Marshall Parker & Associates - PA Elder Law, Estate Planning, Long Term Care Resource Center

CMS Announces Medicare Premiums, Deductibles for 2010

What Alzheimer’s Disease Can’t Take Away

New Jersey Case Upholds Exemption of Transfers to a Disabled Child

Are You at Risk for Dementia?

DPW Increases Payments for Burial or Cremation

Hospice & Palliative Care: An Overview

Follow Jeff Marshall on Twitter

Marshall, Parker & Associates’ is Named Top Corporate Team for Wilkes-Barre Alzheimer’s Memory Walk

Free Consumer Workshops Set to Learn How to Protect Your Assets in Bellefonte and Scranton

CMS Announces Medicare Premiums, Deductibles for 2010

Written By: Attorney Jeffrey A. Marshall, CELA*

The Centers for Medicare and Medicaid Services has announced Medicare Premiums and Deductibles for 2010. The new rates are available here:

As I discussed in an earlier edition of The Elder Care Alert, most Medicare beneficiaries will not see a Part B monthly premium increase as a result of a “hold harmless” provision in the current law. This allows for 73 percent of beneficiaries to be protected from an increase raising the 2010 Part B monthly premiums from $96.40 to $110.50. But the remaining beneficiaries will feel the full brunt of a 15% Part B increase.

The Obama Administration continues to urge Congressional action that would protect all beneficiaries from higher Part B premiums and eliminate the inequity of a high premium for the disadvantaged 27 percent of Medicare beneficiaries.

Attorney Marshall can be contacted at webmail@paelderlaw.com or at 1-800-401-4552. More information about Attorney Marshall is available on our website at www.paelderlaw.com/staff.html

What Alzheimer’s Disease Can’t Take Away

Written By: Josephine Reviello, Planning Specialist

It can be frustrating to watch a loved one with Alzheimer’s Disease slowly decline in his/her ability to participate in activities that once brought enjoyment and satisfaction. Although, this disease may lessen the cognitive and motor skills needed to allow someone to partake in activities and hobbies in the same manner before the disease manifested, it can’t take away the heart’s desires.

People with Alzheimer’s Disease still find interest and enjoyment in activities or hobbies but maybe the ability and skill are not at the same level as before. For example, one may have loved to play the piano and had great talent and skill in doing so, but now that ability to skillfully play is gone. But, he/she may still enjoy listening to piano music or even enjoy sitting at the piano and playing, even if the music is “off key.” Or one may have enjoyed baking but may not be able to safely use the oven or other kitchen appliances. But he/she still has the ability to stir the batter in a bowl or crack an egg. The smallest task or step in an activity can bring the most satisfaction because it’s an accomplishment.

Remember, it’s not the end result of the activity or task that’s important, it’s the little steps in between that are significant. A person with Alzheimer’s Disease can still feel embarrassment, frustration, anger, sadness, lack of self confidence, etc., when he/she realizes his/her failure in accomplishing something they had no problem doing in the past. Even if the cupcakes end up lumpy it’s ok - the goal is not to bake delicious cupcakes but to enhance the life of the person suffering from Alzheimer’s Disease.

Keeping the person stimulated can also help maintain as much of their cognitive skills and motor skills as possible and also help lessen agitation and depression. www.AARP.org offers the following general guidelines for creating activities to help people with Alzheimer’s Disease:

Create meaningful activities. This is not about filling the day with busy work. Try for activities that your loved one used to do and enjoy.

Assess skills. Can they sort objects by size or color? Can they button shirts and zip up jackets? Can they follow written commands? Modify activities to make them more or less challenging to fit the skills of your loved one.

Play up past interests. People with Alzheimer's often maintain old habits and abilities. Try adapting these skills into smaller and more manageable components. Create games based on their interests.

Make activities failure free. If your loved one is involved and happy, don't correct him. The goal is to engage the person with dementia and encourage a sense of success.

