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How Do I Hire an Elder Law Attorney?

Elder law attorneys are lawyers who assist the elderly and their family members, and caregivers with legal questions and planning related to aging.

These attorneys frequently are called upon to assist with tax planning, disability planning, probate and the administration of an estate, nursing home placement, as well as a host of other legal issues, says Forbes’ recent article entitled “Hiring An Elder Law Attorney.”

In addition, there are some elder law attorneys who have the designation of Certified Elder Law Attorney (CELA), a certification issued by the National Elder Law Foundation. A Certified Elder Law Attorney must meet licensing and other requirements, including specific experience in elder law matters and continuing education in elder law. However, note that an elder law attorney does not need to have the CELA certification to be an experienced elder law attorney.

There are many elder law attorneys who specialize in Medicaid planning to help protect a senior’s financial assets, if they suffer from dementia or another debilitating illness that may require long-term care. Elder law attorneys also prepare estate documents, such as a durable power of attorney for health and medical needs and a living will. As you age, the legal issues that you, your spouse, and/or your family caregivers must address can also change.

If you are a senior, then you should have durable powers of attorney for financial and health needs, in the event that you or your spouse becomes incapacitated. You might also need an elder law attorney to help you transfer assets if you or your spouse move into a nursing home to avoid spending your life savings on long-term care.

Healthy people over 65 are in the best spot to do more than having estate planning documents prepared. That’s because they have the opportunity to develop a holistic strategy beyond the legal documents. This can give assurances that the family members and professionals they’ve assembled understand the principle of supported decision-making and how it will be implemented.

For example, an elder law attorney may focus on finding the least restrictive residential environment and making other health care and financial choices. An elder law attorney can also protect seniors with diminished capacity, who are being victimized by personal and financial exploitation.

An initial consultation with an elder law attorney will help determine the types of legal services they can offer, and the fees associated with these services.

Reference: Forbes (Oct. 4, 2021) “Hiring an Elder Law Attorney”

Is a Cup of Joe Help Healthy for Seniors?

Nutrition experts and medical researchers are finding all kinds of reasons to recommend indulging in a cup of joe— most based on the fact that coffee is the single greatest contributor to total antioxidant intake, says AARP’s article entitled “Five Surprising Health Benefits of Coffee.”

“Coffee is abundant in bioactive compounds that promote health,” says Kristin Kirkpatrick, a registered dietitian at Cleveland Clinic. As she explains, research published in The New England Journal of Medicine shows that these compounds may improve the gut microbiome (made up of healthy bacteria that aid in digestion and boost immunity) and reduce what’s called oxidative stress, which occurs when free radicals outnumber antioxidants in a way that leads to disease-causing cellular damage in the body. “The beans also have a deep rich hue, and we know that the deeper the color of a plant, the more benefits we can expect for health.”

However, moderation is the key. Three to five eight-ounce cups of coffee — or up to 400 mg of caffeine — per day can be part of a healthy diet. That is plain black coffee, not cappuccinos, lattes and macchiatos. Those are high in calories, sugar and fat. Let’s look at five health benefits of coffee that give you even more reason to enjoy your next cup.

  1. Lowers Your Risk of Type 2 Diabetes. A large review of studies published in Nutrition Reviews found that your risk of developing type 2 diabetes drops by 6% for each cup you drink per day. That’s because coffee is packed with phytochemicals that may act as antioxidants, anti-inflammatory compounds, insulin-sensitivity boosters and more. The same goes for decaffeinated brews. A study published in the Journal of Internal Medicine found that those who drank two to three cups of filtered coffee a day — as opposed to unfiltered coffee (made with a pod, an espresso machine, or a French press) had a 60% lower risk of developing type 2 diabetes than people who drank less than one cup of filtered coffee a day. Those drinking unfiltered coffee didn’t see such a reduction in risk.
  2. Heart Protection. A review of three major studies published recently in Circulation: Heart Failure found that drinking one or more cups of plain caffeinated coffee a day may reduce your risk for heart failure. (Decaf didn’t yield the same benefits.) Among those without diagnosed heart disease, researchers found that drinking up to three cups of coffee a day was associated with a lower risk of stroke, death from cardiovascular disease and death from any cause.

