Estate Planning Blog Articles

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Does Zinc or Vitamin C Fight COVID?

New research shows that if you take either zinc or vitamin C (ascorbic acid) (or a combination of the two), it doesn’t dramatically reduce the severity or the duration of symptoms associated with COVID-19, according to the Cleveland Clinic.

Money Talk News’ recent article entitled “These 2 Supplements Don’t Curb COVID-19 Danger After All” reports that these findings were recently published in the American Medical Association’s journal JAMA Network Open.

In the past, there had been some thought that vitamins and supplements like zinc and vitamin C might provide some benefits to people hoping to avoid or treat COVID-19.

Zinc can help immune function, and the mineral plays a part in antibody and white blood cell production. Zinc is also known to fight infections. Vitamin C is an antioxidant that decreases the damage to cells and boosts the immune system.

However, researchers at the Cleveland Clinic found that among 214 adult patients known to have COVID-19, taking 10 days of zinc gluconate (50 milligrams per day) or vitamin C (8,000 milligrams over the course of each day), or a combination, had no impact on the amount of time it took for their symptoms to subside, compared to patients receiving standard care.

That is actually why the study was stopped early.

In an announcement, Dr. Milind Desai, director of clinical operations in Cleveland Clinic’s Heart Vascular and Thoracic Institute and co-principal investigator of the study, commented:

“As we watched the pandemic spread across the globe, infecting and killing millions, the medical community and consumers alike scrambled to try supplements that they believed could possibly prevent infection, or ease COVID-19 symptoms. However, the research is just now catching up. While vitamin C and zinc proved ineffective as a treatment when clinically compared to standard care, the study of other therapeutics continues.”

The researchers at the Cleveland Clinic also saw that the patients in the study who were getting outpatient care rather than being treated in a hospital (like those who contract COVID-19 but don’t need hospitalization) are more likely to decline supplements.

The study participants also had an average age of about 45 years, and about 62% were women.

Reference: Money Talk News (Feb. 15, 2021) “These 2 Supplements Don’t Curb COVID-19 Danger After All”

Tips for Caregiving during the Pandemic

The Harvard Health Letter provides some great tips in its recent article entitled “Caregiving during the pandemic” to make certain that a loved one is receiving the best care.

Direct Communication. If your elderly family member can communicate well, talk to them daily and remember that when you ask basic questions like “How are you feeling?” “Are you eating and drinking enough?” “Are you getting enough sleep?” However, that you may not get a straight answer. They may just tell you what you want to hear. Therefore, try to get a more realistic picture. Listen to how they sound on the call, and see if they sound different, sad, confused, or tired. Ask them how they’ve been spending their time and who they’ve seen that day. Look for clues that they may be getting sick.

Speak with The Staff. Ask questions. Start with the director of nursing or a caseworker. You can tell the staff you’re worried and that you may be asking more questions than usual. Find out how often they’re able to give you updates and have a list of questions that includes the following aspects of your loved one’s health and well-being.

  • Socialization. Ask if your family member is participating in activities or just staying in their room most of the time. If they’re not getting out, ask about a plan to get them back into a healthy social and physical routine.
  • Does the staff feel your senior is in generally good spirits, or is there an issue? Is this impacting their health or daily activities?
  • Physical Strength. Is your parent having difficulty rising from a chair or feeling unsteady when walking? Inactivity can diminish muscle strength and cause falls. Get them into an exercise routine or physical therapy.
  • Eating Habits. Are they eating and drinking enough, and what is the staff doing to encourage nutrition and hydration? A change in eating and drinking habits can mean a change in mood and should be addressed by a doctor.
  • Have any medications been added or eliminated recently, and for what reason?
  • Continence. Ask if your senior is able to get to the bathroom on time. If they’re incontinent, what’s the plan to deal with this issue?
  • Hygiene. Is your elderly loved one is able to bathe, brush his or her teeth and do other bathroom activities? If not, ask how often the staff is providing assistance.
  • Cognitive Skills. Ask if there’s been any change in your loved one’s ability to reason or have a conversation. In some cases, it might be linked to something fixable, like medication side effects or a urinary tract infection.

If You Find an Issue. Inform the staff about your concerns, especially if you suspect a new problem. Arrange a visit with a physician and try to be on the call if possible.

