Assistive Listening Devicess Can Improve Quality of Life

Just  listening to a show on the television and radio, using a phone, or even answering the doorbell are activities that many of us take for granted, but if you are hard of hearing these things are a real challenge. Assistive Listening Devices (ALD) can help improve your daily life. Here is a look at how to choose the best device to suit your particular  needs.

Hearing Aids

Many people who are hard of hearing often wear hearing aids to improve their listening in their everyday life, but these might not always work very well, especially if you are driving or are in a noisy environment such as a restaurant. Hearing aids, unfortunately, are not 100% perfect and may you need an additional device such as an Assistive Listening Device to help hear clearly. Using the two together will bring about a significant improvement.

The Benefits of Assistive Listening Devices

Assisted Listening Devices have several benefits for those who are hard of hearing

* Wide range of devices to choose from. From phone amplifiers to TV listeners, there are devices to improve your everyday life. You can even get specific aids such as baby monitors and smoke alarms.

* ALDs bring distant sounds to your ears, so it almost appears that someone is talking into both of yours at the same time, making sound that much clearer.

* ALDs cut out background noise. Microphones are much closer to the speaker’s mouth than other devices, so you only pick up the sounds going into the microphone, not anything else. Meetings, restaurants and parties become much more enjoyable with an ALD.

* Many ALDs are portable. You can take a personal amplifier wherever you go.

The Downsides

There are some downsides to ALDs which users need to be aware of:

* Some ALDs can be expensive.

* Battery powered devices may need frequent battery changes.

* You may also still need to use a hearing aid with them.

Types of ALDs available

There are several kinds of ALDs available to buy. They use several types of technology to help you listen. No technology is absolutely perfect and you may find some types work better than others. Choose one suited to your needs, budget and accommodation/situation. Technologies available include personal amplifiers, radio systems, induction loop systems and Bluetooth systems.

* Personal amplifiers are small portable devices which amplify ambient sound that occurs in social situations such as in the cinema, group conversations and watching TV. These amplifiers can be used with an induction loop system for the hard of hearing in public spaces – you don’t even need to use your hearing aid.

If you are having a meeting or personal conversation, you can also clip a lapel microphone to the person you are speaking to, plug it into your personal amplifier, attach a neck loop and listen to the person through the t-coils in your hearing aids. This helps to significantly reduce any background noise. The downside to this is that you are wired together and can’t move around easily.

* Radio systems use radio waves to send sound to your device. Because they have no wires, you have greater freedom of movement and range. You can sit at the back of a lecture theatre, for example, and listen to the lecturer. You do need to ensure the speaker will wear your transmitter/microphone.

You can also buy TV amplifiers which use radio technology and are ideal if you don’t want to trip over any wires. Doorbells, telephones and alarms are other devices which use this technology.

* Induction Loop systems use magnetic fields to send sound from the speaker to your ears. These are often the most affordable devices. You need to have a hearing aid which has t-coils to use them.

You can buy neck loops to wear around your neck for personal use and install a room loop to help hear the TV. With these loops, you can hear it anywhere in the room.

* Bluetooth systems use Bluetooth technology to listen to devices even if they are in your pocket or bag. They are perfect for use with mobile phones and laptops.

* While not a technology, telephone amplifiers are available to help increase the caller’s voice.

It is probably fair to say on the evidence available that  ALDs can improve the quality of life for the hard of hearing. The range of devices available can help improve your listening wherever you are and make everyday tasks that bit more accessible once again.

The is a guest post from Samantha Harvey of Sarabec Hearing Products.

Elderly adults are often the victims of overly aggressive debt collectors seeking payment for credit card debt, medical bills, and housing related expenses.

Certainly, a valid and binding debt cannot be ignored by any consumer. But there are, unfortunately, many circumstances where those seeking debt have incomplete or inaccurate information, or the debt collector violates the consumer rights of the individual from whom they are seeking payment.

I recently had the opportunity to sit down with my son, Randall P. Ryder, who is a consumer rights attorney and a partner in developing and maintaining Elder Prent Help. Randall specializes in representing consumers against abusive debt collectors and helping consumers who’s rights have been violated by those seeking to collect debt. Our conversation, which follows, addressed the legal rights individuals have when faced with unfair debt collection practices and suggestions for how to deal with debt collectors who may be violated the law.

What protections are available for elderly adults who may be facing over zealous debt collectors?

Individuals have considerable protection under the Fair Debt Collection Practices Act (FDCPA). Essentially this act prohibits debt collectors from being abusive, unfair, or using deceptive practices when they are attempting to collect a debt from you.

A debt collector can be debt collection agencies, attorneys who specialize in collecting debts and companies that buy debts that have not been paid and then seek to collect that debt. In addition to the federal act, many states have separate laws that regulate dept collection. You can locate your state’s laws by contacting the State Attorney General’s Office.

What do you do if you believe a debt collector is violating the FDCPA?

It is very important that if a debt collector contacts you by telephone that you write down everything you can remember from the phone call. In many debt collection cases those notes become essential pieces of evidence.

Thus, it is important that you have written notes that describe what happened because the debt collector will describe from their perspective what happened during the conversation. The sooner that you can write down everything from the conversation the more you will remember, and you will be in a better position to enforce your rights under the FDCPA.

Are there any specifics people should write down?

Start with the basics: what time was the call, what number did they call from, who did you talk to, and what did you talk about. The more details you can remember, the better. It’s also a good idea to save any voicemails and even take pictures of your caller id on your home or mobile phone.

If you received a letter or any any other form of a written communication make sure you keep it. After the conversation if something does not seem right, call a consumer rights attorney. Do not call the debt collector back out of anger and lose your composure.

If someone believes there is a violation of the FDCPA won’t they have to pay to hire an attorney?

The FDCPA entitles the consumer reasonable costs and attorneys fees if their case is successful, which means that most attorneys are willing to take these cases on contingency. It is critical to understand that these cases only have a one-year statute of limitations—you must bring your case within one-year of a violation of the FDCPA.

If the consumer is successful in court, they are also entitled to up to $1,000 in statutory damages, and actual damages. Actual damages can be in the form of emotional distress the consumer suffered as a result of the debt collector’s actions.

Who do debt collectors represent?

In almost every case, the debt collector is just that—someone collecting a debt for someone else. There are lots of companies that only collect debts. There are also lots of law firms that specialize in collecting debt.

The FDCPA generally only protects consumers against abusive debt collectors, so it is important to ask who is calling you and what they are calling about.

Can debt collectors garnish a consumer?

Yes, but in many cases garnishment is a threat used to encourage payment. State laws on garnishment vary, so you really need to talk to a consumer rights attorney in your state.

In Minnesota, for example, garnishment can only happen in one of three ways. One, after a judgment has been entered. Two, with express permission from a court after filing a lawsuit. Or three, after a lawsuit has been filed and the party has not responded after a set period of time. For the most part, most garnishment takes place after a lawsuit has been filed and a judgment has been entered.

Many times, debt collectors are just attempting to collect a debt—not a judgment. In those cases, threats of garnishment are usually just that—threats.

What should I do if I think a debt collector violated the law?

If you are in Minnesota, you can contact Randall. If you are in another state, contact your state’s Attorney General’s Office, the Federal Trade Commission’s information page on debt collection, or the National Association of Consumer Advocates who can assist you in finding an attorney.

(photo:http://www.flickr.com/photos/skettalee/26011383)

Emergencies and the Elderly

During the pst several years there have been an adbundance of natural disasters leading to widespread destruction, injury, and death. Fires cuased by persistent drought, floods, tornadoes, and earthquakes have brought about terrible consequences and demonstrated the need for all of us to be ready for natural disasters. Obviously, these events place elders at even greater risk, especially those who may suffer from chronic disease,s have limited mobility, or be dependent upon caregivers for daily support. The key to dealing with emergencies is to preparation and planning well before a disaster strikes. The U.S. Department of Health and Human Services offers these suggestions:

Step 1 – Know the basics. Learn about the risks your particular community faces; know how to do things like turning off your gas and electricity; get to know your neighbors.

Step 2 – Have your emergency supplies ready. This includes items you would need to survive in your home until help arrives; it should also include a personal evacuation bag, partially packed and ready to go.

Step 3 – Make a personal plan. Many older persons have special needs relating to medications, medical equipment, mobility, and support services; making a personal emergency readiness plan increases the likelihood that essential needs will still be met, even in an emergency situation.

GETTING STARTED

Somewhere in your home you probably already have an emergency readiness checklist – one you’ve clipped out of the paper, or a family member gave you, or you downloaded off the Internet. A checklist can help you get started and know you’ve taken the steps you should be taking. The form we include as a supplement to Aging in Stride is attached and is also available as a free download at www.AgingInStride.org.

As our Checklist suggests, emergency preparedness for yourself or your loved one doesn’t have to be complicated. Think of it as a simple, threestep process.

STEP 1: KNOW THE BASICS

As we’ve all learned from years of experience, the first ingredient in preparing for almost anything is a little practical information. Start by learning what kinds of risks your community faces. Do you live on the Atlantic or Gulf Coast where hurricanes are a concern? Are you in an earthquake zone? What about tornadoes? Do you live near a nuclear power plant or chemical storage complex? Knowing what risks you face will help you prepare. If disasters that strike with little or no warning (such as earthquake, tsunami, or tornado) are a risk for your community, you’ll want to know exactly what to do as your first response. These days, information on emergency planning for your community should be easy to find. Search on the Web; stop by the library or city hall; or ask at your area’s emergency management agency or fire department.

