Estate Planning Blog Articles

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How Can I Save on Medicare Drugs?

New research by the Senior Citizens League shows comparing plans also works for Medicare Part D plans, which cover prescription drugs for those with Medicare health insurance. The advocacy group found that the price of a particular drug can vary by hundreds or even thousands of dollars from one Medicare Part D plan to another. So, shopping around for the best plan could save you hundreds, says Money Talks News’ recent article entitled “How to Save Hundreds of Dollars on Medicare Drug Costs.”

The best time to do comparison shopping is during the annual Medicare open enrollment period that starts October 15 and ends on December 7.

The Senior Citizens League’s analysis identified several reasons for which drug prices can vary so much for Medicare recipients, including the fact that most people on Medicare rarely shop around during open enrollment. each Part D plan also has its own formulary, a list of prescription drugs that a plan covers. The federal government, which runs the Medicare program, doesn’t negotiate drug prices on behalf of Medicare recipients. Each private insurance company that offers Medicare drug coverage does its own negotiating.

There are two main types of Medicare health insurance: Original Medicare, which is offered directly by the federal government, and Medicare Advantage plans, which are offered by private insurers that contract with the federal government’s Medicare program. Note that original Medicare doesn’t include prescription drug coverage. Seniors on Original Medicare who want drug coverage must buy a separate Medicare Part D plan from a private insurer.

Here’s a checklist for the process:

  1. Review your current coverage. Look at the Annual Notice of Change (ANOC) that you get from your Medicare Part D plan or Medicare Advantage plan. This will include changes to your current plan that take effect in the new year, if you stay on that plan.
  2. Do an inventory of your prescriptions. Make a list of all prescription meds you take. For each drug, include the name, dose, quantity taken per day and quantity required per month. You’ll need it to compare drug plans. It is also handy to take with you on each visit to your physician.
  3. Consider getting help. Medicare recipients have access to free, one-on-one Medicare insurance counseling from State Health Insurance Assistance Programs (SHIPs). To find the SHIP for your state, visit the national SHIP website.
  4. Narrow down your options. When you know what your Medicare Part D plan or your Medicare Advantage plan will cover next year, and you have a detailed list of your medications, compare that coverage with other drug plans to determine if they’d provide better or cheaper drug coverage. To compare plans, use the Medicare Plan Finder feature at Medicare.gov, the federal government’s official Medicare website.

If you choose to switch to a new plan, go through the Medicare website rather than the insurer.

Reference: Money Talks News (Nov. 11, 2019) “How to Save Hundreds of Dollars on Medicare Drug Costs”

Can Traveling Help Seniors’ Mental Health?

A study to be published in the October 2022 edition of Tourism Management presents the thoughts of a cross-disciplinary team of experts in both dementia and tourism. Medical News Today’s recent article entitled “’Travel therapy’ may offer treatment for dementia and benefit mental health” reports that the research hasn’t yet been peer-reviewed, but experts think there may be significant benefits of travel for people with dementia, particularly in the areas of mental health and well-being.

Dementia currently has no cure, but some medications and treatments may help control symptoms.

Care is often supportive, including helping those with dementia do as much as they can on their own and helping them have a better quality of life.

Researchers are still working on how to best help those with dementia. One area of interest is how traveling may benefit people with dementia.

The researchers say that the potential benefits of tourism in treating people with dementia are called “travel therapy.” One definition of tourism the researchers used was “visiting places outside one’s everyday environment for no longer than a full year.” They note that the experience of tourism has four main components to it:

  • Affective Experience: how it impacts feelings, emotions and mood
  • Cognitive Experience: how it affects thoughts and memories
  • Conative Experience: how it impacts behavior; and
  • Sensorial Experience: how it impacts the senses.

The authors concluded that tourism may have a potentially positive impact on well-being and quality of life through a variety of components. However, the literature supporting this in the treatment of dementia is limited.

The study authors also noted that focusing on components of positive psychology, such as what people can do, positive experiences, and well-being may also benefit people with dementia.

They proposed a few options to implement components of tourism to help people with dementia, such as group travel that promotes social interactions or traveling to locations that stimulate the senses.

Reference: Medical News Today (June 30, 2022) “’Travel therapy’ may offer treatment for dementia and benefit mental health”

Can My Pet Help Me in Old Age?