Social interaction is also important, so encourage loved ones to take part in activities at their facility. In the same fashion, try to connect with your loved one in any way possible. Make frequent visits if they’re allowed, drop off a care package, a card, flowers, or a picture from a grandchild. This is the best way to stave off feelings of isolation and loneliness that so many people in facilities experience.

Reference: Harvard Health Letter (March 2021) “Caregiving during the pandemic”

How Can I Prep for a Telehealth Appointment with My Doctor?

Caring Bridge’s August 2020 article entitled “5 Tips to Prepare for a Telehealth Appointment” shares five steps to prepare for a virtual doctor’s appointment that will allow you to get the most out of your telehealth experience.

  1. Check your Technology. You need a computer, smartphone, or tablet with a camera. Without a camera, it’s just a phone call, which may not be as effective, since your doctor can’t observe any physical symptoms or your physical expressions during the chat. Get the software and test it out beforehand.
  2. Get Your Medical Info Handy. You may be asked to fill out and return symptom and history forms by the day before your appointment. You should also be sure to write down notes for yourself for the predictable questions you’ll be asked during the visit itself like: When did this start? What makes the pain or issue better or worse? Don’t waste time trying to think through the answers to these questions on the spot.
  3. Be Ready to Do Your Own Physical Exam. Be ready to participate in your own physical exam. You may want to get a good scale, thermometer and blood pressure monitor to conduct your own exam. If you are able, on the day of your call, measure and document your blood pressure, heart rate, temperature, respiratory rate, and weight. You should also wear clothing that will make it easy to do the necessary show and tell during the call.
  4. Make a List of Your Questions. Create this list for the doctor in advance of your visit and be sure to prioritize them to make sure your main issues are addressed first. If all your questions aren’t covered, ask for a follow up telehealth visit.
  5. Sit in a Comfortable Spot. A typical telehealth visit takes about 20 minutes. Use the bathroom beforehand and have a glass of water handy, so you don’t have to get up. Create a comfortable, quiet space.

Remember, telehealth visits aren’t a replacement for ALL visits. You should be seen in-person if you believe you or a loved one are experiencing a heart attack, stroke, a head injury, trauma, or bleeding.

Telehealth is a terrific way to deliver medical care, provided we know its limitations.

Make the most of your visit by following these tips.

Reference: Caring Bridge (Aug. 18, 2020) “5 Tips to Prepare for a Telehealth Appointment”

How to Avoid Medicaid Estate Recovery

Medicaid is a government program that helps seniors and others pay for long term care. However, it’s not always free, explains the article “What Is Medicaid Estate Recovery?” from AOL.com. The Medicaid Estate Recovery Program (MERP) is used by states to recover costs from estates with funds. The goal of Medicaid estate recovery is to make the program affordable for the government, but it can have a severe impact on the beneficiaries of Medicaid recipients. An estate planning elder law attorney should be contacted, if you believe you or a loved one may need Medicaid.

Seniors are eligible for Medicare when they turn 65. This program pays for many healthcare expenses, but not for long-term care in a nursing home. Medicaid is used when someone does not have long term care insurance or enough money to pay for long-term care out of pocket. Medicaid can also be used for long-term or nursing home care, if steps have been taken to protect assets. This usually includes strategies, like trusts and Medicaid Asset Protection Trusts (MAPT).

A federal law passed in 1993 (the Omnibus Budget Reconciliation Act) requires states to attempt to seek reimbursement from a Medicaid beneficiary’s estate after they have died. Some of the costs that the state will try to recover include:

  • Nursing home costs
  • Home and community-based services
  • Medical services received through a hospital where the recipient is a long-term care patient
  • Prescription drug services for long-term care recipient

The recovery program lets Medicaid pursue any eligible assets owned by the estate. While this depends upon where you live, any assets that are part of the probate estate could be attached, including:

  • Bank accounts
  • Your home or other real estate
  • Vehicles or other real property

In addition, some states allow Medicaid to recover assets that are not subject to probate, including jointly held accounts, Payable-On-Death (POD) bank accounts, real estate owned in joint tenancy with right of survivorship, living trusts and any other assets that the Medicaid recipient had a legal interest in.

An estate planning elder care attorney in your state will know what types of assets your state tends to pursue and will help you understand what can and cannot be used for Medicaid benefit recovery.