Our Checklist suggests you test your readiness by asking – and being able to answer – these questions:

❏  If there were an evacuation order, what is the recommended route from    where you live? If you don’t drive, what are your transportation options? Where is the nearest emergency shelter?

❏   Where are the shut-off valves for your household utilities (gas, electricity, water)? Do you know how to use them? If they take a special tool, is it kept right there, ready to use?

❏    In an emergency, local phone service may be down for an extended period. Have you designated someone out-of-area as your emergency contact? Do your loved ones know who your emergency contact will be?

❏    Neighbors helping neighbors can be critical in an emergency. Do you know your neighbors? Do they know you and any special needs you may have?

STEP 2: HAVE YOUR EMERGENCY SUPPLIES READY

Being ready for an emergency means having the supplies you would need.

There are two aspects to this: First, your “stay at home” supplies. These are the things you would need to survive safely in your home until help can arrive. In a major disaster, this can mean several days or perhaps even a week or more. For planning purposes, you need to assume you would be without power and would not be able to go out for food or water. Your household emergency supplies should include:

❏  enough water to last 3 to 6 days (recommended quantity: one gallon per person per day.)

❏ food – also enough for 3 to 6 days – consisting of high energy items that won’t spoil and don’t require cooking

❏ flashlight

❏ portable radio

❏ spare batteries

❏ first aid kit

❏ hand-operated can opener

❏ some light sticks (Along with your flashlight and spare batteries, these are a safe, inexpensive alternative to candles. Remember, any open flame in a post-disaster situation requires extreme caution, since the fire department will have its plate full and may not be able to respond quickly, or at all.)

❏  waterproof matches

❏ a 3 to 6 day supply of your prescription medications, together with an up-to-date list of the medications you’re taking

❏ cell phone, if you have one

❏ some cash or travelers’ checks

❏ your emergency contact list, including the names, phone numbers, and email addresses you would want to have and be able to give aid workers in an emergency.

Second, your “evacuation bag.” These are the things you would need to have for a safe evacuation, if that became necessary. Your evacuation bag should be a backpack or travel bag, preferably one that rolls, that has room for many of the items listed above and that is pre-packed with the following items:

❏ basic personal hygiene items, such as toilet paper, alcohol wipes, and gel hand sanitizer

❏ extra pair of prescription glasses

❏ change of clothing

❏ compact rain slicker

❏ good pair of walking shoes

❏ blanket or sleeping bag

❏ bottle or two of water, some breakfast bars, and some hard candy

❏ some disposable dust masks

❏ a copy of both your emergency contacts list and your current medications list.

Remember, the goal here is to give yourself a margin of preparedness to see you through until help can arrive, or to get you safely through an evacuation. So, think about what other items you might need, given your situation.

For example, if you have a car and would expect to use it if you had to evacuate, you’ll want to keep the gas tank at least half or even threequarters full. This will be a bit inconvenient, because you’ll need to fill your tank twice as often; but that clearly beats worrying about running out of fuel in a real emergency! And if you own a pet, you’ll want to add an extra supply of pet food to your list. Again, this just means getting in the habit of buying it at least a week or two before you run out. Keep in mind, by the way, that most emergency shelters do not allow pets, unless they are service animals, such as a seeing eye dog.

STEP 3: MAKE A PERSONAL PLAN

You’ve gathered the information you need. You’ve pulled together the emergency supplies you should have on hand. You’re ready, right? Not quite. The third step – and for many, the most important – is to make a personal emergency response plan. What special needs do you have? And how will they be met in an emergency?

No one knows your situation better than you. So, you are in the best position to plan ahead. If you have limited mobility or are disabled, you may be able to register with your local fire department or office of emergency services for special assistance. If you use an electric wheelchair or scooter, consider keeping your old, unpowered model around for emergency use.

If you are receiving health care services at home, ask your home health provider about emergency procedures. For example, if you depend on electric power for home dialysis or infusion, you’ll want to know your options for temporary emergency power or, in the case of home infusion, you may want to discuss having a back-up drip system.

If you live in a retirement community, assisted living facility, or adult family home, learn about emergency planning and procedures. How will you be kept informed? What will the facility or community expect of you and your fellow residents?

This is personal planning. But that doesn’t mean doing it all on your own. If you can, work through the checklist with a family member or friend. Chances are they’ll jump at the opportunity; and it will be a good reminder for them to be ready, as well.

NOTE:

The FEMA website includes a 204-page booklet to help you
prepare for specific emergencies (www.fema.gov/areyouready).
The site also offers information on assisting people with
disabilities during a disaster (www.fema.gov/rrr/assistf.shtm)

Photo:http://www.flickr.com/photos/koschi/193402564/sizes/m/in/photostream/

There has been considerable discussion of Medicare over the past year most focusing on how to finance this healthcare program in the future. But there are a number of changes that will take place in 2012, many of which will provide additional coverage. The bad news? Well, premiums will increase. Here are some of the major changes.

New enrollment periods
Beginning October 15 through December 7 of this year, you can enroll for both drugand health-plan benefits at the same time! The plans you enroll in during this time begin January 1, 2012. You can also disenroll from Medicare Advantage plans between January 1, 2012 and February 14, 2012 and switch to Original Medicare. Any changes go into effect on the first day of the following month. So if you disenroll January 15, 2012, the change is effective February 1, 2012.

New Medicare Monthly Premiums

Type of Monthly Premium

Amount of Monthly Premium

Part A monthly premium

 (for people who pay a premium)

$451

Part A Late Enrollment Penalty

+10%

Part B monthly premium

$99.90 Higher-income consumers may pay more.

Part B Late Enrollment Penalty

+10% for each full 12-month period that you could have had Part B, but didn't sign up for it

Part C monthly premium

Varies by plan

Part D monthly premium

Varies by plan

 Higher-income consumers may pay more

Part D Late Enrollment Penalty

Depends on how long you went without creditable prescription drug coverage

Preventive services

Medicare now covers screening and counseling for alcohol misuse, depression, and obesity.

Obesity Screening and Counseling

If you have a body mass index of 30 or more, Medicare covers intensive counseling to help you lose weight. This counseling may be covered if you get it in a primary care setting, where it can be coordinated with your comprehensive prevention plan. Talk to your primary care physician or practitioner to find out more.

Abdominal Aortic Aneurysm Screening

Medicare covers a one-time screening abdominal aortic aneurysm ultrasound for people at risk. You must get a referral for it as part of your one-time “Welcome to Medicare” preventive visit. You pay nothing for the screening if the doctor or other health care provider accepts assignment.

Alcohol Misuse Counseling

Medicare covers one alcohol misuse screening per year for adults with Medicare (including pregnant women) who misuse alcohol, but aren’t alcohol dependant and are competent and alert during counseling. People who screen positive can get up to 4 brief face-to-face counseling sessions per year. A qualified primary care doctor or other primary care provider must provide the counseling in a primary care setting. You pay nothing if the doctor or other health care provider accepts assignment.

Depression Screening

Medicare covers one depression screening per year for all people with Medicare. The screening must be done in a primary care setting that can provide follow-up treatment and referrals. You pay nothing if thedoctor or other health care provider accepts assignment.

Medicare Advantage improvements
If you’re enrolled in a Medicare Advantage “managed care” plan, rejoice. You’re about to get some protection from the higher out-of-pocket costs you faced compared with people who chose standard Medicare coverage. The areas affected are chemotherapy, kidney dialysis, and skilled nursing care.

Most chemotherapy is covered under Part B of Medicare (outpatient services). In 2012, the most you can be charged out of pocket is a 20 percent coinsurance or a $75 co-pay. If your chemotherapy is administered while in the hospital, it’s covered as part of your entire hospitalization.

Kidney dialysis is also covered under Part B and carries either a 20 percent coinsurance  or a $30 co-pay. In 2012, skilled nursing facility stays cost no more than $100 for the first 20 days, then $146 per day for days 21 through 100. After 100 days, you have to pay the entire daily cost.

Beginning in 2011, Medicare Advantage plans also had to set a maximum annual out-of-pocket amount for all hospitalization and outpatient services. They also had to cover more of your costs if you enroll in clinical trials.

Cheaper prescription drugs
If you’re covered under the Part D prescription drug benefit and regularly take medicine, get out your piggy bank; you’re due for some savings! Put simply, the well known “donut hole” will be shrinking.

In 2012, most people will hit a coverage gap for prescription drugs (called the donut hole) after $2,930 in total drug costs (what you spend plus what your drug plan spends for medications). Then you have to pay a percentage of all drug costs until you’ve spent $4,700. If you reach $6,657 in total drug costs before the end of the year, you pay a five percent coinsurance for drugs, or $2.60 for generic and $6.50 for branded drugs, whichever is more, for the rest of the year.

The good news is that the donut hole is shrinking. In 2010, you got a $250 rebate check to help cover costs in the donut hole. Beginning in 2011, drug manufacturers had to slash the cost of all brand-name drugs (i.e., Lipitor, Norvasc, Fosamax, etc.) in half for those who reached the donut hole. Also this year, generic drugs are being discounted by seven percent in the donut hole. In 2012, that doubles to 14 percent. By 2020, the donut hole disappears and you pay just 25 percent of any brand or generic drug once you reach the Part D coverage limit.

Another change: If you’re covered by both Medicare and Medicaid and are in a nursing home or receive long-term care services in your home, you don’t have to payany drug co-payments.