If possible, though, drink filtered coffee because unfiltered coffee contains two compounds that raise LDL cholesterol in some people, and high levels of LDL cholesterol increase your risk for heart disease and stroke.

  1. Boosts brain health. Some research suggests that regular caffeine consumption may offer brain health benefits. In one study of people ages 65 to 84, published in the Journal of Alzheimer’s Disease, those who drank a cup or two of coffee daily had a lower rate of mild cognitive impairment than those who never or rarely consumed coffee. Other studies suggest coffee may also protect against Parkinson’s disease. However, some research shows that having over five or six cups a day may have an adverse health impact on the brain.
  2. Improves your mood. Drinking coffee may reduce your risk of depression by nearly one-third, according to research from Harvard Medical School. The effect may be related to coffee’s anti-inflammatory properties. Coffee also has phytochemicals that feed the good bacteria in our guts. The good bacteria may produce or enhance other compounds that act on the brain and have beneficial effects on mood.
  3. Maximizes workouts. Downing a cup before exercise can make a difference in your workout because coffee improves circulation, endurance and muscular strength. It also may reduce pain, according to a review of research published in 2019 in Sports Medicine. However, it is important to recognize that coffee can also act as a diuretic.

Reference: AARP (Sep. 20, 2021) “Five Surprising Health Benefits of Coffee”

Can Exercise Prevent Dementia?

Market Watch’s recent article entitled “How exercise can help prevent dementia” points out that although there’s no cure for Alzheimer’s disease, and an estimated 3% of all cases are entirely genetic, recent research suggests that some lifestyle interventions could slow its progression.

Dr. Dean Sherzai, a clinical neurologist and co-director of the Brain Health and Alzheimer’s Prevention Program at Loma Linda University in California, has developed a five-component lifestyle intervention therapy he uses with patients.

“We have people coming to us with early signs, or so-called subjective impairment, and then we have people a little more advanced, classified as having mild cognitive impairment, or MCI,” Dr. Sherzai explained. “We give them interventions, give them advice on changes they can make to their lifestyle components and we look at what happens.”

Of the five components in Dr. Sherzai’s lifestyle intervention, exercise is the one he typically recommends starting first.

“Whenever we apply behavior change to a population, we’re looking to create sustainable habits with small successes people can see right away, and nothing is better than exercise. It’s easy to implement, measurable and precise, with a fast return,” Dr. Sherzai said.

After only a couple of weeks of regular exercise, Dr. Sherzai’s patients often feel better, get better sleep and their lipid and blood glucose profiles improve. He says that these are some of the indirect ways exercise reduces risk for Alzheimer’s, because each of those factors are associated with higher rates of the disease. The doctor also mentioned three direct links between exercise and improved brain health:

  1. Exercise increases blood flow to the brain, which delivers more oxygen and nutrients;
  2. Exercise simultaneously flushes inflammatory and oxidative elements out the brain faster; and
  3. An increase in a chemical called brain-derived neurotrophic factor (BDNF) which Sherzai says, “is almost like growth hormones for neurons, but specifically for the connections between neurons.” Maintaining these neuronal connections is a key in preventing Alzheimer’s disease.

Brain scientists agree that exercise is good for preventing cognitive decline but they don’t yet know if any one type is better than another. It is something that scientists are starting to research. For now, a number of studies have shown that both aerobic and resistance training have major cognitive benefits.

Sherzai recommends exercises involving the legs, whether that’s walking, running, cycling or weightlifting he says that’s because, “your legs — not the heart — are the largest pump in the body.”

Reference: Market Watch (Sep. 28, 2021) “How exercise can help prevent dementia”

Will Vets Get a Cost-of-Living Boost?

