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”

Does Bacon Cause Dementia?

A recent study suggests there is a connection between eating 25 grams of processed meat per day and a 44% higher risk of dementia. That’s about a single rasher or strip of bacon.

Medical News Today’s recent article entitled “Dementia: 25 grams of processed meat per day may raise relative risk” reports that this research also found a link between eating unprocessed red meats, like beef, pork, and veal, and reduced risks of all-cause dementia.

A gene variant known as the APOE ε4 allele, which increases a person’s risk of dementia by 3–6 times, didn’t appear to affect the relationship between diet and the condition. Those with dementia have difficulties with their memory, attention, thinking and reasoning that interfere with everyday life. These cognitive difficulties aren’t part of the typical aging process.

According to the Centers for Disease Control and Prevention (CDC), in 2014, about five million adults in the U.S. had dementia, but the CDC estimates this number may be close to 14 million by 2060. And the World Health Organization (WHO) reported that there are around 50 million dementia cases globally, with around 10 million new cases being diagnosed annually.

This new study from scientists at the University of Leeds in the U.K. suggests there is a relationship between eating processed meat in particular and an increased risk of developing dementia. This includes sausage, bacon, salami and corned beef.

However, the research also showed that red meat may have a protective effect against dementia.

The scientists analyzed data from the UK Biobank, a database of genetic and health information from around half a million volunteers in the U.K. aged 40–69 years. The participants completed a dietary questionnaire and completed 24-hour dietary assessments. This let the researchers estimate the total amount of meat each participant regularly consumed and how much of each type they ate.

The database also let them identify which participants had the gene variant APOE ε4 allele, which is known to increase a person’s risk of dementia. The researchers then used hospital and mortality records to identify subsequent cases of dementia from all causes, Alzheimer’s disease and vascular dementia during the follow-up period of approximately eight years.

Of the 493,888 participants, 2,896 had all-cause dementia. These included 1,006 cases of Alzheimer’s disease and 490 cases of vascular dementia.

To estimate the role of meat consumption, the researchers had to account for a wide range of other factors that are known to affect a person’s likelihood of having dementia, such as age, gender, ethnicity, education and socioeconomic status. They also considered lifestyle factors, such as smoking, physical activity and consumption of fruits and vegetables, fish, tea, coffee and alcohol. After the adjustments, the scientists at the University of Leeds found that each additional 25g portion of processed meat eaten per day was associated with a 44% increase in the risk of dementia from all causes. This intake was also associated with a 52% increased risk of Alzheimer’s disease.

However, each additional 50g portion of unprocessed meat eaten per day was linked to a 19% reduction in the risk of all-cause dementia and a 30% reduced risk of Alzheimer’s disease. The results for unprocessed poultry and total meat consumption were not statistically significant, the scientists said.

“Worldwide, the prevalence of dementia is increasing, and diet as a modifiable factor could play a role,” says Huifeng Zhang, a Ph.D. student at the School of Food Science and Nutrition at the University of Leeds, who was the lead researcher of the new study.

“Our research adds to the growing body of evidence linking processed meat consumption to increased risk of a range of nontransmissible diseases,” she added.

Reference: Medical News Today (March 29, 2021) “Dementia: 25 grams of processed meat per day may raise relative risk”

Court Victory for Adults Caring for Parents at Home

A New Jersey Appellate Division recently reaffirmed the state’s regulation that allows older adults to transfer their homes to adult caregiver children without Medicaid penalty, reports an article titled “Major Victory for Adults Who Provide Home Care for Parents” from The National Law Review. The regulation permits the home to be transferred with no Medicaid penalty, when the adult child has provided care to the parent for a period of two years. This allows the parents to remain at home under the care of their children, delaying the need to enter a long-term care facility.

New Jersey Medicaid has tried to narrow this rule for many years, claiming that the regulation only applies to caregivers who did not work outside of the home. This decision, along with other cases, recognizes that caregivers qualify if they meet the requirements of the regulation, regardless of whether they work outside of the home.

The court held that the language of the regulations requires only that:

The adult child must live with the parent for two years, prior to the parent moving into a nursing facility.
The child provided special care that allowed the parent to live at home when the parent would otherwise need to move out of their own home and into a nursing care facility.
The care provided by the adult child was more than personal support activities and was essential for the health and safety of the parent.

In the past, qualifying to transfer a home to an adult caregiver child was met by a huge obstacle: the caregiver was required to either provide all care to the parents or pay for any care from their own pockets. This argument has now been firmly rejected in the decision A.M. v. Monmouth County Board of Social Services.

The court held that there was nothing in the regulation requiring the child to be the only provider of care, and the question of who paid for additional care was completely irrelevant legally.

It is now clear that as long as the child personally provides essential care without which the parent would need to live in a nursing facility, then the fact that additional caregivers may be needed does not preclude the ability to transfer the home to the adult child.

The decision is a huge shift, and one that elder law estate planning attorneys have fought over for years, as there have been increasingly stricter interpretation of the rule by New Jersey Medicaid.

While Medicaid is a federal program, each state has the legal right to set its own eligibility requirements. This New Jersey Appellate Court decision is expected to have an influence over other states’ decisions in similar circumstances. Since every state is different, adult children should speak with an elder law estate planning attorney about how the law of their parent’s state of residence would apply if they were facing this situation.

Reference: The National Law Review (March 22, 2021) “Major Victory for Adults Who Provide Home Care for Parents”

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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”

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