Photo: http://www.flickr.com/photos/72131668@N08/6510494453/sizes/m/in/photostream/

Quality Improvement Organizations (QIOs) work under the direction of the Centers for Medicare & Medicaid Services, an agency of the U.S. Department of Health and Human Services. There are 53 QIOs responsible for each U.S. state, territory, and the District of Columbia.

To get the address and phone number of the QIO for your state or territory, visit www.ahqa.org on the web and click on “QIO Locator.” Or, you can call 1-800-MEDICARE (1-800- 633-4227) for help contacting your QIO. TTY users should call 1-877-486-2048.

Examples of Quality of Care Concerns

Medication errors

Example: Being given the wrong medication, or being given medication at the wrong time, or being given a medication to which you are allergic, or being given medications that interact in a negative way

Unnecessary or inappropriate surgery

Example: Being operated on for a condition that could effectively be treated with medications or physical therapy

Unnecessary or inappropriate treatment

Example: Being given the wrong treatment or treatment that you did not need, or being given treatment that is not recommended for patients with your specific medical condition.

Change in condition not treated

Example: Not receiving treatment after abnormal test results or when you developed a complication, such as an infection after surgery or a bedsore while in a skilled nursing facility

Discharged from the hospital too soon

Example: Being sent home while still having severe pain

Incomplete discharge instructions and/or arrangements

Example: Being sent home without instructions for the changes that were made in your daily medications while you were in the hospital, or during an office visit, you receive inadequate instructions about the follow-up care you need.

Help with other health care concerns

A concern about an issue other than the quality of care you received needs to be addressed by an agency other than a QIO. The agency that can help you depends on the nature of your concern. (Some concerns can be addressed by more than one agency.)

• If you have a concern about a doctor, such as unprofessional conduct, incompetent practice, or licensing questions, you may also contact your state medical board.
• If you have a concern about conditions at a hospital, such as rooms too hot or cold, cold food, or poor housekeeping, you may also contact your state department of health services.
• If you have a concern about Medicare fraud, call the HHS Office of Inspector General Hotline at 1-800-447-8477.
• If you have a concern about billing, such as questions about charges and what Medicare does or does not cover, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-4

(photo:http://www.flickr.com/photos/neilransom/108803427/)

What is a Reverse Mortgage?

A reverse mortgage is a special type of home equity loan that allows you to receive cash against the value of your home without selling it. You can choose to receive a lump-sum payment, a monthly payment, or a line of credit. You must use the funds you receive to pay off any existing mortgages or other debt against your home and to make required home repairs. There are no restrictions on how you use the remainder of the money.

As long as you spend the payments you receive in the month that you receive them, the money is not taxable and does not count towards income or affect Social Security or Medicare benefits. It also does not count as income for Medicaid eligibility.

When you take out a reverse mortgage, you continue to live in the home and you retain title and ownership of it. You are also still responsible for taxes, hazard insurance, and home repairs. However, you do not have to repay the loan as long as you continue to live in the home. Instead, the amount you owe, based on loan payouts and interest on the loan, becomes due when you or the last borrower, usually the last remaining spouse, dies, sells, or permanently moves out of the home.

Reverse mortgages are available to homeowners age 62 and older. Unlike traditional mortgages, you do not have to provide an income or credit history to get the loan.

Types of Reverse Mortgages

There are three types of reverse mortgages. These include:

• Home Equity Conversion Mortgage (HECM) 
  The Department of Housing and Urban Development (HUD) offers HECMs and the Federal Housing Administration (FHA) insures them. HECMs are the most popular reverse mortgages, representing about 90 percent of the market. The federal government regulates most upfront costs for HECM loans. There are limits on the total fees and interest rates that you must pay.
• Fannie Mae Home Keeper Loan
  The loan limits for Fannie Mae Home Keeper Loan is higher than for HECMs. Therefore, you may receive more cash from these loans than with a HECM.
• Financial Freedom Cash Account Loans
  Financial Freedom Cash Account Loans are designed for seniors who own expensive homes.

Most people get reverse mortgages through a mortgage lender. Some credit unions and banks, with state and local housing agencies, may offer these loans as well

Here is a comparison of conventional and reverse mortgages provided by Department of Health and Human Services.

Reverse vs. Conventional Mortgage

Things to think about:

• You continue to own the house and no entity can force you to leave as long as you maintain the home, and make property tax and hazard insurance payments.
• You must meet with a government-approved reverse mortgage counselor before your loan application is complete.
• You or your heirs will never owe more than the value of the home at the time you or your heirs sell the home or repay the loan.
• In order to avoid paying taxes on your reverse mortgage payments, you must spend the entire payment in the month you received it.

Photo: http://www.flickr.com/photos/patrick_q/213724154/sizes/m/in/photostream/

There is no doubt that if you have a chronic medical condition you are struggling with  the high cost of prescription drugs. Over the past decade, prescription drug costs have risen more than any other health care cost on a percentage basis. Certainly, not all prescription drugs are costly. For example diuretics, used to control blood pressure, are 6-10 cents a day. On the other hand, if you take Lipitor, you may be paying as much as $6.00 a day. Unfortunately, many elder adults are not familiar with a wide range of programs and discounts that can significantly lower your annual costs. Many of these programs have income limits, but others are open to most individuals. We have provided a rather lengthy description and links to these prescription drug cost reduction programs within this site. But given the importance of this information, here is a general overview of some of the programs that are available.

Programs Offered by Pharmaceutical Industry

Many individual drug companies offer free or discounted drugs. These programs vary among the companies, but generally they require that you have no prescription drug coverage and that you have limited income. In addition, most provide the drug for a limited period of time and require that you make an application directly with the company. If you qualify, your drugs are sent to your doctor. To see if you would qualify for any of these programs you can see a listing of pharmaceutical companies and the programs they offer at Needy Meds, a non-profit organization dedicated to providing assistance to lower income families and individuals in need of prescription drugs.

Discount Drug Cards

Discount drug cards offer discounts on various medical services including medicine. They are not a form of insurance. Some are free while others may involve a hefty fee. They are offered by state governments, drug companies, non-profit and for-profit businesses. Here are some of the options you have for obtaining drug cards.

The NeedyMeds Drug Discount Card

NeedyMeds ( a non-profit organization) offers a drug discount card that provides a savings up to 80% on many medicines. The card is free and open to everyone. There is no registration and your entire family can use the same card. To download a card and learn more about its benefits click HERE.

Photo: http://www.flickr.com/photos/jumpinjack/5021166807/sizes/m/in/photostream/

Problems with Long Term Care Insurance

In a previous addressing the challenges faced with the upcoming increse in the proportion of the popultion over 65 we discussed the issue of financing future health care costs. As we have noted, planning is an essential element of addressing future needs to provide individuals with financial security and peace of mind,

One proposed solution to rising health care costs and the fact that individuals are living longer and thus more likely to require some form of care as they age is long term care insurance.  And given that about 70% of older adults over age 65 require some services. the older you get, the greater the chance that you will need long-term care. Nationally, an estimated 4-7 % of people in the U.S. over the age of 45 have purchased long-term care insurance.  Most of these people tend to of higher income. Individuals who have pre-existing conditions generally have difficulty obtaining policies. Is there a future for long term care insurance for those who can afford it?

A month ago, MetLife announced it would stop underwriting new long-term care policies for individuals after Dec. 30. The company will also cease new enrollments to group and employer plans. Two of the leading companies in the long-term care business are proposing huge increases in the premiums of their policies. Genworth Financial has proposed an 18 percent increase on older policies held by about 25 percent of its customers. John Hancock has filed for permission to raise premiums for about 80 percent of its customers by an average of 40 percent. It has also temporarily stopped offering new long-term care insurance plans through employers while it tries to figure out what to charge. While state regulators may not approve these requests, the proposed increases point out the problems the insurance industry is having in projecting the rise in costs of their policies.  When most insurance companies were writing their long-term care policies they did not anticipate a number of factors. One, most projected a certain percentage of policy holders would stop making premium payments and give up their policies each year. As it turns out, the projected number of individuals stopping payment was far greater than the number who actually stopped paying premiums. Note the premiums for those stopping payment would remain with the insurance company as pure profit. Insurance companies also underestimated the number of people who first had claims for assisted living and home care and then ended up in a nursing home therefore increasing the insurer’s costs. Finally, the money generated from premiums is not drawing significant rate of returns with interest rates being so low while at the same time health care costs continue to rise. The biggest problem with policies now is the cost the premiums being out-of-reach for most seniors and the refusal of insurance companies to guarantee their rates on a yearly basis. Again, it is important to note that yearly insurance premiums can increase thus as one gets older paying for those premiums becomes more and more difficult. And if you stop paying premiums all of your contributions to this type of insurance are lost.  Another problem with long-term care insurance is that by the time many people purchase policies, they are uninsurable due to health problems. All told, these and other factors raise questions as to the viability of long term care policies to meet the needs of older adults. Accordingly, there is a small but attractive option that is offered by some states referred to as partnership policies.

Partnership Policies

Many middle-income people have too many assets to qualify for Medicaid but can’t afford a pricey long-term care insurance policy. In an effort to encourage more people to purchase long-term care insurance, the Deficit Reduction Act of 2005 (DRA) created the Qualified State Long Term Care Partnership program. The program expands to all states the partnership programs that were previously available only in four states: California, Connecticut, Indiana and New York.