The Veterans’ Compensation Cost-of-Living Adjustment Act passed unanimously in the House and without objection in the Senate earlier in the summer. By the time you read this, President Joe Biden is expected to sign it into law.

Military Times’ recent article entitled “Veterans benefits could see a big cost-of-living boost later this year” explains that the legislation links the cost-of-living boost for veterans benefits to the planned increase in Social Security benefits. Although the Social Security increase is automatic every year, lawmakers must approve the veterans benefits increase annually.

The amount of the increase for next year is still not certain. The Social Security Administration is expected to announce the COLA rate for 2022 in October, based on economic trends over the last few months. That increase will go into effect for benefits checks sent out starting this December.

The cost-of-living bump hasn’t been above 3.0% since 2011, and has averaged less than 1.3% over the last six years.

However, officials from the Senior Citizens League predicted that next year’s rise could top 6.2%, based on recent inflation and wage data released by federal economists. If so, it would be the largest increase since 1983 for Social Security and VA benefits recipients.

Lawmakers praised the bill passage as needed support for American veterans.

“The cost-of-living adjustment to veterans’ benefits is so much more than a rate adjustment tied to inflation,” said Rep. Mark Takano, D-Calif., in a statement. “It is a quality-of-life guarantee in the retirement years for veterans suffering with service-connected disabilities and ailments.”

VA officials will announce the plan soon, which includes a review of service records to see if individuals’ eligibility for benefits should be approved.

Committee ranking member Mike Bost, R-Ill., said the increase is critical for veterans and families who rely on disability benefits as a primary source of income.

“Many veterans rely on disability compensation payments to make ends meet; this was especially true during the pandemic,” he said in a statement. “For millions of veterans and their families, this adjustment is more important now than ever before.”

The VA COLA increase applies to payouts for disability compensation, clothing allowance, dependency and indemnity benefits and other VA assistance programs.

Reference: Military Times (Sep. 21, 2021) “Veterans benefits could see a big cost-of-living boost later this year”

Does My Brain Improve as I Age?

Money Talks News’ recent article entitled “2 Ways Your Aging Brain Actually Improves Over Time” explains that our ability to gather new information and to concentrate on the most important things in any given situation may get better with age, according to new research out of Georgetown University Medical Center. The findings were published in the journal Nature Human Behavior.

As part of the study, researchers examined three distinct components of attention and executive function in group of about 700 participants:

  • Alerting — a state of enhanced vigilance and preparedness in order to respond to incoming information;
  • Orienting — the shifting of brain resources to a particular location in space; and
  • Executive inhibition — in which we inhibit distracting or conflicting information, allowing us to focus on what is important.

Study co-author João Veríssimo, an assistant professor at the University of Lisbon, Portugal, explained:

“We use all three processes constantly. For example, when you are driving a car, alerting is your increased preparedness when you approach an intersection. Orienting occurs when you shift your attention to an unexpected movement, such as a pedestrian. And executive function allows you to inhibit distractions, such as birds or billboards, so you can stay focused on driving.”

They looked at individuals from 58 and 98, the ages when cognition tends to change the most during the aging process. The researchers found that while alerting abilities declined with age, the other two abilities improved. Those two abilities help us with several key parts of cognition, such as:

  • Memory
  • Decision-making
  • Self-control
  • Navigation
  • Math
  • Language
  • Reading

The researchers say orienting and inhibition appear to be skills that can get better over a lifetime the more they’re practiced. However, it appears that alerting — a basic state of vigilance and preparedness — can’t improve with practice.

Study co-author Michael T. Ullman, a professor in the Georgetown University Department of Neuroscience and director of Georgetown’s Brain and Language Lab, commented, “People have widely assumed that attention and executive functions decline with age, despite intriguing hints from some smaller-scale studies that raised questions about these assumptions. However, the results from our large study indicate that critical elements of these abilities actually improve during aging, likely because we simply practice these skills throughout our life.”

Reference: Money Talks News (Sep. 6, 2021) “2 Ways Your Aging Brain Actually Improves Over Time”

What Upgrades Can I Make to ‘Age in Place’?

