Can I Be Paid for Caring for a Loved One?

AARP’s recent article entitled “Can I Get Paid to Be a Caregiver for a Family Member?” says that roughly 53 million Americans provide care without pay to an ailing or aging loved one. They do so for an average of nearly 24 hours per week. The study was done by the “Caregiving in the U.S. 2020” report by AARP and the National Alliance for Caregiving (NAC).

Medicaid. All 50 states and DC have self-directed Medicaid services for long-term care. These programs let states grant waivers that allow qualified people to manage their own long-term home-care services, as an alternative to the traditional model where services are managed by an agency. In some states, that can include hiring a family member to provide care. The benefits, coverage, eligibility, and rules differ from state to state.

Veterans have four plans for which they may qualify:

Veteran Directed Care. This plan lets qualified former service members manage their own long-term services and supports. It is available in 37 states, DC, and Puerto Rico for veterans of all ages who are enrolled in the Veterans Health Administration health care system and need the level of care a nursing facility provides but want to live at home or the home of a loved one.

Aid and Attendance (A&A) benefits. This program supplements a military pension to help cover the cost of a caregiver, who may be a family member. These benefits are available to veterans who qualify for VA pensions and meet certain criteria. In addition, surviving spouses of qualifying veterans may be eligible for this benefit.

Housebound benefits. Vets who get a military pension and are substantially confined to their immediate premises because of permanent disability can apply for a monthly pension supplement.

Program of Comprehensive Assistance for Family Caregivers. This program gives a monthly stipend to a vet’s family members who serve as caregivers who need assistance with everyday activities because of a traumatic injury sustained in the line of duty on or after Sept. 11, 2001.

Other caregiver benefits through the program include the following:

Access to health insurance and mental health services, including counseling
Comprehensive training
Lodging and travel expenses incurred when accompanying vets going through care; and
Up to 30 days of respite care per year.

Payment by a family member. If the person requiring assistance is mentally sound and has sufficient financial resources, that person can pay a family member for the same services a professional home health care worker would provide.

Reference: AARP (May 15, 2021) “Can I Get Paid to Be a Caregiver for a Family Member?”

Will Mediterranean Diet Stave Off Alzheimer’s?

Researchers at the German Centre for Neurodegenerative Diseases in Bonn found the Mediterranean diet could protect the brain from disease triggers linked to Alzheimer’s, specifically protein deposits and the rapid loss of brain matter.

Barchester’s recent article entitled “Mediterranean diet could lower risk of dementia, study suggests” reports that Alzheimer’s disease is the most common form of dementia, affecting between 50 and 75% of people who are diagnosed with the condition.

Worldwide, approximately 50 million people have dementia. There are roughly 10 million new cases every year.

Alzheimer’s disease is the most common form of dementia and may contribute to 60–70% of cases.

Dementia is one of the primary causes of disability and dependency among older people worldwide.

There are physical, psychological, social, and economic impacts on people with dementia, as well as on their careers, families and society at large.

The recent German study results were published in the journal Neurology. The research involved 512 subjects, with an average age of 70 years. The participants were asked to fill out a questionnaire about the foods they regularly ate. Those who ate a considerable quantities of fish, vegetables and fruit, and only occasionally consumed foods considered less healthy, such as red meat–were given high scores on a scale used by the researchers.

Participants then underwent MRI brain scans and participated in tests examining cognitive functions, such as memory. The study also looked for levels of amyloid beta proteins and tau proteins in the cerebrospinal fluid. These are well-known signs of Alzheimer’s.

The results showed that those with the unhealthiest eating habits had more pathological levels of these biomarkers, when compared with those who regularly ate a Mediterranean diet.

In addition, individuals who regularly ate a significant quantities of fish, fruit and vegetables performed better in memory tests.

