exotic Marigold Hotel, an ensemble piece starring the aforementioned Dame Maggie Smith, along with Dame Judi Dench and Bill Nighy. That movie took place in an Indian retirement home and followed its residents and their (misguided) hopes and visions of an exciting and luxurious future. And while not finding quite what they expected, they find joy with each other in their less-than five-star accommodations.

Elderly actors in film are nothing new. Christopher Plummer is the oldest Academy Award recipient who, at 82, won a Best Supporting Actor award for his role in the 2010 film Beginners. What is a relatively new phenomenon is the advent of the elderly ensemble cast, where most, if not all, major characters are seniors — seniors who lead a rich and valuable lives. These ensemble pieces are very attractive to a movie-going population who is getting older as well. The movement is being called the “greying of the silver screen” and turn Hollywood’s obsession with youth on its head.

According to Nielsen’s National Research Group, the proportion of oldest moviegoers (65-74) has been steadily growing over the last few years. Great actors are no longer fading into retirement and are bringing their audience into the theaters with them.

Dustin Hoffman, himself now 75, discussed choosing the material, exploring aging and life’s “third act” in the February/March Issue of AARP The Magazine.

“During filming I was saying to everybody in the cast, ‘We’re all in the same act together.’ I always think it’s a three-act play and we’re in the second act—the third act being something that alters you, some infirmity or whatever. And somebody responded, ‘Maybe it’s a Shakespearean play with five acts.’ I liked that. Maybe I’ve got three more acts.”

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