Keep activities simple. Too many decisions may frustrate people with Alzheimer's. Keep crowds and noise to a minimum.

Give both verbal and visual instruction. Feel free to tell and to show. If your loved one is accepting, even guide his arms gently as you instruct.

Do activities that let your loved one manipulate materials. For people with advanced dementia, avoid small objects that might be swallowed.

Select the best time of day for your loved one. More energy in the morning? Go for a walk. More focused in the afternoon? Try an art project.

Keep the work area safe. Work with unbreakable plastics; keep the surface clean, uncluttered and well lit.

Be prepared with alternate activities. If your loved one doesn't connect with an activity, be sure to have another ready. Through trial and error, you'll find activities that best suit your loved one.

And don't be afraid to try something new, to see if it arouses curiosity.

Repeat favorite activities, and establish a routine. Note the activities your loved one enjoys. Although the patient may not remember them the next time, she may repeat the processes instinctively. While doing familiar activities, such as sorting objects, keep the procedures the same, but try different content from day to day to keep it fresh for the patient and for you.

For more information go to www.aarp.org/caregivers, click on Providing Care at Home, then click on Engaging Activities and you should find an article titled “Activities for People with Alzheimer’s Disease.” You can also visit the Alzheimer’s Association website at www.alz.org.

Josephine can be contacted at webmail@paelderlaw.com or at 1-800-401-4552. More information about Josephine is available on our website at www.paelderlaw.com/staff.html

New Jersey Case Upholds Exemption of Transfers to a Disabled Child

Written By: Attorney Jeffrey A. Marshall, CELA*

Federal law exempts transfers to a disabled child, or to a trust for the sole benefit of a disabled child, from the imposition of transfer penalties. In New Jersey, two parents who were nursing facility residents transferred substantial sums outright to their disabled children. The New Jersey Medicaid Agency tried to impose transfer penalties on these gifts. It argued that transfers must be made to an irrevocable trust to be exempt.

A Federal court in New Jersey has rejected the State’s interpretation of federal law and ordered it to provide Medicaid benefits to the parents. The Court found that New Jersey’s reading of the federal statute was “syntactically implausible” and held that outright transfers of resources to an applicant’s blind or disabled child are exempt from penalty regardless of whether the transferor makes any arrangements to ensure that the transfer is for the child’s sole benefit. The state may not require that the transfer be made to an irrevocable trust. A copy of the court’s opinion is available here.

Are You at Risk for Dementia?

Written By: Shelly J. Heikes, Planning Specialist

Some of you may have noticed recent news reports of an increased incidence of dementia in former players in the National Football League (NFL). This may be linked to football related head injuries such as multiple concussions. Scientists believe that there are many risk factors for dementia. While they are not causes of the disease, these factors may increase a person=s chance of developing symptoms of dementia. Some of the risk factors can be controlled while others cannot.

The following is a list of risk factors that are out of your control:

A family history of dementia. It is clear that those with a family history of dementia have a heightened risk of developing the disease themselves.

Down Syndrome. Studies show that people with Down Syndrome are at very high risk of developing a form of Alzheimer=s disease in middle age.

History of Stroke. People who have previously suffered a stroke are more likely to develop symptoms of dementia, then those who have never had a stroke.

The following is a list of risk factors that you can start controlling today:

High blood pressure. A European study showed that people age 60 and over who are treating their high blood pressure with prescription medications have a sixty percent (60%) decreased risk of dementia compared to those who are untreated.

Diabetes. Diabetics face a heightened risk of dementia. This is mainly due to the diabetics increased likelihood of stroke and atherosclerosis.

Smoking. Smoking significantly increases your risk of mental decline and dementia. People who smoke are also at greater risk of having a stroke, heart disease, and atherosclerosis. Smoking more than triples a person’s risk of developing some form of vascular dementia.