Seniors who own a pet may slow their rate of cognitive decline, according to a preliminary study recently presented at the American Academy of Neurology’s 74th Annual Meeting.

Money Talks News’ recent article entitled “Sharp Mind in Old Age? Thank Your Pet” reports that the positive effect appears to be particularly pronounced for those who own a pet for at least five years.

The study looked at data from 1,369 older adults with an average age of 65.

All had normal cognitive skills at the outset of the study. Of the adults in the study, 53% owned pets, with 32% having had their pet for five years or longer.

After examining cognitive test data, the researchers found that after six years, long-term pet owners had a cognitive composite score that was 1.2 points higher compared than those who did not own pets.

In a press release, study author Dr. Tiffany Braley of the University of Michigan Medical Center in Ann Arbor remarked that the positive impact of pets may stem in part from the animals’ ability to reduce our levels of stress:

“As stress can negatively affect cognitive function, the potential stress-buffering effects of pet ownership could provide a plausible reason for our findings. A companion animal can also increase physical activity, which could benefit cognitive health.”

However, Braley — who also is a member of the American Academy of Neurology — said more research is needed to both confirm the results and identify underlying mechanisms that may be responsible for the link.

Earlier studies have found that the presence of pets can help reduce their owners’ levels of stress and even lower their blood pressure.

Reference: : Money Talks News (May 5, 2022) “Sharp Mind in Old Age? Thank Your Pet”

Estate Planning Tips for Solo Seniors

The people who typically think the most about estate planning are those in a traditional nuclear family unit, with spouses, adult children, grandchildren and a clear idea of how they want to pass along assets and who can be trusted to carry out their wishes. It’s easier to plan ahead, reports a recent article titled “Elder Care: Estate planning when you are on your own” from The Sentinel, when the right person to put in charge is easy to identify.

When more and more families do not fall into the traditional nuclear family unit, how should they proceed with estate planning?

This can be a challenging scenario, especially if the person is not married and has no children. It’s hard to know who to name for important roles, like who will take charge if the person becomes ill or dies.

Some single people may think it doesn’t matter, because they don’t care about who inherits their possessions. However, estate planning is not just about distributing property. Planning for incapacity may be the most important part of estate planning—making legally enforceable decisions about medical care, end-of-life care and managing the business aspect of your life if you are incapacitated.

Two of the most important documents for a person who cannot speak for themselves are a Financial Power of Attorney and a Health Care Power of Attorney. These are the critical documents giving the person you designate the ability to manage your affairs and be involved in your medical care.

Without them, someone will need to take over for you. Who will it be? The process begins in the court, with a legal proceeding called guardianship. There are any number of reasons to avoid this. First, it takes a long time and any actions or decisions requiring a legal guardian will not be made with any speed. Second, guardianships are expensive. The process of having a guardian named and the fees paid to the guardian will be paid by you, whether you are conscious or not. While many people who act as guardians for others are trustworthy and kind-hearted, there are many horror stories—including several true stories made into movies—where guardians are more focused on enriching themselves than their ward’s best interests.

Guardianship can be easily avoided. Meeting with an estate planning attorney to prepare your last will and testament, Power of Attorney and Power of Health Care Attorney gives you control over who will be in charge of your life if you are incapacitated. Having these documents properly prepared by an experienced estate planning attorney ensures that you can be admitted to a hospital or facility offering the care you need, your bills will be paid and if your situation requires filing for long-term care benefits or disability, someone can do it for you.

If you don’t have a spouse or children, you probably have a healthy network of friends and extended family members you trust and are your “family by choice.” If you don’t feel these people are trustworthy or capable, think further afield—someone from your community, a neighbor who you respect and trust, etc.

If possible, name a few people in succession (your estate planning attorney will know how to do this) so if one person cannot serve, then there will be a next-in-line to help.

The next step is to speak with these individuals and explain what you are asking them to do. They need to be comfortable with the responsibility you’re asking them to undertake. You’ll also want to tell them your wishes, perhaps drafting a letter of intent, so they will know what to do in different circumstances. Make sure they know where these documents are located, so they can find them easily.

Once your estate plan is in place, you’ll breathe a sigh of relief, knowing the future is taken care of.

