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VETERANS' DAY - SENIORS HAVE A STRONG CONNECTION

In the year 1919 President Woodrow Wilson proclaimed November 11 as Armistice Day to honor those Veterans who served during World War I. On November 11, 1954, Armistice Day was proclaimed a legal national holiday and the name was changed to "Veterans Day" to honor all veterans of all wars. Every November 11, ceremonies are held throughout the United States honoring Veterans of wars. A National Ceremony is held at Arlington Cemetery at the Tomb of the Unknown Soldier, where the laying of the presidential wreath and military playing of “Taps” is presented. Since its establishment in 1930, the Department of Veterans Affairs has evolved to supporting and aiding the nation’s veterans in numerous ways. One of these services for example, the Veterans Health Administration, is the largest single provider of medical care in the United States. Its 22 regions with 154 hospitals and their associated 875 outpatient clinics offer the following services. · Hospital, outpatient medical, dental, pharmacy and prosthetic services · Domiciliary, nursing home, and community-based residential care · Sexual trauma counseling · Specialized health care for women veterans · Health and rehabilitation programs for homeless veterans · Readjustment counseling · Alcohol and drug dependency treatment · Medical evaluation for disorders associated with military service in the Gulf War, or Treatment for exposure to Agent Orange, radiation, and other environmental hazards · HISA grants · Other special benefits The Department of Veterans Affairs provides three types of long term care services for veterans.

The first are health care benefits provided to veterans who have service-connected disabilities, who are receiving VA Pension or who are considered low income. These services include free medical care, possible free prescription drugs, orthotics and prosthetics, home renovation grants for disabilities, home care, assisted living, domiciliary care, nursing home care, and a possible host of other services or benefits.

The second benefit is state veterans homes. The majority of these homes offer nursing care but some may offer assisted living or domiciliary care. The Department of Veterans Affairs in conjunction with the states helps build and support state veterans homes. Money is provided to help with construction and a federal subsidy of $72.71 a day is provided for each veteran using state veterans nursing home services. These homes are generally available for most veterans and sometimes their spouses and in some cases for so-called "Goldstar parents." Veterans homes are run by the states, sometimes with the help of contract management. There may be waiting lists in some states.

The third benefit for veterans is disability income programs. The most familiar of these benefits is an income for service-connected disabled veterans called "Compensation." The least known of these is a program officially called "Pension" but popularly known as the "aid and attendance" benefit.

Read more by going to our website www.nc-law.com, or go directly to http://www.planforcare.org All of this came from the National Care Planning Council.

Aging Boomers Confronted by an Increase in Age Discrimination as the U.S. Struggles with Recession

In the September 2009 issue of Inside Counsel, Mary Swanton assesses a possible increase in discrimination against the graying workforce of America, providing insights into the cause, effects, and reasoning behind this trend.

Her insightful article can be found at http://www.insidecounsel.com/Issues/2009/September%202009/Pages/Aging-Workforce-Economic-Crisis-Create-Spike-in-Age-Discrimination-Cases.aspx

For information on similar issues of aging in the workplace, as well as other issues confronting aging Americans, please visit our website at www.nc-law.com.

Keeping Mentally Sharp as You Age

Back in May, The New York Times’ Benedict Carey published the second article in a series that looks in depth at some of the insights these projects are producing. In this article, Carey describes the positive and negative findings of a large scientific study of mental acuity and aging. The positive findings of the study show that something as simple as a bridge game with friends can help stave off dementia, while the negative findings show that people past the age of 90 have an increased risk of dementia, especially for women.

Carey wraps his article around the Super Bridge Club, sitting in on the weekly bridge game at Laguna Woods Village and discussing the longest and largest ongoing study of people 90 and over and the potential benefits of mental exercise.

Carey's article can be found in its entirety at http://www.nytimes.com/2009/05/22/health/research/22brain.html?_r=1.

To learn more about how you can protect your assets for future generations, as well as other elder law and aging issues, please visit the website of Booth Harrington & Johns at www.nc-law.com.

ANOTHER YEAR OLDER: IS IT REALLY ALL THAT BAD?

Many people fear the thought of aging, from the financial responsibilities to the changing of the body, and the aches and pains that come with it. In a recent PEW Center Research Study, sampling the expectations of aging amongst younger and middle aged Americans and the realities of aging by older Americans, it was concluded that aging is not so bad after all. When sampled, seven in ten individuals over age sixty-five answered they enjoy spending more time with their families. Two thirds noted they spend more time doing their hobbies, six in ten noted they feel less stress, and over half noted they have more time to travel and do volunteer work. The survey sheds light on the many positive experiences that come with age, but are usually not expected by the younger generation.