The lead author of the study, Tommaso Ballarini, expanding on the findings and explained: “There was also a significant positive correlation between a closer adherence to a Mediterranean-like diet and a higher volume of the hippocampus. The hippocampus is an area of the brain that is considered the control centre of memory. It shrinks early and severely in Alzheimer’s disease.”

The researchers are looking to re-examine the same study participants in four to five years, to have further insights into how nutrition can impact brain aging and health over time.

Reference: Barchester (May 10, 2021) “Mediterranean diet could lower risk of dementia, study suggests”

Should Vets Be on Look-out for COVID Vaccine Scams?

Officials from Operation Protect Veterans — a joint effort from the U.S. Postal Inspection Service and AARP that works on scams targeting veterans and military members — said they have seen a recent uptick in the number of illicit offers for veterans to “cut in the vaccination line,” if they provide cash to third-party groups.

Military Times’ recent article entitled “Warning: Post Office sees rise in COVID vaccination scams targeting veterans” says that the group also warned of scammers offering “cash payments or other incentives around obtaining a COVID vaccination.”

VA officials will reimburse veterans for the cost of vaccines by the department’s Foreign Medical Program. However, they do not help them find vaccine appointments.

Legislation approved last month by Congress allows all veterans, their spouses and caregivers to get coronavirus vaccines through the Department of Veterans Affairs free of cost. The timing and availability of those shots depends on local supplies.

However, VA officials have stressed the fact that people do not need to pay to receive a dose. Any outside group promising quicker delivery in exchange for cash are taking advantage of confused or frustrated veterans.

“In addition to many of the same scams that fraudsters use to target veterans, we’re now seeing more ‘timely’ scams, like those related to COVID,” said Chief Postal Inspector Gary Barksdale in a statement.

“And as May is Military Appreciation Month, it’s a great time for everyone to become informed and spread the word about scams targeting veterans in order to, in some small way, help repay the tremendous debt we all owe those who have served.”

An AARP survey from 2017 found that vets are twice as likely to be victims of scammers as the general public. The survey found that one in six veterans reported losing money to a bogus offer of benefits or assistance.

The U.S. Postal Service cautions vets not to divulge their personal information over the phone to strangers, especially bank account numbers, credit card numbers or Social Security numbers.

Moreover, they also said any veteran with questions about an unsolicited offer or program should check out the deal with a family member, friend, or local Veterans Affairs office.

Anyone who demands veterans act immediately on such a transaction are like scammers.

More information on scams and protections for vets is available at the Postal Inspection Service web site.

Reference: Military Times (April 30, 2021) “Warning: Post Office sees rise in COVID vaccination scams targeting veterans”

How to Protect Loved Ones from Elder Abuse

Predators had an open season on the elderly during the pandemic, as isolation necessitated by COVID severely limited family member’s ability to visit in person. In some instances, caregivers themselves were the predators, and manipulation on important legal documents, including durable power of attorney, trusts, wills and ownership of homes has occurred. All this was reported the article “Warning: Isolation Of Your Aging Parent May Be A Red Flag” from Forbes. The enforced isolation has created worrisome situations for all concerned.

If you haven’t seen your parents or grandparents for a year or more, and are all fully vaccinated, one expert strongly encourages visitation, as soon as is possible. Use the visit to review all of their legal matters and talk about how to increase engagement and end the isolation.

Consider the following a checklist of what needs to be done at that first visit:

Look for any signs that anyone who had access to loved ones may have taken advantage of their isolation during the past year. Don’t assume the best behavior of everyone around them. It’s not how we like to think, but caution needs to be exercised in this situation.

Check on their will and trusts. The pandemic has reminded everyone that life is fragile, and it’s important to go over legal documents or, if they don’t exist, create them. Find out if anyone has pressured family members to change legal documents—if they have been changed in the last year and you weren’t told about it, find out what happened.

If aging parents do not have a will or trusts, or these documents were altered in your absence, speak with an estate planning attorney who can create a new estate plan. Make sure all copies of older wills are destroyed. At the same time, this would be a good time to have their powers of attorney, healthcare proxy and living wills updated.