With our aging population, we need more solutions to help seniors live well. That’s where universal design comes in: it’s a concept that tries to make products and structures usable by everyone, regardless of age, ability, or other factors.

Money Talks News’s  article entitled “8 Essential Home Features for Aging in Place” says that aging in place requires homes that accommodate our needs as we age. The article sets out a list of eight design features buyers focused on accessibility are looking for based on survey data from the National Association of Home Builders’ 2021 “What Home Buyers Really Want” report.

  1. Lower countertops. The kitchen is the center of most homes, and it’s an important part of universal design. Countertops that are three inches lower than the standard height of 36 inches lets seniors and those with limited mobility to fully participate in meal prep. You can round all countertop edges and corners because fewer 90-degree angles may reduce bumping and bruising and minimize injury in the event of a fall.
  2. Lower kitchen cabinets. According to Aging in Place, upper kitchen cabinets that are three inches lower than standard height lessens the tendency to overreach and potentially lose balance. Lower cabinets that feature pull-out shelves, “lazy Susan” corner cabinets and easy-pull handles offer additional convenience for seniors and those who rely on a wheelchair or mobility scooter.
  3. Bathroom aids. For seniors, using the bathroom safely can a challenge. Aging-in-place design recommends these features to make bathrooms more practical and convenient:
  • A walk-in tub or a shower with non-slip seating
  • An adjustable or hand-held showerhead
  • A comfort-height toilet
  • Ground-fault interrupter (GFI) outlets that reduce the risk of shock; and
  • Grab bars near the toilet and shower.
  1. A Stepless entrance. To age in place safely, AgingCare recommends that a home’s main entrance not have steps and should have a threshold height of no more than a half an inch. Here are a couple of ways that an entryway without steps can make life better for seniors:
  • It facilitates smooth entrance/exit by wheelchair, scooters, or walker
  • It decreases the risk of falls, particularly in snowy or icy conditions; and
  • It makes it easier to get deliveries and enter the home carrying groceries.
  1. Non slip floors. According to the CDC, more than 35 million older adults fell at least once in 2018, and 32,000 died from fall-related injuries. To help, non-slip surfaces like low-pile carpet, cork and slip-resistant vinyl can minimize the risk.
  2. Wide hallways. Wide hallways (defined as at least four feet wide) let seniors access every space in their home with a walker, wheelchair, or scooter, or with the assistance of a home health aide.
  3. Wide doorways. A standard doorway can be as narrow as 24 inches, which is a tight fit for seniors who rely on wheelchairs, scooters, or walkers. Seniors like wide doorways, defined as at least three feet wide. According to the ADA, doorways should have at least 32 inches of clear width. To help with an easy transition from room to room, thresholds should be as flush to the floor as possible.
  4. Full bath on main level. Not just convenient, it’s a critical safety feature for seniors. Besides eliminating the need to go up and down stairs several times a day, main floor bathrooms also allow the elderly to (i) respond to incontinence issues more quickly; (ii) practice regular self-care; and (iii) access a private space when required.

Reference: Money Talks News (Aug. 5, 2021) “8 Essential Home Features for Aging in Place”

What Is Science Doing About Hearing Loss?

Thanks to advances in technology and medicine like artificial intelligence and gene therapy, hearing research is producing significant innovations. AARP’s recent article entitled “Three Game-Changing Innovations for Those With Hearing Loss” looks at a couple of them, in various stages of development.