Reference: The Sentinel (June 17, 2022) “Elder Care: Estate planning when you are on your own”

State Bolsters Nursing Home Oversight

The New York State Assembly recently gave final legislative approval in a unanimous vote to a bill requiring the Long-Term Care Ombudsman Program (LTCOP) to publicize, as part of its annual reports, the kinds and patterns of complaints received by its regional offices and the number of ombudsman visits to each long-term care facility.

Harlem World Magazine’s recent article entitled “NYS Lawmakers Move To Strengthen Nursing Home Oversight From Care, To Complaints And More” reports that the New York State Senate passed the companion bill on May 24 with a strong, bipartisan vote.

The move follows a $2.5 million increase in state funding in the 2022 state budget for the federally-required program – more than doubling its previous state-funded budget.

LTCOP has lagged in other states’ programs, while more than 15,000 people have died in New York nursing homes since the start of the COVID-19 pandemic.

“This bill would arm policymakers with the information they need to ensure the Long-Term Care Ombudsman Program is as effective as possible in advocating for and speaking on behalf of our society’s most vulnerable population: nursing home residents,” said AARP New York State Director Beth Finkel.

“After over 15,000 deaths in New York nursing homes and counting since the start of the pandemic, we need a strong advocate. AARP New York thanks Senator Rachel May and Assembly Member Sarah Clark for steering this bill through their respective houses, and we strongly urge Governor Kathy Hochul to sign it into law.”

The New York Ombudsman Program is an advocate and resource for seniors and people with disabilities who live in nursing homes, assisted living and other licensed adult care homes. Ombudsmen help residents understand and exercise their rights to good care in an environment that promotes and protects their dignity and quality of life.

The legislation was supported by the Center for Elder Law & Justice in Buffalo, New York.

Although LTCOP can’t sanction long-term care facilities, it’s the only agency authorized to visit facilities on a regular basis to observe conditions, monitor care and help residents and families resolve problems.

In addition to helping individual residents and families, LTCOP is required by federal rules to act as an independent voice for residents with respect to laws and policies that impact their care.

Reference: Harlem World Magazine (June 4, 2022) “NYS Lawmakers Move To Strengthen Nursing Home Oversight From Care, To Complaints And More”

Elderly Woman Thanks Firefighters for Ride to Visit Husband at Nursing Home

An senior in San Diego was so grateful for the help of local firefighters, she wanted to thank them in person with a big bag of sweets, reports NBC San Diego’s recent article entitled “Stranded La Jolla Woman, 87, Brings Treats to Firefighters Who Gave Her a Lift.”

“It was a long time I was waiting for that cab. If it wasn’t for you, I’d be there all night,” La Jolla resident Sandy Lightman recalled telling San Diego Fire-Rescue Department Captain Jordan Buller on May 10, the night of her “rescue.”

The article said that Mrs. Lightman may have needed a fire engine to haul the three dozen cookies and four cheesecakes to Captain Buller and the Station 35 crew.

The 87-year-old explained that she’d just ended one of her daily trips to a nursing facility, where she cares for her husband who’s living with dementia.

She started requesting a cab around 8:20 p.m., but it didn’t show. So, she kept calling.

Hours later at 11 p.m., while on another call to the facility, Captain Buller and his crew recognized Lightman’s distress.

“She was frantically trying to call family and call a cab and we could tell she was distraught,” he said.

“I can’t walk that well, and I was only two-and-a-half blocks from where I live but I was afraid to go on the street by myself. I didn’t know if I’d make it home,” she said.

Since the cab wasn’t coming, the San Diego fire firefighters loaded Lightman into the cab of their engine.

They strapped her into the jump seat—and even gave her headphones to wear for the trip.

“It felt so secure, it made me feel so good because they were helping me and I knew I was safe, because I was afraid,” said Mrs. Lightman.

Back home safely, the grateful woman says she’s thankful to the local news outlet that was able to help track down the station who treated her with such kindness, so she could spoil them with some sweet treats.

Lightman and her husband will celebrate 40 years of marriage next week.

Reference: NBC San Diego (May 24, 2022) “Stranded La Jolla Woman, 87, Brings Treats to Firefighters Who Gave Her a Lift”

What’s the VA Doing about Long Wait Times?