If your parent or grandparent lives on their own, find out if they are now in need of any caregiving. A year is a long time, and elderly people who started out fine during the epidemic may have had changes in their health or ability to live independently. Go see for yourself how they are managing. Is the house clean? Are the stairs too steep to be managed?

Not everyone will be able to return to “normal” without some help. Senior centers, gyms and recreational facilities have been shut down for a long time. They may need some help getting back into a routine of socializing and exercising.

The end of enforced isolation can also mean the end of an easy cover for anyone who was using isolation as a protection for financial elder abuse or any other type of abuse.

Isolation itself is a form of abuse, including not allowing others to visit in person or speak with a parent alone. You can overcome this by being engaged with family members on a regular basis, by phone, video visits or, if you are able to, more frequent in person visits.

Reference: Forbes (April 23, 2021) “Warning: Isolation Of Your Aging Parent May Be A Red Flag”

Should I Be Paying with Personal Checks?

More than 14.5 billion checks, totaling $25.8 trillion, were written in 2018, according to the Federal Reserve. Although that number has decreased by about 7% every year since 2015, checks are still being written by Americans, including seniors.

Money Talk News’ recent article entitled “Is Writing a Check Still Safe?” says that in an era of identity theft and bank fraud, how safe is writing a check? Remember, when you pay by check, you are handing a piece of paper with your bank account number and other personal details like your name and address, to another person. This is often a complete stranger! Checks can be forged, and identity thieves could steal your personal and banking details from a paper check. Let’s look at what you need to know about writing a check in 2021 — and how to minimize your risk.

Banks apply security measures, like watermarks and gradient backgrounds, to prevent checks from being reproduced by fraudsters. This also lets financial institutions and businesses validate paper checks easily. In 2018, measures such as these prevented 90% of attempted fraud, according to the American Bankers Association. Nonetheless, check fraud—which includes forgery, theft, and counterfeiting—accounted for $1.3 billion that year.

Know that the risk of trouble increases, if you don’t specify a recipient on the check. If you write a check to “cash,” anybody who gets a hold of it could cash it. If you need cash, it’s safer to use your debit card at an ATM or visit your bank and write a check out to yourself.

Seniors are more likely to still write paper checks, and because the elderly are more likely to be the targets of financial fraud than the general population, check-writing can compound their risk. Here are some steps you can take to safeguard your information and reduce your risk of fraud:

Complete the “payee” line in full, along with the current date on every check you write in ink.
Restrict the information pre-printed on your check to just your name and address, and don’t include your birth date, phone number, or driver’s license number. If a merchant requires these details, you can always write them in.
Keep your checks in a safe place, not in your purse or briefcase, which can be lost or stolen; and
Watch your bank account activity regularly. By keeping an eye on your finances, you also reduce your risk of fraud.

Even if you prefer paying electronically, you probably shouldn’t dismiss checks altogether. There are small businesses that still don’t accept debit or credit cards. If they do, they might charge a fee for it.

Checks also offer a paper trail, so they’re usually preferred for a down payment on a home or an IRS tax bill. Therefore, if there’s an issue, you’ll have a copy of the deposited check and a record of when payment was made, received and applied.

Of course, no payment method is 100% fraud-proof. However, with proper handling, checks are an extremely safe method of banking, as they have been for many years.

Reference: Money Talk News (Feb. 17, 2021) “Is Writing a Check Still Safe?”

Link Possible between Diabetes, Dementia and Age

New research says those people who had type 2 diabetes for more than 10 years had more than twice the risk for developing dementia, as compared with those who were diabetes-free at age 70, according to Archana Singh-Manoux, PhD, of the Université de Paris in France.

MedPage Today’s recent article entitled “Diabetes, Dementia, and Age: What’s the Link?” reports that at age 70, every additional five years younger that a person was diagnosed with diabetes was linked to a 24% increased risk of incident dementia, even after adjustment for sociodemographic, health-related and clinical factors including cardiovascular disease, hypertension, body mass index and use of antidepressant or cardiovascular medications, among others.