CNN also reported on this trend of finding happiness at an older age (Elizabeth Landau, More Happiness May Come with Age, Studies Say, available at http://www.cnn.com/2009/HEALTH/08/11/happiness.emotion.age/index.html) finding that people eighty years old and older are the fastest growing segment of the population. In fact, this group will grow 233% between 2008 and 2040, while the total population will only increase 33%. The study also found that as individuals age, they are better able to recognize the situations and types of people that bother and stress them. Therefore, they are able to avoid those environments and people. It also found that other studies determined that older adults limit the time they spend thinking negative thoughts.

While many do find happiness as they age, those that don’t can do many things to relieve their stresses. One is to make sure their estates are in order. Knowing that all of their finances and loved ones will be taken care of after death is a relief. To learn more about how our office can help you, please visit our website at www.nc-law.com.

To access the full PEW Center Research Study, go to http://pewresearch.org/pubs/1269/aging-survey-expectations-versus-reality.

TOP 10 RISKS AGING BOOMERS FACE

Even though Boomers believe “old age” is still many years away, the first of this age wave will be hitting 65 in two years. Although they don’t want to think about it, Boomers can learn from those of the “Greatest Generation” already considered old. What they can learn are the most common challenges that confront older Americans. In a recent internet posting, August 15, 2009, by Marc Onigman, Stone Hearth Newsletters [marconigman@msn.com], the 10 most common medical challenges were listed:

1. FUNCTIONAL DECLINE: Skeletal muscle is eventually replaced with fat and the body becomes weaker.

2. DEPRESSION: Considered as prevalent as the common cold in the elderly, depression can be the result of major life changes, including retirement, losing loved ones and loss of mobility and independence.

3. DISEASE: Chronic diseases associated with the aging process, including high blood pressure, stroke, cardiovascular disease, osteoporosis, chronic obstructive pulmonary disease, hypothyroidism, constipation, incontinence and arthritis.

4. POLYPHARMACY: The number of prescription and over-the-counter medications that elderly people are taking in alarming numbers.

5. FALLS: Low blood pressure, which can be a result of poorly managed hypertension or dehydration, can lead to dizziness. That dizziness, combined with a decreased ability of the vascular system to compensate for changes in position such as standing up, is the largest cause of falls.

6. ABUSE AND NEGLECT: These two problems, including self-neglect, will continue to afflict the elderly.

7. FINANCIAL EXPLOITATION: Vulnerable elderly people can easily become victims of family members or caregivers.

8. DEMENTIA: Alzheimer’s disease is the most common form of dementia, a gradual decline in a person’s mental functioning, and is the fifth leading cause of death for Americans over age 65, according to the National Center for Health Statistics. The Alzheimer’s Association reports that Alzheimer’s disease and dementia triple healthcare costs for people over 65.

9. CAREGIVER BURNOUT: As baby boomers age, many will also be taking care of their own aging parents. That brings caregiver burden, which can lead to a higher risk for depression and other stress-related illnesses.

10. DEATH AND DYING: Baby boomers will have to decide how they want to live out the end of their lives and how they want to die. Cultural and religious beliefs will impact these decisions.

    For more in-depth discussion of these and other challenges faced by Boomers, go to Stone Hearth Newsletter referenced above. For more on aging, elder law, special needs and estate planning for Boomers, visit our web site, www.nc-law.com.

Promoting Environmental and Policy Change to Support Healthy Aging

On September 15-16, the “Healthy Aging Program” Conference at the UNC Friday Center will present the third conference in the highly successful symposia series developed by the PRC – Healthy Aging Research Network.

Considered an action oriented event, the goal of the conference is to give participants fresh ideas, new partners from different fields, and an action plan to guide their next steps to implement environmental and policy change in their communities or spheres of influence. Conference organizers use as their base of support a growing body of research that points to the influence of the environment on the health and health behaviors of older adults. Since there is little if any activity to promote environmental and policy change to support healthy aging, the organizers expect that this symposium will serve as a catalyst for many new initiatives in this area.

The conference will focus on challenges amenable to environmental and policy change, evidence that supports specific approaches and their outcomes, and promising practice strategies.

To register for this conference, sponsored by the Center for Disease Control and Prevention, go to http://prc-hanconferences.com/2009-conference.

To learn more about how environmental factors affect the way we age, as well as other information about elder law and care, please visit the website of Booth Harrington & Johns at www.nc-law.com.