Note that while Medicaid cannot take the primary residence while the recipient is still living, they can place a lien on the home. If the recipient passes away and a beneficiary inherits the home, they will not be able to sell the property until the lien has been satisfied.

For beneficiaries, Medicaid recovery means a smaller inheritance. However, that’s not the only thing to be mindful of. There are laws known as “filial responsibility laws” that allow healthcare providers to sue the children of long-term care recipients to recover nursing care costs. This is not commonly done as of this writing, but the costs of COVID may change this in the near future.

Strategic planning can help you or loved ones avoid the financial impact of Medicaid estate recovery. If you are eligible and can afford to buy a long-term care policy, that may help to cover most of the cost of care. Another option is to remove as many assets from the probate process as possible. An estate planning attorney will be able to help you create a plan to protect your assets.

Reference: AOL.com (February 5, 2021) “What Is Medicaid Estate Recovery?”

 

living longer

What are the Scariest Statistics for Retirement?

Think Advisor’s recent article entitled “11 Scariest Retirement Statistics: 2020” says that there is a lack of preparation, savings difficulty and general uncertainty that American retirees are facing. Here are those scary stats:

  1. Just a quarter of Americans are on a trajectory to maintain their lifestyles in retirement. The other 75% will need to work longer, move to lower-cost housing and cut spending to maintain their standard of living, largely due to the coronavirus downturn.
  2. The Social Security trust funds would be empty by 2023, without the payroll tax. While President Trump let employers temporarily defer the employee portion of payroll taxes, he said the deferred taxes could later be forgiven, or the cut made permanent. When he signed the order, he vowed to “terminate the tax,” if reelected. Republican lawmakers subsequently debuted a plan to fund any shortfalls from the Treasury.
  3. Social Security benefits will be decreased by 21% if the trust fund runs out. Congress will have to intercede, or it could happen 10 years from now, if not sooner.
  4. Those born in 1960 will have a big problem because of the complicated formula the Social Security Administration uses to calculate benefits. Pre-retirees born in 1960 will see a nearly 15% cut to their lifetime benefits from Social Security when it’s time to collect. If the pandemic suppresses the economy into 2022, those cuts will impact more pre-retirees. The impact to their Social Security benefits will also be permanent.
  5. The 2021 Social Security cost of living adjustment, or COLA, will be just 1.3%. Retirees should note that rising health care costs and a potential 6% increase in Medicare Part B premiums may absorb that benefit increase.
  6. More than 50% of Americans think the economy is worse now than in 2008, with 51% of Americans seeing the COVID slowdown as worse than the 2008 recession. A survey from Edelman Financial Engines also found that 26% had withdrawn money from retirement or savings for living expenses.
  7. About 60% of retirement savers have fallen behind, according to a TIAA study. Among these, 30% said it was directly due to the pandemic.
  8. Internet searches for “move out of the U.S.” have increased 16 times. International Living magazine says it had seen the jump in search traffic around the phrase since May. A total of 20% of respondents in a survey it conducted also said they wanted to move due to the pandemic. However, just 45% cited a desire to save money.
  9. Approximately 42% of investors sold stock, and most of them (88%) of them regretted it. In response to the drop in stocks in mid-March last year, 42% of investors in a survey by MagnifyMoney sold at least one stock and 24% sold all their holdings. About 69% of those who sold stock at the start of the pandemic greatly regretted it, and 19% said they were somewhat regretful.
  10. Roughly 80% of older Americans don’t understand retirement planning and don’t know the basics of how to successfully plan for a financially secure retirement, according to a study by The American College of Financial Services. The survey also found only 30% of respondents had a plan in place to fund long-term care needs, and just one in four actually had long-term care insurance.
  11. About 3 million workers may have been driven into early retirement due to the pandemic. From March to August of 2020, 2.8 million older workers might have been pushed out of their jobs prematurely, with economic turmoil and poor health making it hard for them to resume their careers elsewhere, according to by the Schwartz Center for Economic Policy Analysis at the New School. The report found that 38% of unemployed older adults stopped looking for work and left the workforce, and an additional 1.1 million were expected to do likewise.

Reference: Think Advisor (Oct. 30, 2020) “11 Scariest Retirement Statistics: 2020”

Underlying Conditions Most Dangerous for COVID-19?