This is equal to a dementia rate of 8.9 per 1,000 person-years among patients age 70 without diabetes versus a rate of 10 to 18.3 for those with diabetes, depending on age at onset:

Diabetes onset 5 years earlier: 10.0 per 1,000 person-years
Diabetes onset 6-10 years earlier: 13.0 per 1,000 person-years
Diabetes onset 10+ years earlier: 18.3 per 1,000 person-years

The strongest connection with incident dementia appeared to be younger age at onset of type 2 diabetes. Patients at age 55 who were diagnosed with diabetes within the past five years saw a twofold increased risk for incident dementia; those age 60 who were diagnosed with diabetes six to 10 years prior saw a similar twofold increased risk. However, late-onset diabetes wasn’t found to be tied to incident dementia. Prediabetes (fasting blood glucose of 110-125 mg/dL) also was not linked to risk of subsequent dementia. Singh-Manoux said this finding suggested that “a certain threshold of high glucose” might be needed to ultimately see hyperglycemia-induced brain injury.

However, cardiovascular comorbidities played into this link. Patients with diabetes who also had a stroke had a dramatically higher risk for dementia. Those with three heart conditions — stroke, coronary heart disease and heart failure – were at five times increased risk for subsequent dementia. Thus, these findings emphasize the importance of age at diabetes onset and cardiovascular comorbidities, when determining risk for dementia, the study authors said.

A few possible explanations could explain the connection between diabetes and dementia. “One hypothesis is that brain metabolic dysfunction is the primary driver of Alzheimer disease, highlighting the role of decreased transport of insulin through the blood-brain barrier, impairments in insulin signaling and consequently decreased cerebral glucose utilization,” they wrote. This idea was supported by findings from the 2019 SNIFF trial, which found some benefit with 40 IU of daily intranasal insulin for Alzheimer’s disease patients. The group also suggested that episodes of hypoglycemia, more often experienced by those with a longer diabetes duration, may increase the risk for dementia.

Reference: MedPage Today (April 27, 2021) “Diabetes, Dementia, and Age: What’s the Link?”

Does Sleeping Too Little Increase Risk of Dementia?

Researchers have looked at the issue of a lack of sleep and a link to developing dementia for many years, as well as other questions about how sleep relates to cognitive decline. The answers have been tough to find because it is hard to know if insufficient sleep is a symptom of the brain changes that underlie dementia — or if it can actually help cause those changes.

The New York Times’ recent article entitled “Sleeping Too Little in Middle Age May Increase Dementia Risk, Study Finds” reports that a large new study found some of the most persuasive findings to date that suggest that people who don’t get enough sleep in their 50s and 60s may be more apt to develop dementia when they are older.

The research, published recently in the journal Nature Communications, has limitations but also several strengths. Researchers monitored 8,000 people in Britain for about 25 years, starting when they were 50. They found that those who consistently reported sleeping six hours or less on an average weeknight were about 30% more likely than those who regularly got seven hours sleep (defined as “normal” sleep in the study) to be diagnosed with dementia nearly three decades later.

Drawing on medical records and other data from a prominent study of British civil servants called “Whitehall II,” which began in the mid-1980s, the researchers logged the number of hours that 7,959 participants said they slept in reports filed six times between 1985 and 2016. By the end of the study, 521 people had been diagnosed with dementia at an average age of 77.

The team was able to adjust for several behaviors and characteristics that might influence people’s sleep patterns or dementia risk, like smoking, alcohol consumption, how physically active people were, body mass index, fruit and vegetable consumption, education level, marital status and conditions like hypertension, diabetes and cardiovascular disease.