  1. Eyeglasses That Turn Speech into Subtitles. With these, you’ll be able to read what people are saying. An app on your smartphone would listen to a conversation and transcribe the speech into sentences in real time. The text would be sent instantaneously to your enhanced eyeglasses, which would create subtitles. Vuzix, a tech company, recently released smart glasses that work with transcription software. Automatic speech-to-text programs have proliferated in recent years, and live computer-generated captions are now available on most videoconferencing platforms. Smartphone apps can also generate real-time transcriptions for in-person conversations. However, the issue is that users have to be in front of a PC or looking at a phone, which detracts from full social engagement. However, companies are making subtitles more natural, by using “smart glasses” technology, which can project text to a user’s field of vision in a comfortable, nonintrusive way. We may see this in a few years.
  2. An App That Lets You Hear Someone in a Crowded Room. This technology can isolate a person’s speech in a noisy environment, which would solve what scientists call the “cocktail party problem.” An app would “listen” to the soundscape surrounding you and separate out different streams of sound, including voices, ambient music and other background noise. It would then isolate the sound you want to hear based on the direction you’re facing — and reduce everything else. The cleaned-up sound would then be delivered straight to your ear through your hearing aid, cochlear implant, or earbuds. Powerful de-noising programs look to be available on hearing technology within five years.
  3. Drug Therapy That Regrows Cells That Help Your Hearing. Your body would repair damage to your inner ear — like when a salamander regrows his tail. A drug delivered into your inner ear would turn on chemical switches to regrow the cells responsible for hearing and most hearing loss. Those born with hearing loss or those who lose hearing later in life would get injections to restore some or all of their hearing. This hair cell regeneration would be ideal for anyone who’s lost hearing because of missing or damaged hair cells. However, this isn’t anticipated to be available very soon. Some hair cell regrowth therapies using different methods are currently in human clinical trials. There are trials being conducted at Novartis, Eli Lilly, Frequency Therapeutics, and Pipeline Therapeutics. However, most of this work is still being tested in the lab.

Reference: AARP (August 2, 2021) “Three Game-Changing Innovations for Those With Hearing Loss”

This Breathing Trick may Make You More Heart-Healthy

An easy technique, called high-resistance inspiratory muscle strength training (IMST) is when a person inhales deeply through a hand-held device that provides resistance. Doctors say that to get an idea of how it works, think of “sucking hard through a tube that sucks back.”

Money Talks News’ recent article entitled “This 5-Minute Trick Could Help Your Heart More Than Exercise” reports that, as part of the study, 36 adults ages 50 to 79 with above-normal systolic blood pressure readings (120 or higher) were divided into two groups. Half of them performed high-resistance IMST for six weeks; and the other half did a placebo protocol, which involved much less resistance. (Systolic blood pressure refers to the first or top number in a blood pressure reading. For example, if your reading is 120/80, your systolic blood pressure is 120.)

After six weeks, the systolic blood pressure of the IMST group went down an average of nine points. That reduction is better than what’s normally achieved by walking 30 minutes a day, five days a week. It is also equal to the effects of some drugs that work to lower blood pressure. Moreover, those in the IMST group saw a 45% improvement in vascular endothelial function. That’s the ability of arteries to expand upon stimulation. Levels of nitric oxide — a molecule that dilates arteries and prevents plaque buildup — also increased. Lastly, markers of inflammation and oxidative stress fell drastically. Higher levels of these markers are linked to increased heart attack risk. These findings were published recently in the Journal of the American Heart Association.

IMST has been used for years to help patients with respiratory disease to strengthen their diaphragm and other breathing muscles. Researchers now say that more widespread use of IMST might help aging adults lower their risk of cardiovascular disease, the No. 1 cause of death in America.

In a press release, Daniel Craighead, lead author of the study and an assistant research professor in UC Boulder’s Department of Integrative Physiology, noted, “There are a lot of lifestyle strategies we know can help people maintain cardiovascular health as they age. But the reality is, they take a lot of time and effort and can be expensive and hard for some people to access. IMST can be done in five minutes in your own home while you watch TV.”

The researchers say that 65% of U.S. adults over age 50 have above-normal blood pressure—this raises their risk of heart attack or stroke.

It’s usually suggested that those performing IMST engage in a 30-minute-per-day regimen at low resistance. However, Craighead and others have found that a reduced regimen of 30 inhalations per day at high resistance, six days per week also offers cardiovascular, cognitive, and sports performance benefits. The researchers noted that the IMST regimen may be of particular benefit to postmenopausal women. Earlier research has found that postmenopausal women who aren’t taking supplemental estrogen don’t see as much benefit to vascular endothelial function from exercise as men do.