THE NEW REALITY OF ALZHEIMER’S DISEASE

Most people assume Alzheimer’s disease develops at or near the end of life. Unfortunately this assumption is not always the reality. A recent 2009 report found that 200,000 Americans live with early Alzheimer’s. (John McKenzie and Peter Martinez, Est. 200,000 Americans Living with Early Alzheimer’s—and They Have Not Hit 65, available at http://abcnews.go.com/print?id=8230700). The ABC News report offered the example of Jay Jones:

At the Social Security Administration hearing in Chicago held at the end of July, he spoke on what its like to live with Alzheimer’s at a young age. At forty six, he and his wife began noticing his personality changes, agitation, nervousness, and forgetfulness. His wife recalled that his routines begin changing and she knew it was time to take him to the family physician. The physician diagnosed Jay’s symptoms as related to job stress. Over the next three years, however, his symptoms became more severe, and at age forty nine a neurologist diagnosed him with Alzheimer’s disease.

Jay Jones’s diagnosis is not typical of the estimated 5.3 million Americans with Alzheimer’s (every 70 seconds another person is diagnosed with the disease). However, in addition to the number of Americans under the age of sixty five have developed the early onset stages of Alzheimer’s, there are another 500,000 Americans under the age of sixty five diagnosed with some form of dementia. While it is understood how difficult the symptoms associated with Alzheimer’s are to both the victims and their family members, the victimization of younger Americans is even more devastating. Many families try to provide as much care as possible at home, but eventually the disease takes over and the individual needs specialized assistance in a nursing home or professional care facility.

As the prevalence of Alzheimer’s disease among younger Americans increases, it is important for individuals to set up their finances and powers of attorney early in their lives, ensuring that their and wants and needs are taken care of when they are unable to do so. Alzheimer’s disease can triple a victim’s health care costs. So it is vital to know early on the available government options that can help curb the costs. Currently there is no cure for Alzheimer’s disease or even for slowing its symptoms. The report notes that the FDA has only approved five drugs that help slow the worsening of symptoms for about six to twelve months in about half of the patients who take them. Referring back to Jay Jones three years after being diagnosed with the disease, the report evidenced what most always happens, finding the symptoms had worsened. However, the family adopted strategies to help him adapt to the disease. His schedule was completely rearranged, like placing him in the kitchen every morning. Of course none of it was enough to cure his usual forgetfulness. According to Jay, the hardest part for him was to fade away from his six year old daughter, ‘I think about her all the time. How long I’m going to be able to be with her.”

Those diagnosed with Alzheimer’s disease can stay positive knowing the Alzheimer’s Association continues its research for a cure, and has also begun to develop support strategies for family care-givers. This fall, as in past years, the Alzheimer’s Association is raising money to help live in a world Alzheimer’s free by hosting Memory Walks. There are thousands of teams formed in every state and to learn more about how you can be involved visit the site: http://www.alz.org/index.asp.

To learn more about Alzheimer’s disease and to access the 2009 publication, visit http://www.alz.org/national/documents/report_alzfactsfigures2009.pdf.

To learn more about planning for a future with Alzheimer’s or any other disability, please visit our website at: http://www.nc-law.com.

Whitney Perry, Elon University Law School student and summer intern at Booth Harrington & Johns of NC, PLLC, provided research and writing assistance in developing this blog article.

UNIVERSAL HEALTHCARE: WHAT DOES IT MEAN FOR MEDICAID?

Since the election of President Barak Obama, the issue of universal healthcare has been hotly debated amongst all Americans. At a time when the economy is facing a recession, millions of Americans struggle to pay high medical bills and employers struggle to finance insurance for employees. State governments are also struggling to fund their share of the Medicaid costs. According to Karen Tumulty, a writer for TIME, last month at the National Governors Association in Biloxi, Mississippi, a group of governors discussed one of the latest proposals for revisions to the healthcare plan, this one expanding Medicaid. (Karen Tumulty, Medicaid and the States: Health-Care Reform’s Next Hurdle, available at www.time.com/time/printout/0,8816,1911856,00.html).

Ever since Medicaid was established in 1965, it has provided health care insurance to low income families, people with disabilities, and the elderly. To qualify for Medicaid, an individual’s income and other assets are considered. The proposed healthcare bill would allow non-elderly people earning at or below 133% of poverty, to be eligible for the program. The Federal Government would cover the entire cost of the expansion, roughly $438 billion over ten years. This expansion would provide an estimated 40 million uninsured Americans with health care insurance, including the cost of nursing home care. However, those Americans will still face their own difficult financial choices in order to qualify.

Tumulty opined that “the proposal could hardly come at a worse time for governors…at least 48 states are facing shortfalls totaling $166 billion.” As politicians gear up for the fight over just which health care plan should be enacted, individuals need to determine what the various plans could mean for them in the future. Most people would agree that all citizens should have access to quality health care. As the broad array of healthcare plans wind through Congress, the determination of the best option will be coupled with the financial expense to individuals. The latter will surreptitiously wind through the process unseen by most of us. As the debate continues, individuals need to be aware of the changes and the possible heavy financial impact on their lives. Be sure that unless we get from under the oppression, control and sky-rocketing expense of the health insurance industry, the expense of doing nothing will crush us. Please continue reading the blog to learn more about the proposed changes. If you are concerned about your own health care needs and plans, please visit our website at: www.nc-law.com.