When asked what people could do to reduce their risk of developing dementia Neil Hunt, chief executive of the Alzheimer=s Society, said A Dementia is one of people=s biggest fears later in life but few people realize there are things that they can do now to help. People should keep active, eat a balanced diet, not smoke, and have their blood pressure and cholesterol checked regularly.@

Sources:

www.medicinenet.com

www.healthfinder.gov

www.guardian.co.uk

www.medicalnewstoday.com

www.ehow.com

Shelly can be contacted at webmail@paelderlaw.com or at 1-800-401-4552. More information about Shelly is available on our website at www.paelderlaw.com/staff.html

DPW Increases Payments for Burial or Cremation

Written By: Attorney Jeffrey A. Marshall, CELA*

The Department of Public Welfare has adopted final rules to govern its payment to funeral directors for burial and cremation services. The new rules increase the maximum payment to funeral directors for burial or cremation services to a standard $750 for all eligible individuals. They also increase the maximum level of contributions that may be made by another agency or individual towards burial expenses without reducing the Department payment. This amount is increased from $180 to $750. Additionally, the final rules eliminate several restrictive requirements for burial, thus allowing families and funeral directors more flexibility and choice in planning and selecting burial goods and services.

Click here for more information on the new regulations. Click Here for Remainder of this Article

Hospice & Palliative Care: An Overview

Written By: Jerry Petro, Planning Specialist

Presented by Ralph DeMario, MD

Chief Medical Officer

Hospice of the Sacred Heart

HISTORY

Hospice was initially begun in Europe as a place for tired and sick travelers to recuperate; modern day hospice started in England through the work of Dame Cicely Saunders; The Hospice Medicare benefit was passed by Congress in 1982 in US.

HOSPICE DEFINITION

Active treatment of patients and their families who suffer with an advanced or terminal illness with a prognosis of less than 6 months and who have chosen a non-curative approach to care. Hospice attends to physical as well as social, emotional and spiritual care of patients and their families.

WHO IS ELIGIBLE?

Those who have chosen a non-curative approach to care with terminal or advanced illness. Physician determined prognosis of less than 6 months if disease follows natural course or can be updated if necessary. Need patient consent. Attending physician orders and Hospice Medical Director must consent.

HOSPICE DISEASE CRITERIA

Non-curative cancer; Advanced cardiac disease; progressive dementia; COPD; Neurological illnesses; Liver/Kidney disease/ AIDA/ Debility and Decline/Failure to Thrive.

WHO PAYS FOR HOSPICE CARE?

Hospice can be paid for by Medicare, Medicaid, Private Insurance, or provided as Free care.

LEVELS OF CARE

Routine home care; Continuous care; Respite care; General inpatient care

HOSPICE TEAM

The Hospice Team includes: Patient and Family; Attending physician/hospice physician/nurse practitioner; RN case manager; LPN’s/Home health aides; Social worker/Chaplain; Volunteers; Bereavement counselors.

WHAT HOSPICE INCLUDES

Medications per goals of care; Durable Medical Equipment; Supplies/Oxygen; Nursing visits; Personal care per plan of care; Full interdisciplinary team support; Bereavement.

WHERE DOES HOSPICE OCCUR?

Home; Assisted care facility; Long term care facility; Prison; “Wherever the patient calls home”. Remember hospice is a service not a place.

PAIN MANAGEMENT

15% of patients with cancer have no physical pain, however emotional, social and or spiritual pain may be higher on priority list for pain management. Until physical pain is controlled, any other intervention is difficult, if not impossible. Use pain medication around the clock, not as needed; provide breakthrough medication; use as much medication as necessary to control pain.

Jerry can be contacted at webmail@paelderlaw.com or at 1-800-401-4552. More information about Jerry is available on our website at www.paelderlaw.com/staff.html

Follow Jeff Marshall on Twitter

As an additional way to help you stay on top of the ever-changing world of elder and special needs law, our managing attorney is now “tweeting” on Twitter. You can follow Jeff Marshall at http://twitter.com/ElderLawGuy. Just click on that link or on the Twitter link below in this newsletter.