The program offers special long-term care policies that allow buyers to protect assets and qualify for Medicaid when the long-term care policy runs out. Private companies sell long-term care insurance policies that have been approved by the state and meet certain standards, such as having inflation protection. The program is intended to provide incentives for people to purchase long-term care insurance policies that will cover at least some of their long-term care needs. As of June 1, 2009, 29 states had implemented partnership programs: Arkansas, California, Colorado, Connecticut, Florida, Georgia, Idaho, Indiana, Kansas, Kentucky, Maryland, Minnesota, Missouri, Nebraska, Nevada, New Jersey, New York, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, South Carolina, Tennessee, Texas, Virginia, and Wisconsin. For more information on partnership programs and on long-term care insurance in general from the National Clearinghouse for Long-Term Care Information,

Under the new Qualified State Long Term Care Partnership program and California’s and Connecticut’s programs, the asset protection offered by partnership policies is dollar-for-dollar: for every dollar of coverage that your long-term care policy provides, you can keep a dollar in assets that normally would have to be spent down to qualify for Medicaid. So, for example, if you’re single, you would normally be allowed only $2,000 in assets in order to qualify for Medicaid coverage of long-term care. But if you buy a long-term care insurance policy that provides $150,000 in benefits, you would be allowed to retain $152,000 in assets and still qualify for Medicaid. (These states set limits on the assets that can be protected.)

In New York, the partnership policy benefits are even more significant. Once you have exhausted the benefits from your long-term care partnership policy, you can qualify for Medicaid coverage no matter your level of assets. In other words, an unlimited amount of assets can be protected.

Indiana offers either of the above models, depending on when the policy was purchased and the policy’s design.

Bear in mind that currently the Medicaid asset protection will only work if you receive your long-term care in the state where you bought the policy, or in another partnership state that has a reciprocal agreement with the first state.

The purpose of the partnership programs is to reduce Medicaid costs, however a study by the Government Accountability Office indicates that any cost savings will be limited. Hopefully modifications to the partnership program or hybrids of this model will offer a viable long-term care option in the future.

Photo: http://www.flickr.com/

The Centers for Medicare & Medicaid Services (CMS) recently announced that Medicare is adding coverage for a number of preventive services to reduce cardiovascular disease.

This new coverage policy will add to the existingportfolio of free preventive services that are now available for people with Medicare, thanks to the Affordable Care Act.

It contributes to the Million Hearts initiative led jointly by CMS and the Centers for Disease Control and Prevention in partnership with other HHS agencies, communities, health systems, nonprofit organizations, and private sector partners across the country to prevent one million heart attacks and strokes in the next five years.

Under this coverage decision, CMS will cover one face-to-face visit each year to allow patients and their care providers to determine the best way to help prevent cardiovascular disease. Intensive behavioral therapy for cardiovascular disease (referred to below as a CVD risk reduction visit) consists of the following three components:

• encouraging aspirin use for the primary prevention of cardiovascular disease when the benefits outweigh the risks for men age 45-79 years and women 55-79 years;
• screening for high blood pressure in adults age 18 years and older; and
• intensive behavioral counseling to promote a healthy diet for adults with hyperlipidemia, hypertension, advancing age and other known risk factors for cardiovascular and diet-related chronic disease.

We note that only a small proportion (about 4%) of the Medicare population is under 45 years (men) or 55 years (women), therefore the vast majority of beneficiaries should receive all three components.  Intensive behavioral counseling to promote a healthy diet is broadly recommended to cover close to 100% of the population due to the prevalence of known risk factors.

Therefore, CMS will cover one face-to-face CVD risk reduction visit each year for Medicare beneficiaries:

• who are competent and alert at the time that counseling is provided; and whose counseling is furnished by a qualified primary care physician or other primary care practitioner and in a primary care setting.

The behavioral counseling intervention for aspirin use and healthy diet should be consistent with the Five As approach that has been adopted by the USPSTF to describe such services:

• Assess:  Ask about/assess behavioral health risk(s) and factors affecting choice of behavior change goals/methods.
• Advise:  Give clear, specific, and personalized behavior change advice, including information about personal health harms and benefits.
• Agree:  Collaboratively select appropriate treatment goals and methods based on the patient’s interest in and willingness to change the behavior.
• Assist:  Using behavior change techniques (self-help and/or counseling), aid the patient in achieving agreed-upon goals by acquiring the skills, confidence, and social/environmental supports for behavior change, supplemented with adjunctive medical treatments when appropriate.
• Arrange:  Schedule follow-up contacts (in person or by telephone) to provide ongoing assistance/support and to adjust the treatment plan as needed, including referral to more intensive or specialized treatment.

The visit must be furnished by primary care practitioners, such as a beneficiary’s family practice physician, internal medicine physician, or nurse practitioner, in settings such as physicians’ offices.  During these visits, providers may screen for hypertension and promote healthy diet as part of an overall initiative to reduce the burden of cardiovascular disease in the United States.

Cardiovascular disease characterizes conditions affecting the heart and blood vessels, including hypertension, coronary heart disease, heart failure and stroke.  Cardiovascular disease is also the leading cause of mortality in the United States. Today’s new coverage policy does not change current Medicare coverage for beneficiaries diagnosed with cardiovascular disease to receive assessment and intervention services.

Earlier this year, the U.S. Department of Health and Human Services announced its Million Hearts national initiative, aimed at preventing a million heart attacks and strokes in the U.S. by 2017. Through Million Hearts, CMS, the CDC and other HHS agencies are working together with public and private sector organizations to make a long-lasting impact against cardiovascular disease.

Photo: http://www.flickr.com/photos/doug88888/5539136193/

In recent years, much has been written about the silver tsunami – the onrush of baby boomers who will 65 leading to a higher percentage of the elderly population and the challenges we face in meeting their social, health, housing, and financial needs. As we anticipate the needs of the ever expanding elderly population our understanding of some of their demographics provides insight into the formulation of public policy and individual planning. In an effort to draw together data on a large number of economic and well-being issues, the Federal Intragency Forum, which has 15 participating federal agencies has published Older Americans 2010: Key Indicators of WellBeing.

Here are some of the major findings.

Population

The demographics of aging continue to change dramatically. The older population is growing rapidly, and the aging of the baby boomers, born between 1946 and 1964 (and who begin turning age 65 in 2011), will accelerate this growth. This larger population of older Americans will be more racially diverse and better educated than previous generations. Another significant trend is the increase in the proportion of men age 85 and over who are veterans.

Economics

Most older people are enjoying greater prosperity than any previous generation. There has been an increase in the proportion of older people in the high-income group and a decrease in the proportion of older people living in poverty, as well as a decrease in the proportion of older people in the low-income group just above the poverty line. Among older Americans, the share of aggregate income coming from earnings has increased since the mid-1980s, partly because more older people, especially women, continue to work past age 55. Finally, on average, net worth has increased almost 80 percent for older Americans over the past 20 years.  Yet major inequalities continue to exist with older blacks and people without high school diplomas reporting smaller economic gains and fewer financial resources overall.

Health Status

Americans are living longer than ever before, yet their life expectancies lag behind those of other developed nations. Older age is often accompanied by increased risk of certain diseases and disorders. large proportions of older Americans report a variety of chronic health conditions such as hypertension and arthritis. Despite these and other conditions, the rate of functional limitations among older people has declined in recent years.

Health Care

Overall, health care costs have risen dramatically for older Americans.  In addition, between 1992 and 2006, the percentage of health care costs going to In 2008, 39 million people age 65 and over lived in the United States, accounting for 13 percent of the total population.  The older population grew from 3 million in 1900 to 39 million in 2008.  The oldest-old population (those age 85 and over) grew from just over 100,000 in 1900 to 5.7 million in 2008.

The baby boomers (those born between 1946 and 1964) will start turning 65 in 2011, and the number of older people will increase dramatically during the 2010–2030 period.  The older population in 2030 is projected to be twice as large as their counterparts in 2000, growing from 35 million to 72 million and representing nearly 20 percent of the total U.S. population.prescription drugs almost doubled from 8 percent

Ethnicity

In 2008, non-Hispanic whites accounted for 80 percent of the U.S. older population.  Blacks made up 9 percent, Asians made up 3 percent, and Hispanics (of any race) accounted for 7 percent of the older population.Projections  indicate that by 2050 the composition of the older population will be 59 percent non-Hispanic white, 20 percent Hispanic, 12 percent black, and 9 percent

Marital Status

In 2008, older men were much more likely than older women to be married.  Over three-quarters of men age 65–74 were married, compared with over one-half (57 percent) of women in the same age group.  The proportion married is lower at older ages: 37 percent of women age 75–84 and 15 percent of women age 85 and over were married.  For men, the proportion married also is lower at older ages but not as low as for older women.  Even among the oldest old, the majority of men were married (55 percent).Widowhood is more common among older women than older men.  Women age 65 and over were three times as likely as men of the same age to be widowed, 42 percent compared with 14 percent.  In 2008, 76 percent of women age 85 and over were widowed, compared with 38 percent of men.

Living Arrangements

In 2008, 72 percent of older men lived with their spouse while less than half (42 percent) of older women did.  in contrast, older women were more than twice as likely as older men to live alone (40 percent and 19 percent, respectively).