To further clarify the sleep-dementia relationship, researchers culled out those who had mental illnesses before age 65. Depression is considered a risk factor for dementia and mental health disorders are strongly connected to sleep disturbances. The study’s analysis of participants without mental illnesses found a similar association between short-sleepers and increased risk of dementia.

The link also held whether people were taking sleep medication and whether they had a mutation called ApoE4 that makes people more apt to develop Alzheimer’s.

Experts seem to agree that researching the sleep-and-dementia connection is challenging and that previous studies have sometimes produced confusing findings. In some studies, those who sleep too long (usually measured as nine hours or more) seem to have greater dementia risk, but several of those studies were smaller or had older participants. In the new study, results intimated increased risk for long sleepers (defined as eight hours or more because there weren’t enough nine-hour sleepers), but the association was not statistically significant.

The new study also looked at whether people’s sleep changed over time. There appeared to be slightly increased dementia risk in people who shifted from short to normal sleep—a pattern thought to reflect that they slept too little at age 50 and needed more sleep later because of developing dementia.

Reference: New York Times (April 20, 2021) “Sleeping Too Little in Middle Age May Increase Dementia Risk, Study Finds”

How Long has Medicare Sequestration Holiday Been Extended?

The U.S. House of Representatives has overwhelmingly voted by a 384-38 margin in favor of a continued sequestration delay.

The bill was one of two measures introduced since early March designed to delay the return of Medicare sequestration, which is an automatic 2% cut for all health care providers paid through Medicare.

Home Healthcare News’s recent article entitled “Biden, Congress Extend Medicare Sequestration Holiday Through 2021” reports that recently President Joe Biden officially signed the legislation. Because the U.S. Centers for Medicare & Medicaid Services (CMS) has been expecting Congress to pass this type of law, it hasn’t been enforcing the 2% cut, despite the holiday’s expiration coming earlier in April.

Organizations, such as the Partnership for Quality Home Healthcare (PQHH) and others have supported the legislation. CMS has been cutting Medicare reimbursements to home health providers by 2%, as directed by Congress, since 2014. Under the law, payments that exceed Medicare’s cap must be returned to CMS.

In 2020, the Coronavirus Aid, Relief and Economic Security (CARES) Act stopped the automatic 2% cut to all Medicare providers. In December, this temporary moratorium was extended through March 2021.

This was intended to let home health providers have the resources to provide care during the COVID-19 emergency, while staying afloat financially.

The legislation will defer $36 billion in previously scheduled Medicare cuts in 2021.

In March, the House passed different sequestration legislation. However, the key difference between the two laws is, in addition to extending the sequestration delay, the previously introduced bill also dispensed with statutory pay-as-you-go (PAYGO) budget enforcement measures.

The PAYGO rule requires new legislation not to raise the federal budget deficit or lower the surplus.

The bill passed last week in the House and signed by the president doesn’t address the PAYGO issue.

Reference: Home Healthcare News (April 14, 2020) “Biden, Congress Extend Medicare Sequestration Holiday Through 2021”

Are You Clueless about Social Security?

If you haven’t a clue about Social Security, it’s vital that you learn, so you can be ready to grow and maximize your benefits.

Lake Geneva Regional News’ recent article entitled “35% of Near-Retirees Failed a Basic Social Security Quiz. Here Are 3 Things You Need to Know About It” provides several important things you should know:

Your benefits are determined by your top 35 years of earnings. The monthly benefit you get in retirement is based on your specific earnings during your 35 highest-paid years in the workforce. If you don’t work a full 35 years, you’ll have $0 factored into that equation for each year you’re missing an income. So, you can see how important it is to try to fill in those gaps. If you lost your job during the pandemic and are thinking about early retirement, check your earnings history before you do.

You’re only entitled to your full monthly benefit when you hit full retirement age. You can claim your monthly retirement benefit in full once you hit your full retirement age (FRA). However, many people don’t know what that age is. About a quarter (26%) of those aged 60 to 65 couldn’t correctly identify their FRA on the quiz. Your FRA is based on your year of birth.