AARP’s recent article “Three Most Dangerous Underlying Conditions for COVID-19” reports that it is well-established that risk increases with age. The CDC lists nearly two dozen health conditions that could put you at higher risk of becoming seriously ill or dying of COVID-19. AARP did some research with doctors, who said three conditions worried them the most: diabetes, high blood pressure/underlying heart disease and obesity.

This corresponds with the results of one of the largest studies so far on COVID-19 mortality, published in the journal Clinical Infectious Diseases in December 2020. It looked at data from nearly 67,000 hospitalized coronavirus patients and found that these health conditions are associated with a higher risk of death:

  • Obesity,
  • Diabetes (with complications such as organ damage), and
  • High blood pressure (with complications, such as heart damage or kidney disease).

Each is an inflammatory disease that is prevalent among American adults, and experts say they are closely linked.

Obesity is a risk factor for diabetes and high blood pressure, and diabetes can contribute to high blood pressure. Moreover, diabetes and high blood pressure both can trigger kidney disease and lung disease—two other conditions that make COVID-19 riskier, says the CDC.

Some of the other dangerous conditions mentioned by the physicians include dementia, chronic kidney disease and chronic obstructive pulmonary disease (COPD). Immunocompromised patients, those who smoke and those with organ transplants also are a concern.

Lets’ look at those three health conditions that are associated with a higher risk of death:

High-risk condition: Obesity. Obese people diagnosed with COVID-19 are more than twice as likely to be hospitalized and about 50% more apt to die compared to patients who are a healthy weight. If you test positive for the coronavirus, ask your doctor if you are a good candidate for monoclonal antibodies. It is a life-saving treatment that can reduce hospitalizations among high-risk patients by as much as 70%.

Obesity is frequently associated with other health problems, but doctors note how hard COVID-19 impacts even those obese patients who have no other underlying conditions.

Obesity can make it difficult for a person’s lungs to expand, impairing breathing and oxygenation. Obesity is also believed to increase your risk of blood clots.

High-risk condition: High blood pressure. Researchers reviewed 22 studies from eight countries in 2020 and found that high blood pressure was present in 42% of hospitalized COVID-19 patients. That makes it the most prevalent health condition by a big margin. Even more surprising is the fact that those patients had twice the risk of death compared with patients without high blood pressure, said Vikramaditya Samala Venkata, M.D., one of the study’s authors and a hospital medicine physician at Cheshire Medical Center in Keene, N.H.

However, the Clinical Infectious Diseases study on COVID-19 mortality found that hypertension on its own raised the death rate only for those under age 40. For those age 40+, mortality risk increased only if their high blood pressure had caused a complication, such as heart damage or chronic kidney disease.

Experts think that the coronavirus damages the cells that line blood vessels, causing clots and making it more difficult for them to carry oxygen. Therefore, it is important to keep your blood pressure under control. Studies show that patients with unregulated high blood pressure are at greater risk from COVID-19 compared with patients who take medication to control it.

High-risk condition: Diabetes. Research of the medical records of 61 million people in England published in The Lancet Diabetes & Endocrinology found that the risk of dying from COVID-19 was almost three times higher for people with Type 1 diabetes and almost twice as high for people with Type 2 diabetes, compared with those with neither. High blood sugar weakens the immune systems, which makes it harder for the body to fight off infections. Diabetes puts you at risk for both cardiovascular complications and infectious complications. Both of those are common with COVID.

So, watch your blood sugar levels because patients with well-controlled diabetes have a COVID-19 death rate of about 1%, according to a study published in Cell Metabolism. What about those with poorly controlled disease? Their rate is closer to 11%.

Reference: AARP (Feb. 3, 2021) “Three Most Dangerous Underlying Conditions for COVID-19”

Should I Worry about Medicaid Estate Recovery?

What is It? The Medicaid Estate Recovery Program (MERP) may be used to recoup costs paid toward long-term care. It’s designed to help make the program affordable for the government, but it can financially affect the beneficiaries of Medicaid recipients.

AOL’s article entitled “What Is Medicaid Estate Recovery?” explains that’s where Medicaid can help fill the void. Medicaid can assist with paying the costs of long-term care for aging seniors. It can be used when someone doesn’t have long-term care insurance coverage, or they don’t have the assets to pay for long-term care out of pocket. It can also be used to pay for nursing home care, if you’ve taken steps to protect assets using a trust or other estate planning tools.