Poverty

In 1959, older people had the highest poverty rate (35 percent), followed by children (27 percent) and those in the working ages (17 percent).  By 2007, the proportions of the older population and those of working age living in poverty were about 10 percent and 11 percent, respectively, while 18 percent of children lived in poverty

Income Sources

In 2008, aggregate income for the population aged 65 and over came largely from four sources.  Social Security provided 37 percent, earnings provided 30 percent, pensions provided 19 percent, and asset income accounted for 13 percent.  About 89 percent of people age 65 and over live in families with income from Social Security.  About three-fifths (59 percent) are in families with income from assets, and two-fifths (44 percent) with income from pensions.  About two-fifths (38 percent) are in families with earnings. About 1 in 20 (5 percent) are in families receiving cash public assistance.

Life Expectancy

Americans are living longer than ever before. Life expectancies at both age 65 and age 85 have increased. Under current mortality conditions, people who survive to age 65 can expect to live an average of 18.5 more years, about 4 years longer than people age 65 in 1960. The life expectancy of people who survive to age 85 today is 6.8 years for women and 5.7 years for men.

Data from reports such as those published by the Federal Interagency Forum provide evidence of the dramatic changes that will occur in our population, and the accompanying challenges. The most pressing issue will be how health care will be financed in the future and how health care, itself, may need to focus more on such issues as preventative care, the efficiencies of our training of medical personnel, and the role of programs such as Medicare and Medicaid in meeting the health care needs of our elder adults. Future posts in Elder Parent Help will begin to address these issues.

photo: http://www.flickr.com/photos/peterfisk/6199779847/sizes/m/in/photostream

Cancer Death Rates Decline

A recent report by the National Cancer Institute (NCI) shows continuing declines in death rates from cancer for both men and women. The following is a summary provided by the NCI.

Rates of death in the United States from all cancers for men and women continued to decline between 2003 and 2007, the most recent reporting period available, according to the latest Annual Report to the Nation on the Status of Cancer. The report also finds that the overall rate of new cancer diagnoses for men and women combined decreased an average of slightly less than 1 percent per year for the same period The drop in cancer death rates continues a trend that began in the early 1990s. The report finds, for the first time, lung cancer death rates decreased in women, more than a decade after rates began dropping in men.

The report is co-authored by researchers from the North American Association of Central Cancer Registries (NAACCR), the National Cancer Institute (NCI), part of the National Institutes of Health, the Centers for Disease Control and Prevention, and the American Cancer Society. It appeared online March 31, 2011, in the Journal of the National Cancer Institute, and in print on May 4, 2011.

Of special note, childhood cancer incidence rates (rates of new diagnoses) continued to increase while death rates in this age group decreased. Childhood cancer is classified as cancers occurring in those 19 years of age or younger.

Overall cancer incidence rates in men were essentially unchanged. There was a very small uptick in prostate cancer rates, and if these rates were excluded from the analysis, there would be a continued decline in overall male incidence rates.

In the Special Feature section of the report, the authors explore the diversity of brain tumors and other nervous system cancers beyond those that are identified as malignant, including those that are borderline and benign. The researchers analyzed data between 2004 and 2007 and found that in adults, non-malignant tumors were about twice as common as malignant tumors.

“Our new data show that non-malignant brain tumors are far more common than malignant brain tumors, and affect different population groups. Brain tumors have a far-reaching effect on our families and friends, yet they are difficult to study due to their diversity,” said Betsy Kohler, executive director, NAACCR. “We hope that the collection of both malignant and non-malignant brain tumors by central cancer registries will continue to provide a significant source of information and insight to researchers.”

Other highlights from the report show that, in men, incidence rates have declined for cancers of the lung, colon and rectum, oral cavity and pharynx, stomach, and brain (malignant only) while rates have risen for kidney, pancreas and liver cancers, as well as melanoma of the skin. In women, incidence rates decreased for breast, lung, colorectal, uterine, cervical, bladder, and oral cavity cancers, but increased for kidney, pancreas, and thyroid cancers as well as for leukemia and melanomas of the skin.

“It is gratifying to see the continued steady decline in overall cancer incidence and death rates in the United States — the result of improved methods for preventing, detecting, and treating several types of cancer,” said Harold Varmus, M.D., NCI Director. “But the full repertoire of numbers reported today also reflects the enormous complexity of cancer, with different trends for different kinds of cancers, important differences among our diverse people, and different capabilities to prevent, detect, and treat various cancers. Moreover, as our population continues to age, we have an obligation to discover and deliver better ways to control all types of cancers.”

Among racial/ethnic groups, cancer death rates were highest among black men and black women, but this group also showed the largest decline for the period between 1998 and 2007 compared with other racial groups. For new cancers, black men had the highest incidence rates in the 2003 to 2007 period studied. Among women, white women had the highest overall incidence rates. Breast cancer was the most commonly diagnosed cancer among women regardless of race or ethnicity. The differences and fluctuations in death rates by racial/ethnic group, sex, and cancer site may reflect differences in risk behaviors, socioeconomic status, and access to and use of screening and treatment.

“As we work towards reducing the cancer burden in the population as a whole, it is important that we apply what we know about prevention, detection and treatment of cancer to populations at highest risk,” said John R. Seffrin, Ph.D., chief executive officer of the American Cancer Society. “While it’s promising that mortality gaps are closing for some racial/ethnic groups, continued efforts are needed to prevent the avoidable deaths that these gaps represent.”

Despite the drop in lung cancer deaths among women nationwide, lung cancer still kills more people than any other type of cancer. “Lung cancer can become a rare disease if states support well-funded tobacco control programs,” said CDC Director Thomas Frieden, M.D. “Aggressive ad campaigns that show the impact of smoking, combined with higher cigarette prices and strong state laws that protect nonsmokers from secondhand smoke, will decrease the number of adult smokers and save lives.”

In the Special Feature section, the authors note that non-malignant tumors make up two-thirds of all adult brain tumors and one-third of childhood brain tumors, with meningiomas being the most common type of brain and other nervous system tumor in the U.S. Changes in diagnostic techniques, including the introduction of computed tomography, or CT, scans in the 1970s and magnetic resonance imaging, or MRI, in the 1980s, have led to less invasive methods for diagnosing brain tumors, but also have had a strong influence on incidence rates over the past decades. Newer molecular studies have improved classification of brain tumors for treatment and prognostic purposes.

Of note in the discussion of trends in malignant brain tumor incidence is the relative stability of long-term trends for tumors of neuroepithelial tissue, which arise from glial (support) cells in the brain and other tissues. Incidence rates for glioblastoma, the most common, as well as highly fatal, form of these malignant tumors, increased from 1980 through 1991, likely due to increasing use of aggressive diagnostic procedures in elderly patients, but since 1991 the rates have been stable. The report notes that the relatively low variation in incidence and mortality rates over the past several decades for brain cancers suggest that external risk factors in the environment do not play a major roles in this disease.

###

Reference: Kohler BA, Ward E, McCarthy BJ, Schymura MJ, Ries LAG, Eheman C, Jemal A, Anderson RA, Ajani UA, Edwards BK. Report to the Nation on the Status of Cancer, 1975-2007, Featuring Tumors of the Brain and Other Nervous System. JNCI; May 4, 2011.

To view the full report, go to http://www.oxfordjournals.org/our_journals/jnci/press_releases/kohlerdjr077.pdf

For a Q&A on this Report, go to http://www.cancer.gov/newscenter/qa/2011/ReportNation2011QandA

For Spanish translations of this press release and Q&A, go tohttp://www.cancer.gov/espanol/noticias/ReportNation2011SpanishRelease

NAACCR: http://www.naaccr.org

NCI: http://www.cancer.gov and SEER (NCI’s Surveillance, Epidemiology, and End Results program):http://www.seer.cancer.gov

CDC’s Division of Cancer Prevention and Control: http://www.cdc.gov/cancer ; National Program of Cancer Registries: http://www.cdc.gov/cancer/npcr; and the National Vital Statistics System:http://www.cdc.gov/nchs/nvss.htm

ACS: http://www.cancer.org

Central Brain Tumor Registry of the United States: http://www.cbtrus.org

Photo: http://www.flickr.com/photos/81538501@N00/6171494989/sizes/m/in/photostream/

We have noted in our End of Life section on this Web site resources that better inform and prepare individuals who may be experiencing death for the first time. We also provide links to organizations that seek to help prepare an individual for the passing of a loved one. There is no doubt, that with medical advances that can prolong life so too will arise moral issues as to what extent medicine can support life although the quality of living does not keep step with medical advances. Recently, researchers at the Mayo Clinic are drawing a distinction between one’s lifespan and their healthspan, or the quality of one’s life at a given time. Recognizing that a majority of adults over 65 will develop at least two chronic diseases such as diabetes or heart disease, the issue become one of determining how the quality of life changes s the effects of chronic or other diseases make radical changes in our lifestyle. there is a growing awareness that individuals have the right to direct their medical treatments and guide their life in accordance with the quality of life that may accompany chronic disease or failing overall health. Legal documents such as advance directives and no not resuscitate orders can assist an individual in making decisions as to how long and to what extent they wish medical interventions to prolong their life.

One alternative to death without the intervention of another individual is the decision to stop taking food or liquids. Unlike assisted suicide, the cessation of taking food or liquids is an individual choice that can be specified in an advance directive. Stopping eating is not suicide as it I a choice made by an individual who is at the end of their natural life. When this decision is made, an individual becomes progressively weaker and death comes weks or months sooner than if the individual had been hydrated and nourished. Individuals making this decision do so to avoid prolonging pain, to gain control over their own death, According to a study in the New England Journal of Medicine, individuals who make this decision are generally the elderly who have a poor quality of life.