In his recent testimony before the House Appropriations Committee, Veterans Affairs Secretary Denis McDonough said he’s concerned about delivering accurate information on appointment timeliness to veterans as they seek to resume care that was deferred or canceled in recent years, reports Military Times’ recent article entitled “VA secretary promises improvements in medical wait time data.”

“If you look at our average wait times across the system, they’re good, but it’s a big system and we’re coming out of a pandemic,” he said. “So, I fear that there are outliers where people are waiting too long.”

Wait times at VA facilities made headlines in 2014, after whistleblowers revealed that officials were manipulating data to cover up long delays in care to meet performance metrics. During President Trump’s administration, the department began posting wait-time data online for all VA hospitals and clinics in an attempt to show more transparency into how long veterans have to wait for routine or specialty appointments.

However, in a report released Thursday, the VA Inspector General’s office said much of that data remains confusing and misleading.

“The Veterans Health Administration] has sometimes presented wait times with different methodologies, using inconsistent start dates that affect the overall calculations without clearly and accurately presenting that information to the public,” officials wrote.

In response to similar concerns raised by lawmakers, Secretary McDonough said that “we have to do a better job with that” and said he expects an announcement on changes related to the wait time issues in coming months. We’re working really hard on it because I am frustrated with it myself.”

Broad legislation has been stalled in the Senate over concerns about cost and potential workload burdens on Veterans Affairs workers. That’s raised concerns about pressure on the VA health care system, and if veterans could see a significant increase in the time it takes to schedule appointments.

Health officials have touted new pandemic telehealth options within the department as a way to help ease the burden on facilities facing increased requests.

However, lawmakers said that in rural areas — locations with some of the longest wait times already — a lack of reliable internet access may restrict the availability of those services.

Reference: Military Times (April 8, 2022) “VA secretary promises improvements in medical wait time data”

Can I Help Parents Remember Online Passwords?

Hacked usernames and passwords are the most common causes of malicious online identity attacks, accounting for 61% of breaches.

Seniors Matter’s recent article entitled “Why your loved one needs a password manager” explains that keeping your loved one’s passwords safe is actually nearly as important as the security and complexity of the passwords themselves. This is why a password manager can help. It’s software that allows the user to generate, store and manage credentials in one central and secure location online.

A password manager can help make your loved one’s day-to-day interactions with technology easier and more secure for several reasons. For instance, older adults are vulnerable to scammers, more likely to forget their passwords or store them in unsafe locations. Online accounts should be included in estate planning, but many family members find themselves “locked out” of important accounts after their loved one passes, with no access to the credentials—especially if the death is unexpected.

A password manager puts all your loved one’s online account credentials and documents into one secure place, then they have just one password to remember. Many password managers let you share credentials with other people, so nothing’s ever lost forever. This way they can make certain that the right people will have the details they need to access the accounts necessary to settle the estate.

With many password managers, you can not only store, change and access passwords in these apps but also write notes about information like:

  • Financial account details
  • The location of valuables and important documents
  • Important contact info
  • Important logins or security codes that aren’t website logins; and
  • Instructions in case of death.

Research has shown that older adults who use password managers were satisfied with their experiences overall and even felt confident using multiple features, like the password generator and auto-fill.

After a senior gets over the hurdle of setting up and learning how to use the software, they love it and are quite adept at using it.

This is the reason for you as the caregiver to help your loved one get a password manager set up and help them get acquainted with using it properly.

Reference: Seniors Matter (March 6, 2022) “Why your loved one needs a password manager”

Tips on Finding the Right In-Home Aide

About 90% of older adults would prefer to age in place, rather than move into an assisted living facility or nursing home, according to an AARP survey.

WRAL’s recent article entitled “How to choose an in-home health aide” says that, fortunately, you can have good health care and independent living with an in-home health aide. An aide can provide you with care for a short amount of time during the day or can stay with you around the clock. Depending on your needs, an aide can help with many tasks. These include things such as:

  • Chores, such as laundry, cooking and shopping
  • Daily activities, such as bathing, dressing, eating, grooming, moving from one place to another and toileting
  • Monitoring vital signs, like blood pressure, respiration, and pulse
  • Keep an eye on your physical and mental health, including your level of exercise and how much you are eating, drinking, and going to the bathroom; and
  • Assist in emergencies, like an accident, heart attack, or stroke.

