Frankly Speaking Blog - North Carolina's First Elder Law Firm

New Research Into How the Brain Cleans Itself During Sleep

A new study has been published about how the brain cleans itself of waste products. The brain, like every other body organ, produces waste products. Among those waste products is a protein called amyloid-beta, which is a key component in the plaque that builds up in the brains of individuals with Alzheimer’s disease. Researchers noted that levels of amyloid-beta are higher during wakefulness than during sleep, and designed a study to learn more about why the protein levels change so much.

The study concludes that essentially the brain “cleans” itself during sleep by contracting the size of brain cells and pumping cerebral spinal fluid through the resulting spaces, flushing waste into the circulatory system, and eventually the liver. The lead author, Dr. Maiken Nedergaard, explains that “the brain has different functional states when asleep and when awake. In fact, the restorative nature of sleep appears to be the result of the active clearance of the by-products of neural activity that accumulate during wakefulness.” The studies performed thus far have been on the brains of mice.

This research may indicate a direction for future Alzheimer’s research. If scientists can learn more about the timing and mechanism of the brain’s own cleaning system, they may better understand why the amyloid-beta protein builds up in Alzheimer’s patients, and how that might be prevented. The research may also point the way for further research into Parkinson’s disease and Lewy Body dementia. More information may be found here and here.

 

Reporting Elder Abuse Without Violating Privacy Laws

Last month, the Federal Government issued new guidelines aimed to help banks understand how to report suspected financial elder abuse without violating privacy laws. It was co-authored by eight federal agencies, including the FTC, SEC, FDIC, and the new Consumer Financial Protection Bureau. The privacy protection law in question is the 1999 Gramm-Leach-Bliley Act (GLBA).

As the Guidance explains, GLBA allows banks to disclose private information “to comply with…state laws that require reporting by financial institutions of suspected abuse.” It may also be released to respond to a government investigation or to respond to judicial process. The guidance was issued to reassure financial institutions that they will not run afoul of federal law by reporting suspected abuse as required under state law.

North Carolina law protects disabled adults from abuse, neglect, and exploitation, and requires “any person [including a financial institution] having reasonable cause to believe that a disabled adult is in need of protective services” to report such information.

For more information on the new federal guidance, see here, or see the full document here.

For more on reporting elder abuse, see the Attorney General’s website here.

 

Rewards of Caregiving

We hear and speak so often of the burdens of caregiving. We speak of the strain it places on the caregiver. A new study finds that caregiving may help people actually live longer. This article from NPR summarizes the study’s findings, and reflects on what may be a more representative picture of the true impact of caregiving on the caregivers themselves. The researchers found that family caregivers in the study were eighteen percent less likely to die over six years than non-caregivers.

These numbers may point to a truer understanding of the caregiving experience. Of course there are caregivers whose health and well-being suffer due to the stress of caring for a sick or elderly loved one. However, it appears the more typical experience is that caregiving for loved ones is rewarding and gives meaning to a caregiver’s life and his or her relationship with the person needing care. If you face the prospect of becoming a caregiver, it can be comforting to know that rather than being simply a source of stress and anguish, caregiving is a normal, meaningful, and rewarding part of life.

 

Future Changes in Medicaid Rules

Elder law attorneys in North Carolina live day-to-day with the expectation that the state may soon change the laws that govern asset preservation planning. Specifically, Elder Law attorneys anticipate that new Medicaid rules will displace the current rules, and will not allow jointly owned property to be considered “non-countable” when determining eligibility.

Under the current Medicaid rules, an applicant is allowed to have only $2,000 in “countable” assets. Countable assets are those that count against the applicant when he applies for Medicaid benefits. The applicant can have an unlimited amount of assets that are non-countable. Non-countable assets include things like the applicant’s primary residence, one vehicle, a pre-paid funeral contract, and personal items. Additionally, all real property owned jointly is considered non-countable. In other words, if you own your home and another piece of property, that second piece of property can be made non-countable (“exempt”) if another owner is added to the property. Equally as important as exempting the property is protecting the property from any “Medicaid lien” or estate recovery claim. Owning the property jointly means that Medicaid can’t claim the property or recover from it in the future.