You can claim Social Security as early as age 62 or wait until age 70 and grow your benefits in the process. However, you’ll need to know your FRA first.

You can collect Social Security, even if you never worked. If you are or were married to someone who’s entitled to Social Security, you may be eligible for spousal benefits that amount to 50% of what your current or ex-spouse collects.

MassMutual found that 30% of older Americans didn’t know that a person who’s divorced may be able to collect Social Security benefits based on a former spouse’s earnings history. Thus, it pays to read up on spousal benefits as retirement nears, even if you never held a job.

Being ill-informed about Social Security could make it more difficult to file at the right time and make the most of your Social Security income

Stay up to date on how Social Security benefits work, so you’re able to make wise choices for your retirement.

Reference: Lake Geneva Regional News (April 10, 2021) “35% of Near-Retirees Failed a Basic Social Security Quiz. Here Are 3 Things You Need to Know About It”

When do Medicaid Recipients have to Cash Stimulus Checks before Government Collects?

Medicaid enrollees are generally allowed to have only a limited amount of assets, outside of their primary residence, car and other essentials.

For singles, it’s typically about $2,000. Those who exceed that threshold could be deemed ineligible for the health insurance program for low-income Americans.

CNN’s recent article entitled “Nursing home residents have a little more time to spend stimulus checks before losing Medicaid” notes that the $1,200 stimulus payments that many people received last spring didn’t count as income under Medicaid rules.

As a result, nursing home residents didn’t have to give the money over to the facilities where they live and could save it for their own use.

However, the funds are considered an asset after one year. That is a deadline that is rapidly drawing near for the first of the three relief payments Congress has authorized since the pandemic began.

Even so, another coronavirus provision that lawmakers approved last March prevents states from disenrolling residents from Medicaid during the public health emergency, which is currently set to end next month. However, it’s expected to be extended again.

This means that Medicaid recipients, including nursing home residents, don’t have to worry about spending the funds until the pandemic is over.

The same is true for the $600 checks many received from the December relief bill and the $1,400 payment that is being distributed from President Biden’s $1.9 trillion recovery package, but the time on those funds started more recently.

Just the same, people shouldn’t wait until the last minute to spend their stimulus funds. They can buy things they need and can also give the money to family or friends or make a charitable contribution. They just need to prove that the gift isn’t part of a strategy to give away assets to qualify for Medicaid.

“People should just be conscious of Medicaid asset limits and deal with it without trying to wait until the last month of the public health emergency,” said Eric Carlson, a directing attorney with Justice in Aging, a non-profit legal advocacy group. “There’s no particular benefit to cutting it close.”

Reference: CNN (March 30, 2021) “Nursing home residents have a little more time to spend stimulus checks before losing Medicaid”

Estate Planning Blog Articles

Estate & Business Planning Law Firm Serving the Providence & Cranston, RI Areas

Can I Be Paid for Caring for a Loved One?

Will Mediterranean Diet Stave Off Alzheimer’s?

Should Vets Be on Look-out for COVID Vaccine Scams?

How to Protect Loved Ones from Elder Abuse

Should I Be Paying with Personal Checks?

Link Possible between Diabetes, Dementia and Age

Does Sleeping Too Little Increase Risk of Dementia?

How Long has Medicare Sequestration Holiday Been Extended?

When do Medicaid Recipients have to Cash Stimulus Checks before Government Collects?

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Can I Be Paid for Caring for a Loved One?

Will Mediterranean Diet Stave Off Alzheimer’s?

Should Vets Be on Look-out for COVID Vaccine Scams?

How to Protect Loved Ones from Elder Abuse

Should I Be Paying with Personal Checks?

Link Possible between Diabetes, Dementia and Age

Does Sleeping Too Little Increase Risk of Dementia?

How Long has Medicare Sequestration Holiday Been Extended?

When do Medicaid Recipients have to Cash Stimulus Checks before Government Collects?

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