Jeff is giving his “followers” links to online articles he is reading on issues of importance to seniors and to people who may need long term supports and services. Here are some examples:

-What to take when moving into assisted living - http://tinyurl.com/yl7lr7w

-How to Hire In-Home Help for Elderly Parents -http://agingcare.com/135896 These are some great tips! (via@HomeCareAdvisor via @AgingCare)

-Top 14 Health Care Provisions of House Health Care Reform Bill that Would Take Immediate Effect - http://tinyurl.com/yakodxw

-What you need to know about your Medicare and Medicaid Benefits - http://tinyurl.com/ygcsyfr

International Survey: U.S. Health Care Lags in Access, Quality, Use of Health IT http://tinyurl.com/ylmuysd

-The Coming Tsunami of Parental Nursing Home Costs” (Florida Attorney’s comments): http://tinyurl.com/yl4lmcj

-DEA Crackdown on Pain Meds Hurting Those in Nursing Homes and Hospices - http://www.talkleft.com/sto...

-The Gift That Keeps On Giving: a Roth IRA- http://tinyurl.com/yz6ty67

-Estate Tax fix at current levels supported by House Majority Leader Hoyer. Expects adoption this year. http://tinyurl.com/yf3kt8o

For those of you who aren’t familiar with Twitter, it’s basically “micro-blogging.” Writers are forced to communicate in 140 characters or less (which is exceedingly tough for lawyers to do). You can get lots of information very quickly. It’s free to sign up. Plus, it’s fun. Sign up to be able to access all of Jeff’s “tweets.”

Marshall, Parker & Associates’ is Named Top Corporate Team for Wilkes-Barre Alzheimer’s Memory Walk

Thanks to everyone for their support of this year’s Memory Walk team. Photos from the Wilkes-Barre and Lycoming/Clinton Memory Walk are online at http://www.paelderlaw.com/2009MemoryWalk.html

Free Consumer Workshops Set to Learn How to Protect Your Assets in Bellefonte and Scranton

-Protect Your Home & Assets from Long Term Care Costs scheduled for Saturday, November 21, 2009 from 10:00 AM until 12:00 PM at Bonfatto’s, Park Place in Bellefonte

- Protect Your Home & Assets from Long Term Care Costs Saturday, December 5, 2009 from 10:00 AM until 12:00 PM at The Hilton, 100 Adams Avenue, Scranton

Follow Marshall, Parker & Associates’ Managing Attorney

Jeff Marshall on twitter at:

www.twitter.com/ElderLawGuy

Contacting Marshall, Parker & Associates for Assistance

Marshall, Parker & Associates is a nationally recognized law firm which provides long-term care planning, estate planning & estate administration services to Pennsylvania clients from our offices in Jersey Shore, Williamsport, Wilkes-Barre and Scranton.

Marshall, Parker & Associates is the ONLY law firm in the United States with more than two Certified Elder Law Attorneys (CELAs) on it's staff. Each of our five attorneys is a CELA. CELA status, which has been attained by only 37 attorneys in Pennsylvania, is authorized by the Pennsylvania Supreme Court. In approving the CELA professional designation, the Supreme Court found that it provides a measure of assurance to the public that the attorney has an in-depth working knowledge of the legal issues impacting the elderly,

If you or someone you know needs assistance with estate planning or with qualification for Medicaid benefits for nursing home or home care you can trust the specialists at Marshall, Parker & Associates. Please call us toll free at 1-800-401-4552 or email our Scheduling Coordinator, Lynn Wesley at webmail@paelderlaw.com.

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*Attorneys Marshall, Parker, Grebas, Weber & Colbert are certified as Elder Law Attorneys by the National Elder Law Foundation under authorization from the Pennsylvania Supreme Court.

**In addition to her law degree and CELA status, Attorney Colbert holds an advanced legal degree (LLM) in Estate Planning from the University of Miami School of Law.

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