Currently, practitioners can use a number of methods to exempt real property. These methods require a transfer of some interest in the property. In North Carolina, the interest transferred can be as little as 1%, thanks to North Carolina’s conservative real property laws. But the State of North Carolina has made attempts to change these laws in the past and Elder Law attorneys fear that the threat of change is again rising. It is common knowledge in the Elder Law community that the advantages that current real property laws provide to clients will not last forever. Attorneys are working fast to help qualify elderly and disabled individuals for benefits under the current laws, so that they are grandfathered in under the current Medicaid rules and are not effected by future changes in the law.

Knowing that change is coming has allowed attorneys to better plan for their clients’ future Medicaid eligibility. While the old adage “all good things must come to an end” may be true, also true is the saying “knowledge is power.”

Life is a Dance – Are You Dancing into Late Age?

A few years ago, a study was published that found that square dancing helped prolong memory loss. Don’t be Square – Dance!! Do-Si-Do Fitness. My mother, Catherine O’Steen, currently 90 years young, is the best example I know. She’s been square dancing as often as she can when a partner is available. Her mind and physical health are as good as ever (for which my sisters are thankful.) In the “your health” section of the AARP Bulletin, September 2013, Margery D. Rosen, reminds us that dancing give us a “great cardio boost, strengthens bones, works on all major muscle groups, builds stamina and improves balance.” It drives away loneliness and ramps up brain power – to all of which my mother can attest. Life is a dance and when you keep dancing, you keep living.    

 

NEW AND NEWER SCAMS CAUSING MORE ALARMS FOR THE ELDERLY

Recently I've shared with you how many of my elder abuse and exploitation cases were the basis for the fiction novel, The Crown of Life Society (epublished through Amazon, Smashwords and other platform–-go to www.crownoflifesociety.com. We included an appendix for discussion of the different kinds of scams that are popping up around the country.

This was highlighted in the most recent AARP Bulletins, and Consumer Reports. In Sid Kirchheimer's article, Cause for Alarm (AARP Bulletin July-August 2013), reference is made to scammers calling to warn elders of the dangers of falling, and promising to send free medical alert devises. Of course the more information given the more the elder person is taken advantage, never receiving the device. He also gives several sound bites for elders to remember: "Hang up on unsolicited offers", "Flee from free", "Reject Robocalls", "Don't Respond to Offers to "Opt out" of Future Calls", "Don't Pay for Anything You Didn't Order".

In Consumer Reports (August 2013), the editors write “Theses New Scams Target Seniors.” They mention reverse mortgage fraud and self-directed IRA scams. They raise the question of whether or not financial credentials such as Certified Senior Advisor, Chartered Senior Financial Planner, or Registered Financial Gerontologist are a help or hype. The Consumer Reports article comes to the same conclusion as the AARP Bulletin–if unsolicited, just hanging up is usually best.

Seniors and Reverse Mortgages - No More Big Lump Payouts

We are pleased to read that fewer elders will be able to benefit from reverse mortgages when tighter Federal Housing Administration (FHA) rules go into effect, some as soon as October 1st. This is happening because of the high default rate of these types of mortgages that are insured by FHA.

Fewer elders will qualify for these mortgages, and the maximum amount available will be reduced. As reported in the Wall Street Journal, Tighter Rules for Reverse Mortgages, by Anne Tergesen (WSJ August 25, 2013), a homeowner with property valued at $300,000 and eligible to borrow $175,000, may only take 60% in the first year, $105,000. FHA will also require lenders to assess borrowers ability to pay insurance and taxes, and may require an escrow account to cover them in the future.  