However, the benefits you (or an aging parent) receive from Medicaid are not necessarily free. The Medicaid Recovery Program lets Medicaid recoup or get back the money spent on behalf of an aging senior to cover long-term care costs. Federal law requires states to attempt to seek reimbursement from a Medicaid beneficiary’s estate when they die.

How It Works. The Medicaid Estate Recovery Program lets Medicaid seek recompense for a variety of costs, including:

  • Nursing home-related expenses or other long-term care facility stays
  • Home- and community-based services
  • Medical services from a hospital (when the recipient is a long-term care patient); and
  • Prescription drug services for long-term care recipients.

If you (or an aging parent) die after receiving long-term care or other benefits through Medicaid, the recovery program allows Medicaid to pursue any eligible assets held by your estate. Exactly what that includes depends on your state, but generally any assets that would be subject to the probate process after you pass away are fair game.

That may include bank accounts you own, your home or other real estate and vehicles or other real property. Each state makes its own rules. Medicaid can’t take someone’s home or assets before they pass away, but it’s possible for a lien to be placed upon the property.

What Medicaid Estate Recovery Means for Heirs. The biggest thing about the Medicaid estate recovery for heirs of Medicaid recipients is that they might inherit a reduced estate. Medicaid estate recovery rules also exclude you personally from paying for your parents’ long-term care costs. However, filial responsibility laws don’t. It is rare, but the laws of some states let healthcare providers sue the children of long-term care recipients to recover nursing care costs.

How to Avoid Medicaid Estate Recovery. Strategic planning with the help of an elder law attorney can help you or your family avoid financial impacts from Medicaid estate recovery. You should think about buying long-term care insurance for yourself. A long-term care insurance policy can pay for the costs of nursing home care, so you can avoid the need for Medicaid altogether.

Another way to avoid Medicaid estate recovery is to remove assets from the probate process. For example, married couples can do this by making certain that assets are jointly owned with right of survivorship or using assets to purchase an annuity to transfer benefits to the surviving spouse when the other spouse passes away. You should know which assets are and are not subject to probate in your state and whether your state allows for an expanded definition of recoverable assets for Medicaid. Speak with an experienced elder law lawyer for assistance.

Medicaid estate recovery may not be something you have to concern yourself with, if your aging parents leave little or no assets in their estate. However, you should still be aware of it, if you expect to inherit assets from your parents when they die.

Reference: AOL (Feb. 5, 2021) “What Is Medicaid Estate Recovery?”

Underlying Conditions Most Dangerous for COVID-19?

AARP’s recent article “Three Most Dangerous Underlying Conditions for COVID-19” reports that it is well-established that risk increases with age. The CDC lists nearly two dozen health conditions that could put you at higher risk of becoming seriously ill or dying of COVID-19. AARP did some research with doctors, who said three conditions worried them the most: diabetes, high blood pressure/underlying heart disease and obesity.

This corresponds with the results of one of the largest studies so far on COVID-19 mortality, published in the journal Clinical Infectious Diseases in December 2020. It looked at data from nearly 67,000 hospitalized coronavirus patients and found that these health conditions are associated with a higher risk of death:

  • Obesity,
  • Diabetes (with complications such as organ damage), and
  • High blood pressure (with complications, such as heart damage or kidney disease).

Each is an inflammatory disease that is prevalent among American adults, and experts say they are closely linked.

Obesity is a risk factor for diabetes and high blood pressure, and diabetes can contribute to high blood pressure. Moreover, diabetes and high blood pressure both can trigger kidney disease and lung disease—two other conditions that make COVID-19 riskier, says the CDC.

Some of the other dangerous conditions mentioned by the physicians include dementia, chronic kidney disease and chronic obstructive pulmonary disease (COPD). Immunocompromised patients, those who smoke and those with organ transplants also are a concern.

Lets’ look at those three health conditions that are associated with a higher risk of death:

High-risk condition: Obesity. Obese people diagnosed with COVID-19 are more than twice as likely to be hospitalized and about 50% more apt to die compared to patients who are a healthy weight. If you test positive for the coronavirus, ask your doctor if you are a good candidate for monoclonal antibodies. It is a life-saving treatment that can reduce hospitalizations among high-risk patients by as much as 70%.