Legally, the United States Supreme Court ruled in 1990 ( Cruzan vs. Director 1990) that artificial nutrition and hydration are not different than other life-sustaining treatments. Courts in the United States have made the following  rulings consistently in the recent past:

• Competent adults may refuse artificial nutrition and hydration treatments even though this action may hasten death;

• Surrogate decision makers may withdraw artificial nutrition and hydration;

• Surrogate decision makers may refuse artificial nutrition and hydration on behalf of an incompetent adult.

One might question whether the cessation of providing water and food is effectively killing a patient or allowing a person to die as an indiviual cannot live without food and water. Generally if an individual has expressed the desire for the cessation of food and water the health care team and patient’sfamily members discuss if  hydration and food will benefit the patient. Physically, a person’s body begins to shut down prior to death thus food and water are processed in  manner distinct from a healthy individual. Providing water may actually bloat an individual and providing food may cause intestinal problems and discomfort.

Does And Individual Suffer When Food and Water are no Longer Given to Them

Medical research indicates there is no suffering. The New England Journal of Medicine (Jacobs, 2003)reported 94% of nurses reported these patients’ deaths as peaceful. The cessation of eating and drinking is a normal part of the dying process that typically occurs days to weeks before death. Once the body becomes mildly dehydrated, the brain releases endorphins which act as natural opioids, causing the patient to feel euphoria as well as less pain and discomfort. Surprisingly, few patients express the feeling of hunger or the need for water although the mucous membranes and mouth do become very dry and are generally moistened to lessen the discomfort.

How Does Cessation of Food and Water Compare to Doctor Assisted Suicide?

When death by voluntarily stopping of eating and drinking was compared with death resulting from physician-assisted suicide (actions, which an individual helps another person who is terminally ill die upon their wanting to do so) nurses reported that patients in the former group had less suffering, less pain, and were more at peace than the latter group. Nurses reported that both groups had a high quality of death, which sounds strange but means that their deaths proceeded with lower levels of pain and struggle.

How Long After Does Death Occur?

Once a person stops eating and drinking, death usually occurs within two weeks. He may continue to take small amounts of water to swallow pills or moisten his mouth, and these small sips of fluids may prolong the dying process by a couple of days.

The decision to stop drinking and obtaining food is clearly a serious decision which must involve the individual, relatives, and care providers. In making that decision one must consider religious, moral, ethical, and medical issues. The best solution to making the decision is to have a discussion of long before one is nearing the end of life. For that reason, people state their preference in their advance directive following discussion with their family members, religious representatives, and physicians.

Cruzan v. Director, Missouri Department of Health, 110 S.Ct. 2841 (1990).

Jacobs S. Death by Voluntary Dehydration — What the Caregivers Say. N Engl J Med 349:325, July 24, 2003.

Photo:http://www.flickr.com/photos/ryanstone/1051869571/sizes/m/in/photostream/

Some Advantages of Trusts

A majority of older individuals have taken the time to have a valid will written and shared with members of their family. Most people assume that since they have a will there will be no need for one’s assets to pass through a court after they die. Unfortunately, that is now always the case as in many states the court must certify the will and examine claims against the estate as well as distribute the assets of the estate. Probate can be an expensive process with costs ranging from 6-10% of the gross proceeds of the estate prior and debts are paid off. Probate is also a public process with all records of your estate being public. Probate can also consume a great deal of time. It is not uncommon for an estate to be in probate for one to two years. An alternative to a will is a living trust, which reads much like a traditional will but has many advantages over a will. First, a living trust is private. It does not become a public document open to public scrutiny. Second, a living trust is highly flexible for you while you are living. As the trustee you can buy and sell property, make changes in the trust, and you can even cancel the trust. A living trust also has the benefit of potentially reducing federal estate taxes. The Estate Tax is a tax on your right to transfer property at your death. It consists of an accounting of everything you own or have certain interests in at the date of death. The fair market value of these items is used, not necessarily what you paid for them or what their values were when you acquired them. The total of all of these items is your “Gross Estate.” The included property may consist of cash and securities, real estate, insurance, trusts, annuities, business interests and other assets.

Taxes and Trusts

Once you have accounted for the Gross Estate, certain deductions (and in special circumstances, reductions to value) are allowed in arriving at your “Taxable Estate.” These deductions may include mortgages and other debts, estate administration expenses, property that passes to surviving spouses and qualified charities. The value of some operating business interests or farms may be reduced for estates that qualify.

After the net amount is computed, the value of lifetime taxable gifts (beginning with gifts made in 1977) is added to this number and the tax is computed. The tax is then reduced by the available unified credit. Presently, the amount of this credit reduces the computed tax so that only total taxable estates and lifetime gifts that exceed $1,000,000 will actually have to pay tax. In its current form, the estate tax only affects the wealthiest 2 percent of all Americans.

Most relatively simple estates (cash, publicly traded securities, small amounts of other easily valued assets, and no special deductions or elections, or jointly held property) do not require the filing of an estate tax return. A filing is required for estates with combined gross assets and prior taxable gifts exceeding $1,500,000 in 2004 – 2005; $2,000,000 in 2006 – 2008; $3,500,000 for decedents dying in 2009; and $5,000,000 or more for decedent’s dying in 2010 or later (note: there are special rules for decedents dying in 2010.

There are other reasons for creating a trust. First a trust can establish conditions on how your assets are distributed after you die.  Second, a trust can reduce estate and gift taxes by effectively dividing the trust into A and B trust if one spouse dies before another. In that case, the deceased spouse has $5 million in assets which are not taxable. The trust provides a Part B for the living spouse who also has $5 million in non-taxed assets. Any amount over the $5 million is subject to estate taxes. Third, beneficiaries to the trust are not entitled to have access to the trust document itself, only the assets that are named in their behalf. If a beneficiary wishes to contest the trust they may do so only through legal action they would have to initiate and pay for.

In general, trusts have the advantage of maintaining the privacy of how your estate is distributed or managed after death. Trusts also do not involve court proceedings or accounting. The construction of a trust for your estate rather than having only a will is a matter that must consider the size of your estate, the individuals involved, the complexity of your finances, if there are special tax considerations, and the level of management you wish to have over your assets. Accordingly, you should discuss your desires with an attorney who deals with estate planning and writing trusts.

Photo: http://www.flickr.com/photos/shawn-walton/6006587387/sizes/m/in/photostream/

We have noted on this site that there are various types of elder abuse and neglect with each having distinct warning signs. We have also described how elders can seek legal assistance for abuse and negligence through Title III-B providers.

No one knows precisely how many older Americans are being abused, neglected, or exploited. While evidence accumulated o date suggests that many thousands have been harmed, there are no official national statistics. There are several reasons:

1. Definitions of elder abuse vary. It is difficult to pinpoint exactly what actions or inactions constitute abuse, and the problem remains greatly hidden.

2. State statistics vary widely as there is no uniform reporting system.

3. Comprehensive national data are not collected. In the absence of a large-scale, nationwide tracking system, studies of prevalence and incidence conducted over the past few years by independent investigators have been crucial in helping us to understand the magnitude of the problem.

The following highlights some of the most widely used estimates of elder abuse prevalence and incidence in the United States today.

What Do the Studies Say?

Prevalence

According to the National Research Council Panel to Review Risk and Prevalence of Elder Abuse and Neglect, between 1 and 2 million Americans age 65 or older have been injured, exploited, or otherwise mistreated by someone on whom they depended for care or protection. Estimates of the frequency of elder abuse range from 2% to 10% based on various sampling, survey methods, and case definitions.

Data on elder abuse in domestic settings suggest that 1 in 14 incidents, excluding incidents of self-neglect, come to the attention of authorities. Current estimates put the overall reporting of financial exploitation at1 in 25 cases, suggesting that there may be at least 5 million financial abuse victims each year.

The National Center on Elder Abuse estimates that for every one case of elder abuse, neglect, exploitation, or self-neglect reported to authorities, about five more go unreported.

Warning Signs

While one sign does not necessarily indicate abuse, some tell-tale signs that there could be a problem are:

• Bruises, pressure marks, broken bones, abrasions, and burns may be an indication of physical abuse, neglect, or mistreatment.
• Unexplained withdrawal from normal activities, a sudden change in alertness, and unusual depression may be indicators of emotional abuse.
• Bruises around the breasts or genital area can occur from sexual abuse.
• Sudden changes in financial situations may be the result of exploitation.
• Bedsores, unattended medical needs, poor hygiene, and unusual weight loss are indicators of possible neglect.
• Behavior such as belittling, threats, and other uses of power and control by spouses are indicators of verbal or emotional abuse.
• Strained or tense relationships, frequent arguments between the caregiver and elderly person are also signs. Most important is to be alert. The suffering is often in silence. If you notice changes in personality or behavior, you should start to question what is going on

Who Are the Abusers?

It has been estimated that roughly two-thirds of all elder abuse perpetrators are family members, most often the victim’s adult child or spouse. Research has shown that the abusers in many instances are financially dependent on the elder’s resources and have problems related to alcohol and drugs.

What if I Suspect Elder Abuse? What Should I do?

If someone is in immediate danger, call 911 or the local police for immediate help.
(You may also contact the Eldercare Locator on weekdays for state specific information at:1-800-677-1116.)

Photo: http://www.flickr.com/photos/capannelle1/2142742435/sizes/m/in/photostream/

Shingles is considered an extremely painful virus that can affect elder individuals.

Here is what you need to know about the virus and how you can potentially protect yourself against it.