Whitney Perry, Elon Law School student and summer intern at Booth Harrington & Johns of NC PLLC, provided research and writing assistance in developing this blog article.

YOU’D THINK IT WAS OBVIOUS: NOT-FOR-PROFIT NURSING HOMES USUALLY PROVIDE BETTER CARE

You’d think it was obvious that nursing homes run by non-profit organizations are better than investor based for-profit nursing homes. If you’ve visited both kinds of operations lately, you know it is. This was recently trumped in the headline of an LA Times article, announcing the results of a nursing home examination published in the British Medical Journal. The paper was a study of studies. Of 82 studies of nursing homes between 1965 and 2003, measuring 4 primary quality care measures (staffing ratios, lower pressure ulcer prevalence, physical restraint and regulatory deficiencies), almost 50% (40) analyses found better staffing and fewer “bed sores” in non-profits, compared to less than 4% (3) for-profit nursing homes. The rest of the studies were and the other two measures were statistically insignificant.

Reporter Shari Roan, wrote that two-thirds of all US nursing homes are for-profit businesses. These places have the singular goal of making greater profits for investors. Roan, however, asked the question as if the simple fact that there are so many more for-profits leads to the assumption that they are better. The paper on papers provides more than a suggestion (Roan’s word), emphatically declaring by a huge statistical margin that non-profit nursing homes provide higher quality care overall.

The authors of the journal article mention that statistical analyses may not account for the tremendous variations in both profit and non-profit nursing homes. The variations are found in how facilities are managed, what motivates staff and the organizational culture or behavior. This led to their retreat from what was found to be obvious, diluting the report by stating that it is not a blanket judgment of all institutions. However, Roan refocuses readers on the big picture of the analysis that found nursing home residents in the United States would receive 500,000 more hours of nursing care per day if all not-for-profit institutions provided all nursing home care.

Roan ends with an excellent suggestion. “Given the costs of nursing home care and the fears families have about the well-being of their loved ones, more research describing the qualities of superior nursing homes might be in order.” Families should be doing their own investigations. See several earlier blogs on this site that can help. Find more on our website, www.nc-law.com

GOLD DIGGERS, GIGOLOS AND MADELINE WICKHAM

In 1998, Madeline Wickham (also known as Sophie Kinsella of the Shopaholic Series) wrote a book titled “The Gatecrasher”. (2ed St. Martins Press 2007) Since then, Wickham has gained such popularity and fame that the publishers have repackaged her earlier books, making sure that “Sophie Kinsella” appears somewhere in all of the titles. While the packaging is new, the content remains an old and somewhat dangerous plot. The Gatecrasher showcases gold diggers and gigolos in situations where their primary interests in male or female relationships are the material benefits; women and men who care more about bank accounts than they do about the people they are luring into illusionary romance. This book takes the plot further, skimming close to reality with real plots of women and men who go after the weak, elderly, and/or grieving widow/er. However, The Gatecrasher one has one gold digger learning to love, falling for one of her “victims” by the end of the book.

In reality, there is rarely if ever a sudden change of heart, and though the fantasy plot of The Gatecrasher ends with a happy family, the real story usually ends up in court. That said, it is not easy to distinguish true companionship and late life romance from predatory infestation of gold diggers and gigolos.

It is doubtful that Wickham wrote the book with the intent of making this issue light-hearted and whimsical. However, the unfortunate truth is that in countless situations there are no magical turn arounds for the gold diggers and gigolos of this world. Often the predator will hunt for an elderly person with early signs of dementia, taking on the role of caregiver, girlfriend, boyfriend or even nurse. As the elder’s mental capacity starts to diminish, the predator starts undulely influencing and controlling the victim to gain money and assets, cutting out all other immediate family. The end result has the gold diggers and gigolos ending up with the assets of many victims. The assets that are taken can range from simple things like a car, or a credit card, to the entire estate of the victim being passed by will to the gold digger or gigolo.

It is because of the infestation of these gold diggers and gigolos that families must take steps to secure trustworthy and properly qualified caregivers for their elderly loved ones.

In a blog to come, there will be comments about love and old age, addressing the complexities of intervention versus staying out of the elder’s personal business. Is it protecting the elder’s privacy or is it protecting the elder from exploitation? Is it protecting the elder, or the family's legacy? Read more on our website www.nc-law.com.