But IMST looks to boost vascular endothelial function in women just as much as men. Craighead says, “If aerobic exercise won’t improve this key measure of cardiovascular health for postmenopausal women, they need another lifestyle intervention that will. This could be it.”

The breathing-muscle training device used in the study is called a POWERbreathe K3, manufactured by a company in England. It costs a few hundred dollars. However, the researchers say they’re developing a smartphone app that will enable people to do the same IMST regimen at home with other devices.

Reference: Money Talks News (July 15, 2021) “This 5-Minute Trick Could Help Your Heart More Than Exercise”

Does Air Pollution Cause Alzheimer’s Disease?

The air quality study was released by the Alzheimer’s Association.

Researchers monitored two groups of at-risk adults, one in Europe and the other in the U.S., over a 10-year period.

WTOP’s article entitled “Study: New evidence shows link between air pollution, Alzheimer’s disease” reports that Dr. Heather Snyder, the vice president of Medical and Scientific Relations at the association, commented that those in Europe who were in less-polluted areas saw a drop in risk by 15% for dementia and 17% for Alzheimer’s disease.

More than six million Americans are living with Alzheimer’s. By the year 2050, this number is expected to increase to nearly 13 million.

The Alzheimer’s Association reports that one in three seniors dies with Alzheimer’s or another dementia. It kills more people than breast cancer and prostate cancer combined.

Women in the U.S. who participated in the study saw a 26% decrease in risk of developing dementia.

This included a reduction in certain categories of pollution, including traffic-related pollution.

Long-term exposure to air pollution was linked to a possible biological connection to physical brain changes that result in Alzheimer’s disease.

“When you actually modify or change air pollution, decrease it, there actually also seems to be a benefit on cognition in a population that are aging,” Snyder said. “I think these data demonstrate the importance of policies and action by federal, state and local governments to address reducing air pollution.”

Snyder remarked that it’s important for those with loved ones battling the disease to take advantage of community resources to see better outcomes overall.

According to the Alzheimer’s Association, more than 11 million people in the United States provide unpaid care for people with Alzheimer’s or other dementias.

in 2020, these caregivers provided an estimated 15.3 billion hours of care, valued at approximately $257 billion.

Reference: WTOP (July 26, 2021) “Study: New evidence shows link between air pollution, Alzheimer’s disease”

Can a Retired Police Officer Qualify for Medicaid?

An 84-year-old retired police officer recently took a fall in his home and injured his spinal cord. He retired from the police force more than 20 years ago and received a lump sum.

Currently, he gets more than $2,000 per month from his pension and Social Security.

How does this retired police officer spend down to qualify for Medicaid, since he is now a paraplegic?

State programs provide health care services in the community and in long-term care facilities. The most common, Medicaid, provides health coverage to millions of Americans, including eligible elderly adults and people with disabilities.

Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.

Nj.com’s recent article entitled “How can this retired police officer qualify for Medicaid?” advises that long-term services and supports are available to those who are determined to be clinically and financially eligible.

A person is clinically eligible, if he or she needs assistance with three or more activities of daily living, such as dressing, bathing, eating, personal hygiene and walking.

Financial eligibility means that the Medicaid applicant has fewer than $2,000 in countable assets and a gross monthly income of less than $2,382 per month in 2021.

The applicant’s principal place of residence and a vehicle generally do not count as assets in the calculation.

If an applicant’s gross monthly income exceeds $2,382 per month, he or she can create and fund a Qualified Income Trust with the excess income that is over the limit.

The options for spending down assets to qualify for Medicaid are based to a larger extent on the applicant’s current and future living needs and the amount that has to be spent down.

Consult with an elder law attorney or Medicaid planning lawyer to determine the best way to spend down, in light of an applicant’s specific situation.

Reference: nj.com (July 19, 2021) “How can this retired police officer qualify for Medicaid?”

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