What is shingles?

Shingles comes from the varicella-zoster virus (VZV the same virus that causes chickenpox. When a child recovers from the chickenpox, the VZV virus remains in the body for life. As one ages, their immunity to VZV begins to decline. At older ages, the virus can travel back up the nerve to the skin where it causes a painful rash. Which is called shingles. Generally this rash is limited tto a small area on one side of the body, often the face or torso. Clusters of small bumps become fluid filled blisters which later drain and form scabs. In addition to the painful rash, shingles can also cause chills, fever, upset stomach, or headache.

Once shingles is present an anti-viral can be administered by a doctor to reduce the severity and duration of shingles but it will not eliminate the shingles. Anti-virals have been shown to reduce other complications, such as those involving the eye (ophthalmic herpes zoster). The rash may continue for two to four weeks, but eventually improves and the pain diminishes. The person then returns to a normal schedule.

Some people are not so fortunate and suffer indefinitely from shingles They develop chronic pain and serious complications that make it difficult to sleep, leave the house or shop  Sometimes they never return to normal activities, and become depressed and reclusive because of  long-term pain and disability.

Complications, which rise with the age of the individual, develop in somewhere between one-third and one-half of older adults with shingles. The most frequent complication is the chronic pain syndrome called postherpetic neuralgia (PHN). PHN is the occurrence of persistent pain after the shingles rash heals; it can last for months or even years. Only rarely does PHN cause disability and suffering for the rest of the patient’s life.

Research puts shingles and postherpetic neuralgia on a par with congestive heart failure, diabetes and depression for disrupting a person’s quality of life. Thus, shingles can have a major impact on morbidity, lost work productivity and quality of life in older adults.

In addition to the excruciating pain of PHN, other complications of shingles may include scarring, secondary bacterial infections, pneumonia, visual and hearing impairments and, rarely, death. If left untreated, 10% of patients whose shingles affects an eye will experience severe visual loss, eyelid scarring or chronic in-turning of the eyelashes.

Although shingles is not highly communicable, it is a public health concern because of the serious complications, the detrimental impact on quality of life and the cost of care. The Agency for Healthcare

Who gets shingles?

Each year it is estimated that 1 million individuals in the U.S. are affected by shingles. About 50% of those cases are among people aged 60 or older. Anyone who has previously had chickenpox is at risk of getting shingles. It is estimated that between 20% to 30% of people will develop shingles during their lifetime. People are more likely to get shingles if they are receiving chemotherapy, radiotherapy, immunosuppressant drugs, or steroids. Because the risk of acquiring shingles increases with age, likely because of lower immune systems, 50% of adults who reach 85 will acquire shingles. In addition, shingles tends to be more severe in older than younger people.

How is shingles treated?

Most cases of shingles can be managed in the primary care setting, but specialists are sometimes required if the eyes, lungs or other organs are involved, or if a pain specialist is needed.  Appropriate and immediate treatment of herpes zoster can control acute symptoms and reduce the risk of longer term complications. Starting anti-viral medication within 72 hours of the onset of shingles can reduce the pain and the length of time the outbreak lasts. Topical antibiotics may be prescribed if the blisters become infected. A medicated lotion (such as Benadryl or Caladryl) or astringent soaks (such as Bluboro or Domeboro) may relieve pain and itching, according to the American Academy of Family Physicians. Pain medicine (analgesics or opioids) also may be prescribed for shingles or PHN.

While shingles cannot spread to exposed persons the shingles rash can be transmitted to cause chickenpox in persons (mostly younger children) who have never had chickenpox or never been vaccinated with the varicella vaccine. Shingles is considerably less contagious than chickenpox, and it is generally not necessary to isolate the affected person while the rash is present.

The shingles vaccine

A preventive vaccine, Zostavax was approved by the FDA in 2006, Zostavax is licensed as a one-dose vaccine for people age 60 years or older. For adults aged 60 or older studies have shown the Zostavax vaccine reduced:

• the overall incidence of shingles in older adults by about 51% and

• the incidence of PHN by 67%.

The vaccine’s effectiveness in reducing the incidence of shingles drops with the age of the vaccine recipient. For example, Zostavax was 64% effective for those age 60-69 years, 41% effective for those ages 70-79 years and 18% effective for those age 80 years or older.

Paying for the vaccine

The shingles vaccine ranges between $165 and $300  and it is not covered by Medicare Part B. For other low-income adults without insurance, Merck offers a vaccine assistance program. (contact: 1-800-293-3881 or go to http://www.merckhelps.com).

(photo: http://www.flickr.com/photos/ringai/3173722475/sizes/z/in/photostream/)

Influenza is a viral infection that is highly contagious and affects people of all age groups. Seasonally, influenza reaches epidemic proportions in the autumn and winter months in temperate climates. Even though it reaches such proportions, it is not a major problem for most young, healthy people. It does however become a serious issue for those in the high-risk populations. High-risk populations for this disease are the very young, elderly, and the chronically ill. Worldwide, serious cases of influenza cases number between 3 to 5 million, and deaths range from 250,000 to 500,000. According the Center for Disease Control, one statistic that shows how dangerous influenza can be for those over 65, is that 90% of deaths related to influenza comes from people in this age group.

For preventing the disease, the World Health Organization recommends that nursing home residents, both those who are elderly and those who are disabled, receive the vaccine. Because they live in such close proximity and are thus very susceptible to contracting the disease if there is any occurrence of it at a nursing home, these residents are the highest priority under the WHO recommendations. The next group is the elderly. By nature of just being elderly, a person has a weaker immune system than someone much younger. Even if they do not live in close proximity with other individuals and thus have less of a risk of contracting the disease, older persons are urged to get the vaccine just by the nature of their immune systems not being as strong. In addition to receiving the flu vaccine, the Center for Disease Control provides the following suggestions to limit the spread of influenza.

After the age of 40, bone density decreases and can lead to osteoporosis. Although the elderly are particularly at risk for developing this disease, they are rarely assessed or treated for it.

One of the main risks of the disease is bone fracture or breakage due to a fall. Even elderly people who are in reasonable health should consider talking to their doctors about ways to improve bone health and whether they should be screened for osteoporosis.

Here are a few other things the elderly can do to promote good bone health.

Calcium and Vitamin D

Aging bodies cannot absorb calcium from the diet in the same way they could at a younger age. As a result, the elderly body produces a hormone called parathyroid that actually takes calcium from the bones to put into the bloodstream. For this reason, elderly people should consider taking calcium supplements to reduce the high level of parathyroid.

Another cause of osteoporosis is vitamin D deficiency. Besides bone loss, this can also lead to muscle weakness, which increases the risk of falls and fractures as a result. Vitamin D should therefore be taken as a supplement along with calcium.

Exercise

If an elderly person is not active, a special exercise program may help them to retain bone and muscle strength. Elder exercise also improves balance, posture, and coordination. Types of exercise include weight-bearing exercise like walking or dancing, resistance exercise like water aerobics or free weights, and flexibility exercise like stretching, yoga, and tai chi.

Preventing Falls

If a person has osteoporosis, a fracture can be caused by any minor trauma such as coughing, minor knocks or falls. Elderly people fall more often to the side because they have slower response times. This may cause direct impacts to the hip. Falls from fractures are intrinsic and caused by slow gait, unstable posture, muscle weakness, malnutrition, poor vision, or medications. Maintaining muscle strength and coordination in old age can significantly reduce the risk of fractures and falls.

An elderly person who is very frail may need to see a physiotherapist or occupational therapist. These types of therapists will perform physical therapy and provide types of assistance such as walking aids and installing rails in the home. In addition, they may recommend a hip protector to reduce the incidence of hip fractures.

After a First Fracture

The first fracture is a warning sign of deteriorating bones. However, action can be taken to prevent more fractures in the future. Medication for pain and osteoporosis should be started as soon as possible. Nutrition should include a healthy, balanced diet, with possible calcium and/or vitamin D supplements.

Protein and dairy consumption is also important, along with exposure to sunshine. A therapist can help improve mobility and muscle strength, which can also help relieve pain. Adjustments may also need to be made in the elderly individual’s daily activities and home life.

Lisa Livingston manages the site Radiology Technician Guide. She writes many articles related to healthcare and has been a radiologist for 7 years.

(photo:http://www.flickr.com/photos/keone/453348683/)

We have noted in several of our posts some of the issues raised by depression and alcohol use by elder adults. Alcohol can be a double edged sword. While there are some benefits for moderate consumption of alcohol, there are also are a number of risks depending on the medications you take, pre-existing conditions, and the level of dependence you have for alcohol. Depression can often be a seasonal malady for which there are some simple treatments,

Similarly, exercise can play a valuable role in diminishing the effects of depression as well as improving your health.  For aging Americans, a multitude of chronic illnesses can lead to depression. The Centers for Medicare & Medicaid Services (CMS) today announced two new national coverage determinations that cover alcohol misuse screening and behavioral counseling for Medicare beneficiaries as well as screening for depression. These new coverage policies add to the existing portfolio of covered preventive services, most of which are now available to people with Medicare at no additional cost.

Risks of Alcohol Abuse

Alcohol misuse puts individuals at risk for ill health as misuse is linked to diseases such as cancer, liver disease and cardiac disease, as well as mental and emotional problems. For society at large, alcohol-related problems include economic losses from illness and injury, and disruption of family and social relationships.