Obesity is frequently associated with other health problems, but doctors note how hard COVID-19 impacts even those obese patients who have no other underlying conditions.

Obesity can make it difficult for a person’s lungs to expand, impairing breathing and oxygenation. Obesity is also believed to increase your risk of blood clots.

High-risk condition: High blood pressure. Researchers reviewed 22 studies from eight countries in 2020 and found that high blood pressure was present in 42% of hospitalized COVID-19 patients. That makes it the most prevalent health condition by a big margin. Even more surprising is the fact that those patients had twice the risk of death compared with patients without high blood pressure, said Vikramaditya Samala Venkata, M.D., one of the study’s authors and a hospital medicine physician at Cheshire Medical Center in Keene, N.H.

However, the Clinical Infectious Diseases study on COVID-19 mortality found that hypertension on its own raised the death rate only for those under age 40. For those age 40+, mortality risk increased only if their high blood pressure had caused a complication, such as heart damage or chronic kidney disease.

Experts think that the coronavirus damages the cells that line blood vessels, causing clots and making it more difficult for them to carry oxygen. Therefore, it is important to keep your blood pressure under control. Studies show that patients with unregulated high blood pressure are at greater risk from COVID-19 compared with patients who take medication to control it.

High-risk condition: Diabetes. Research of the medical records of 61 million people in England published in The Lancet Diabetes & Endocrinology found that the risk of dying from COVID-19 was almost three times higher for people with Type 1 diabetes and almost twice as high for people with Type 2 diabetes, compared with those with neither. High blood sugar weakens the immune systems, which makes it harder for the body to fight off infections. Diabetes puts you at risk for both cardiovascular complications and infectious complications. Both of those are common with COVID.

So, watch your blood sugar levels because patients with well-controlled diabetes have a COVID-19 death rate of about 1%, according to a study published in Cell Metabolism. What about those with poorly controlled disease? Their rate is closer to 11%.

Reference: AARP (Feb. 3, 2021) “Three Most Dangerous Underlying Conditions for COVID-19”

Some Veteran Caregivers Eligible for COVID-19 Vaccine through VA

The move is the result of a coalition of veterans groups that lobbied for the caregivers to be sent to the top of the vaccine list, arguing that they deserved to be included in the first wave of medical professionals being protected against the deadly illness, says Military Times’ recent article entitled “Tens of thousands of veteran caregivers now eligible for the coronavirus vaccine through VA.”

Dr. Richard Stone, executive in charge of the VA, released a memo stating that those registered with the department’s Program of Comprehensive Assistance for Family Caregivers can be given the vaccine “in a coordinated manner with the veterans for whom they provide care.”

More than 6,700 VA patients have died from COVID complications in the last 10 months. Stone’s memo states that decisions will be made “in balance with site-specific resources, needs, vaccine availability, hesitancy to accept the vaccine and status of the pandemic locally.”

In an interview with Military Times, Stone commented that he is shifting many of those vaccination decisions to local officials to give coverage to more individuals.

“We need to leave it up to people at the bedsides, to make sure they are making the best decisions for veterans,” he said. “When someone brings a veteran in to give them the vaccine, they can easily identify what the other needs are.”

Roughly 20,000 veterans are registered in the caregiver program at the Department of Veterans Affairs. This program provides monthly stipends and other support to individuals providing regular medical assistance to infirm veterans.

The data shows that the majority of this group are family members of post-9/11 veterans. The caregiver assistance program was expanded last fall to veterans who served before May 1975.

And recently, a coalition of veteran groups, including The Independence Fund, Military Order of the Purple Heart and the Non-Commissioned Officers Association sent a letter to Federal Emergency Management Agency officials asking them to authorize the VA to administer the caregiver vaccines, under its role as the lead coordinator of federal response to the pandemic.

Dr. Stone said as of January 13, VA officials had administered the first dose of the two-part vaccine to more than 332,000 department health care employees and veterans at high-risk of contracting coronavirus. Another 45,000 individuals have already received their second dose. The vaccine has been sent to nearly 200 department facilities. However, officials have warned that it could be months before they can administer the more than 7 million vaccines they expect to be requested by veterans and staff.

Reference: Military Times (Jan. 14, 2021) “Tens of thousands of veteran caregivers now eligible for the coronavirus vaccine through VA”