Elder Scams and Abuse in my new ebook The Crown of Life Society

Elder Scams and Abuse in my new ebook The Crown of Life Society

Elder abuse and exploitation has become the hidden epidemic. That's why I co-authored with Bill Henry the facts of many of my cases in a fiction novel titled the Crown of Life Society. It is epublished on many platforms. But first see the video on YouTube http://www.youtube.com/user/CrownOfLifeSociety And the go to our website www.thecrownoflifesociety.com or see the release here http://www.prweb.com/releases/crownoflifesociety/08/prweb10983522.htm
 
Over the past several years, we have voiced our concern for the escalation in elder scams, and the highly sophicated new schemes that are coming to the attenditon of law enforecement, and elder advocates. Once you've read the book, share the discussion questions with your family, friends and professional colleagues.   

North Carolina No Longer Entitled to One-Third of Medical Malpractice Award

                As most Medicaid recipients know, at the end of that recipient's life, Medicaid will be allowed to recover against their estate in repayment for Medicaid's expenditures on their care. Medicaid is also allowed to demand reimbursement when a Medicaid recipient is awarded damages in a medical malpractice suit.

                 Until March of 2013, North Carolina's Department of Health and Human Services (DHHS) had been enforcing North Carolina state law that enabled DHHS to automatically recover the lesser of either: a) full reimbursement of Medicaid's expenses; or b) one-third of the total medical malpractice award, regardless of how much was designated for medical expenses.

                 However, in March of 2013, the U.S. Supreme Court ruled in a case involving a young girl who was awarded $2.8 million in medical malpractice settlement, that the federal Medicaid Act preempts this North Carolina state law. As a result, North Carolina (and all other states) can no longer demand "any portion of a beneficiary's tort recovery except the share that is attributable to medical expenses," Justice Anthony Kennedy. The Court made clear that determining the appropriate amount of reimbursement should be done on a case by case basis, and that states will no longer be able automatically take as recompense one-third of a medical malpractice award. States are now considering setting up administrative processes by which to review each case and make individual determinations.

Planning for Veterans Benefits May Leave You Ineligible for Medicaid Benefits

If you are a veteran or a surviving spouse of a veteran who has served at least 90 days active duty, with at least one day served during a time of war, you may be eligible for veterans benefits to assist with continuing care in the home, assisted living facility, or in a nursing home. While most benefits programs have strict financial requirements, the Department of Veterans Affairs evaluates each case individually regarding the amount of assets and income a veteran or their spouse may have and still receive benefits. In addition, there must be a medical reason for the veterans (or surviving spouse’s) need for assistance with activities of daily living (such as bathing, dressing, meals, toileting). These benefits come in form of around $1,000-$2,000.

Often, veterans who apply for veterans benefits find that they are ineligible due to their level of income or financial resources. Many attorneys assist those families with asset transfers and planning aimed at getting the veterans eligible for veterans benefits. This type of planning can come at a very high price, however. In fact, it can cost you hundreds of thousands of dollars.

It isn’t that attorneys charge thousands of dollars to assist in planning for veterans benefits, it’s that their planning often results in Medicaid eligibility. Many attorneys or advocates that assist veterans in qualifying for veterans benefits know only the rules for veterans benefits, and not the Medicaid eligibility requirements. When they transfer assets, they make sure the transfers are seen as exempt by the Veterans Affairs administration, but those same transfers very often result in penalties under the Medicaid program. In effect, by qualifying to receive around $1,500 per month for skilled nursing assistance in the form of Veterans benefits, you sabotage your ability to acquire Medicaid benefits, which cover all of the costs of skilled nursing care (an average of $7,500 per month in North Carolina). It is often very difficult to qualify for both programs, which makes choosing the program you will plan for critical.

If you are a veteran who may be in need of skilled nursing care, you should speak with an attorney who is knowledgeable in the areas of both veterans benefits and Medicaid benefits. Ask that attorney to help you determine which program would provide you with the benefits best suited to your needs, and how to plan for those benefits.

We can help you with these issues. Call us at 877.503.5337 or visit us on the web at www.nc-law.com.