Annual alcohol misuse screening by primary care providers, such as a beneficiary’s family practice physician, internal medicine physician, or nurse practitioner, in settings such as physicians’ offices are covered under CMS’ new policies.  The benefit also includes four behavioral counseling sessions per year furnished by the primary care provider, if beneficiaries screen positive for alcohol misuse.

Effects of Depression

Depression is a medical disorder characterized by feeling sad, diminished interest in pleasurable activities, feelings of guilt, decreased ability to concentrate and other symptoms experienced nearly every day. Depression may also include thoughts of suicide. Among people 65 years and older one in six suffers from depression.

Annual screening for depression for Medicare beneficiaries is now covered in primary care settings that have staff resources to follow up with appropriate treatment and referrals.  The purpose of this screening is to assure accurate diagnosis, effective treatment and follow-up.

Among persons older than 65 years, one in six suffers from depression.  Depression in older adults occurs in a complex psychosocial and medical context, and the prevalence of clinically significant depression in later life is estimated to be highest (~25%) in those with comorbidities including cancer, arthritis, stroke, chronic lung disease and cardiovascular disease. 

Frequency of other stressful events such as the loss of friends and loved ones increases with age, and bereavement is an important and well-established risk factor for depression. Opportunities are missed to improve mental health and general medical outcomes when mental illness is under-recognized and undertreated in primary care settings. A significant number of older adults with depression are not diagnosed or treated in the primary care setting. Beliefs that depression is normal with older age, as well as difficulties presented by patients with cognitive deficits, make identification of depression in older adults challenging.

Depression wields significant public health impacts and economic costs. Pignone, et al. (2002), for instance, noted that depressive illness has substantial effect on healthcare utilization and is projected to be the second leading source of disability worldwide by 2020. In 2003, Greenberg, et al. reiterated that the economic burden of depression is substantial and estimated that the combined U.S. direct and indirect costs of depression were $83.1 billion, including $31.5 billion in direct costs and the remainder in indirect, mostly workplace costs.

Critically, older adults have the highest risk of suicide of all age groups. In fact, a 1992 NIH Consensus Development Panel on depression in older adults found most of these patients were experiencing their first episode of major depressive disorder, which had gone unrecognized and untreated. Such patients are important in the primary care setting because > 50-75% of older adults who commit suicide saw their medical doctor during the prior month for general medical care, and 39% were seen during the week prior to their death.

(photo: http://www.flickr.com/photos/32911376@N07/3146550561/)

According to the National Institute on Neurological Disorders and Stroke, stroke is the third leading cause of death in the United States and a leading cause of serious, long-term disability in adults. About 600,000 new strokes are reported in the U.S. each year.

The good news is that treatments are available that can greatly reduce the damage caused by a stroke. However, you need to recognize the symptoms of a stroke and get to a hospital quickly. Getting treatment within 60 minutes can prevent disability.

What is a stroke?

A stroke, sometimes called a “brain attack,” occurs when blood flow to the brain is interrupted. When a stroke occurs, brain cells in the immediate area begin to die because they stop getting the oxygen and nutrients they need to function.

What causes a stroke?

There are two major kinds of stroke.

The first, called an ischemic stroke, is caused by a blood clot that blocks or plugs a blood vessel or artery in the brain. About 80 percent of all strokes are ischemic. The second, known as a hemorrhagic stroke, is caused by a blood vessel in the brain that breaks and bleeds into the brain. About 20 percent of strokes are hemorrhagic.

What disabilities can result from a stroke?

Although stroke is a disease of the brain, it can affect the entire body. The effects of a stroke range from mild to severe and can include paralysis, problems with thinking, problems with speaking, and emotional problems. Patients may also experience pain or numbness after a stroke.

Know the Signs

Because stroke injures the brain, you may not realize that you are having a stroke. To a bystander, someone having a stroke may just look unaware or confused. Stroke victims have the best chance if someone around them recognizes the symptoms and acts quickly.

What are the symptoms of a stroke?

The symptoms of stroke are distinct because they happen quickly:

• Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body)
• Sudden confusion, trouble speaking or understanding speech
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

What should a bystander do?

If you believe someone is having a stroke – if he or she suddenly loses the ability to speak, or move an arm or leg on one side, or experiences facial paralysis on one side – call 911 immediately.

Act in Time

Stroke is a medical emergency. Every minute counts when someone is having a stroke. The longer blood flow is cut off to the brain, the greater the damage. Immediate treatment can save people’s lives and enhance their chances for successful recovery.

Why is there a need to act fast?

Ischemic strokes, the most common type of strokes, can be treated with a drug called t-PA, that dissolves blood clots obstructing blood flow to the brain. The window of opportunity to start treating stroke patients is three hours, but to be evaluated and receive treatment, patients need to get to the hospital within 60 minutes.

What is the benefit of treatment?

A five-year study by the National Institute of Neurological Disorders and Stroke (NINDS) found that some stroke patients who received t-PA within three hours of the start of stroke symptoms were at least 30 percent more likely to recover with little or no disability after three months.

What can I do to prevent a stroke?

The best treatment for stroke is prevention. There are several risk factors that increase your chances of having a stroke:

• High blood pressure
• Heart disease
• Smoking
• Diabetes
• High cholesterol

If you smoke – quit. If you have high blood pressure, heart disease, diabetes, or high cholesterol, getting them under control – and keeping them under control – will greatly reduce your chances of having a stroke.

The National Institute on Neurological Disorders and Stroke provides an informative video you can watch on-line. Just click on the link below.

Know Stroke video. This eight-minute video features experts in the field of stroke discussing the symptoms of stroke and what to do, as well as stories from people who have successfully recovered from a stroke. This presentation requires the latest free version of RealPlayer.

(photo:http://www.flickr.com/photos/reighleblanc/3854684694/)

What do We Know About Falls?

Each year, one in every three adults age 65 and older falls. Falls can cause moderate to severe injuries, such as hip fractures and head traumas, and can increase the risk of early death. Soemtimes, falls can be indicative of a phsiyological condition such as a min-stroke. Fortunately, falls are a public health problem that is largely preventable.

The most immediate way to address falls is to examine the living environment to determine of modifictions will need to be made with carpets, rugs, wires, steps, or any architectural element taht may contribute to a fall. We have provided a discussion of whether home modifications are right for you.

One out of three adults age 65 and older falls each year1,2 but less than half talk to their healthcare providers about it.

Among older adults (those 65 or older), falls are the leading cause of injury death. They are also the most common cause of nonfatal injuries and hospital admissions for trauma.

In 2008, over 19,700 older adults died from unintentional fall injuries.

The death rates from falls among older men and women have risen sharply over the past decade.

In 2009, 2.2 million nonfatal fall injuries among older adults were treated in emergency departments and more than 581,000 of these patients were hospitalized.

In 2000, direct medical costs of falls totaled a little over $19 billion—$179 million for fatal falls and $19 billion for nonfatal fall injuries.5 This equals $28.2 billion in 2010 dollars.

What Happens after a Fall?

Twenty to thirty percent of people who fall suffer moderate to severe injuries such as lacerations, hip fractures, or head traumas. These injuries can make it hard to get around or live independently, and increase the risk of early death.

Falls are the most common cause of traumatic brain injuries (TBI).8 In 2000, TBI accounted for 46% of fatal falls among older adults.

Most fractures among older adults are caused by falls. The most common are fractures of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand.10

Many people who fall, even if they are not injured, develop a fear of falling. This fear may cause them to limit their activities leading to reduced mobility and loss of physical fitness, which in turn increases their actual risk of falling.

Fall-related Deaths

In 2008, 82% of fall deaths were among people 65 and older.

Men are more likely to die from a fall.  After taking age into account, the fall death rate in 2007 was 46% higher for men than for women.

Older whites are 2.5 times more likely to die from falls as their black counterparts.

Rates also differ by ethnicity. Older non-Hispanics have higher fatal fall rates than Hispanics.

The chances of falling and of being seriously injured in a fall increase with age. In 2009, the rate of fall injuries for adults 85 and older was almost four times that for adults 65 to 74.3

People age 75 and older who fall are four to five times more likely than those age 65 to 74 to be admitted to a long-term care facility for a year or longer.

Women are more likely than men to be injured in a fall. In 2009, women were 58% more likely than men to suffer a nonfatal fall injury

Rates of fall-related fractures among older women are more than twice those for men.

Over 90% of hip fractures are caused by falls. In 2007, there were 264,000 hip fractures and the rate for women was almost three times the rate for men.

White women have significantly higher hip fracture rates than black women.

How Can Older Adults Prevent Falls?

Older adults can remain independent and reduce their chances of falling.  They can:

Exercise regularly. It is important that the exercises focus on increasing leg strength and improving balance, and that they get more challenging over time. Tai Chi programs are especially good.

Ask their doctor or pharmacist to review their medicines—both prescription and over-the counter—to identify medicines that may cause side effects or interactions such as dizziness or drowsiness.

Have their eyes checked by an eye doctor at least once a year and update their eyeglasses to maximize their vision.  Consider getting a pair with single vision distance lenses for some activities such as walking outside.

Make their homes safer by reducing tripping hazards, adding grab bars inside and outside the tub or shower and next to the toilet, adding stair railings and improving the lighting in their homes.

To lower their hip fracture risk, older adults can:

Get adequate calcium and vitamin D—from food and/or from supplements.

Do weight bearing exercise.

Get screened and treated for osteoporosis.

Photo: http://www.flickr.com/photos/slabsofabsence/363816582/sizes/m/in/photostream/