There are a number of actions to take when you hire an in-home health aide. Here’s the rundown:

  1. Determine what kind of care, and how much, you need.
  2. Decide if you want to hire through an agency or on your own. The advantages of using an agency are that you will get a prescreened aide and will have backup care when that person is unavailable. You also won’t have to be concerned about offering benefits as an employer because the agency takes care of those.
  3. Consider what you can afford. If you qualify for Medicare or have long-term care insurance, some or all your care may be paid for. If you use an agency, the Mayo Clinic suggests you ask for written, detailed explanations of all services and fees associated with home care. Once you have this from several agencies, you’ll be able to choose the best one for your budget. If you hire a home health aide yourself, remember to think about sick days, holidays, vacation, payroll taxes and Social Security. That is because your aide will be considered a household employee.
  4. After you’ve found your health aide, create a care plan, which may include the following:
  • The days and hours you need assistance
  • The daily tasks that need to be completed
  • A schedule of appointments and medication times
  • A list of contacts, such as your doctor’s information
  • An emergency plan; as well as
  • Any of your personal preferences.

Re-evaluate your care plan every few months. Ask your family to discuss this with you because having loved ones on board will be helpful in the future, when you may need more support as you continue to age in place.

Reference: WRAL (April 17, 2022) “How to choose an in-home health aide”

Medicare’s Coverage of New Controversial and Expensive Alzheimer’s Drug Is Limited

The final decision, which comes after a proposed policy released in January, will have significant consequences for millions of Alzheimer’s patients and tens of millions of Medicare enrollees. It’s the latest step in the drug’s contentious path to market, reports CNN’s recent article entitled “Medicare limits coverage of controversial Alzheimer’s drug to those in clinical trials.”

The policy is expected to restrict the number of people who can receive the medication. This coverage policy would also apply to other drugs in this class, such as monoclonal antibodies that target amyloid, or plaque, for the treatment of Alzheimer’s disease, that the FDA may approve in the future.

Biogen, the maker of Aduhelm, called CMS’ decision unprecedented and said it will deny all Medicare enrollees access to the drug and may limit coverage for treatments approved in the future.

“When additional data from this new class of treatments become available, Biogen urges CMS to reconsider today’s decision for all FDA-approved amyloid-beta targeting therapies,” the company said in a statement, noting that it is considering its options.

The CMS made this decision based on evidence and analysis of public feedback, CMS Administrator Chiquita Brooks-LaSure said in a statement. More than 10,000 comments on the proposed policy were submitted.

“CMS has a responsibility to ensure that people with Medicare have equitable and appropriate access to therapies that are reasonable and necessary for use in the Medicare population,” she said. “Through this decision, we are creating a pathway for people with Medicare to quickly access drugs the FDA determines have shown a clinical benefit and encourages manufacturers and trial administrators to ensure that the clinical trials recruit racially diverse participants.”

The agency examined the potential for patient benefits against the significance of serious unknown factors that could result in harm, Dr. Lee Fleisher, CMS chief medical officer, said in a statement.

“There is the potential for promise with this treatment; however, there is not currently enough evidence of demonstrating improved health outcomes to say that it is reasonable and necessary for people with Medicare, which is a key consideration for CMS when making national coverage determinations,” Fleisher said.

CNN says that Medicare has never required enrollees to participate in a clinical trial for a drug already approved by the FDA that is being used for its intended purpose.

The FDA’s approval of Aduhelm last June brought about questions and concerns about the process, the drug’s efficacy, as well as its annual cost. Biogen initially priced it at about $56,000 a year. The approval was also a big motivator for a huge increase in Medicare Part B premiums for 2022. The standard monthly payment increased to $170.10, up from $148.50 last year, for the more than 63 million enrollees.

Roughly $10 of the premium spike is due to Aduhelm, a CMS official told CNN. The remainder is from a general increase in health care prices and usage, as well as from congressional action that limited the rise in Part B premiums for 2021 amid the coronavirus pandemic.

Reference: CNN (April 7,  2022) “Medicare limits coverage of controversial Alzheimer’s drug to those in clinical trials”