Seniors Can Choose Wisely
I learned something valuable working in the hospice field for many years – not all medical tests are necessary. I’ve come to ask my doctor, “If you perform this test, will it change the plan of care?” “Do the health risks outweigh the benefits of the test or treatment?”
“7 Medical Procedures You Don’t Need,” is an article in the May 2012 AARP Bulletin (www.aarp.org) about unnecessary medical procedures and tests that have been identified by physicians as part of the American Board of Internal Medicine (ABIM) (www.abim.org) Foundation’s Choosing Wisely campaign. They are:
- EKGs and stress tests for healthy people without symptoms.
- Bone density scans for osteoporosis for women under 65 and men under 70 with no risk factors.
- Antibiotics for mild to moderate sinus infections.
- NSAID painkillers for people with high blood pressure, heart failure and any chronic kidney disease.
- CT scans and other imaging for uncomplicated headaches.
- Dubious diagnostic tests for suspected allergies.
- X-ray, CT scan or MRI for low back pain.
If more seniors and their families asked similar questions to those posed above, they might have lower healthcare costs, and be less at risk of potentially dangerous or unwanted side effects and exposures.
New Senior Living Options Make Sense in Arizona
The “New Old Age,” which is one of my favorite blogs, includes a recent post about a new idea for senior housing, in which they describe some homebuilders’ experiments with prefabricated cottages designed to be erected in the backyard as stand-alone residences for elderly family members.
We all know families that are struggling with the decision of where our parents should live when they are no longer safe in their own homes. Even if their children are willing to have them live with them, their homes may not be suitable. And while our parents may acknowledge the need to leave their current homes, they don’t want to relinquish all of their independence and privacy.
Here in Arizona, many homes have separate “casitas,” or guest houses, which many families have converted to “mother-in-law” apartments. The ideas described in this post specifically address the needs of seniors who may have issues with mobility or otherwise be in declining health that are definitely worth exploring. http://nyti.ms/JQxef6. It seems to me that it is another way in which good ideas for our seniors could also be good business.
May is Older Americans Month
May has been designated as Older Americans Month.
This year’s theme is ”Never Too Old to Play,” which highlights the importance of staying active, both mentally and physically. We have all seen the articles about the importance of exercise, and of socializing, to maintaining our mental health. (A recent article also said that housework and gardening might be as beneficial as golfing and playing bridge, but what fun is that?!)
As with any exercise program, for any reason, what is most important is finding something your enjoy so that you will stick with it. I have previously reported in this blog about my own experience as a competitive power lifter, a sport to which I was introduced through Senior Olympics. (Go to www.seniorgames.org to learn about that organization in Arizona, and for links to the Senior Olympics site for your state.) Senior olympics invites people over 50 to engage in friendly competition in the sport they enjoy, as a way to maintain physical and mental health. Once I got my feet wet through Senior Olympics, I learned that I can compete against my own age group in all sorts of competitions, which opened the door for me to compete, and make new friends, in competition events throughout the Mountain West.
What will you do to play this month? I would love to hear your stories!
World Health Organization Focus on Aging
The theme of World Health Day this past Saturday was “Good health adds life to years.” (www.cnn.com). I was pleased to see the focus on aging well and the challenge to stereotypes about elders. The article described the need to ensure that people are living healthier, as well as longer lives, as a public health issue that the World Health Organization (WHO) has identified as a priority.
Though the catalyst for retaining a life care planning law firm may well be a precipitating event such as a sudden or worsening illness, the benefit is that people get the help they need to find the best possible care, in the least restrictive environment, and assistance with accessing resources to pay for it. By bundling asset protection, public benefits qualification, care coordination, long-term care advocacy and crisis intervention services, people can live healthier and longer lives. The opportunity for improved quality of life and lower costs to society as a whole are enhanced.
Medicare Prescription Drug Assistance can Save $4,000
Mr. Jones is able to live within his $1300 Social Security check, but the cost of of his prescription medications take a big bite out of his income. I was able to make his family aware that their father, who is covered by Medicare and has limited income and resources, may be eligible for Extra Help — available through Social Security — to pay part of his monthly premiums, annual deductibles, and prescription co-payments.
To qualify for the extra help, the recipient must be receiving Medicare and have:
• Income limited to $16,335 for an individual or $22,065 for a married couple living together. Even if annual income is higher, he still may be able to get some help with monthly premiums, annual deductibles, and prescription co-payments. Some examples where income may be higher include if he and, if married, his wife:
—Support other family members who live with them;
—Have earnings from work; or
—Live in Alaska or Hawaii.
• Resources limited to $13,070 for an individual or $26,120 for a married couple living together. Resources include such things as bank accounts, stocks, and bonds. We do not count the primary residence or car as resources.
If you think that you or your parent may be eligible, Social Security has an easy-to-use online application. Find it at www.socialsecurity.gov/prescriptionhelp. To apply by phone or have an application mailed to you, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) and ask for the Application for Help with Medicare Prescription Drug Plan Costs (SSA-1020). Or go to the nearest Social Security office.
I was happy to be able to help my client save an estimated $4,000 a year on Medicare prescription drugs.
Medicare Benefits Summary More User-Friendly
The Acting Administrator of the Centers for Medicare and Medicaid Services (CMS) Acting Administrator has announced the redesign of the statement that informs Medicare beneficiaries about their claims for Medicare services and benefits. The form will include the following new features:
- A clear notice on how to check the form for important facts and potential fraud;
- Clearer language, including consumer-friendly descriptions for medical procedures;
- Definitions of all terms used in the form; and
- Larger fonts throughout to make it easier to read.
The redesigned MSN is already available to beneficiaries who use mymedicare.gov. In 2013, Medicare recipients who rely on paper copies of the Medicare Summary Notice (“MSN”) will start to recieve the redesigned form as well.
I recently wrote about new regulations that make it clear that Medicare should cover rehabilitation services that help patients maintain their current condition, even if they are not improving. Among other benefits, he new MSN will make it easier for patients to make sure that reimbursement for rehabilitation services is not being terminated for a reason inconsistent with these regulations.
Bullying: Elders Are Victims Too
Bullying as it relates to young people is back in the news thanks in part to the recent school shootings in Ohio. But were you aware that bullying is not just common among adolescents, but something that is experienced by our older adults? According to Robin Bonifas in her article in the latest edition of AARP Bulletin (www.aarp.org/bulletin), 10-20% of residents in senior care homes are mistreated by their peers. She cites examples of name calling, bossy behavior, loud arguments, and even cases of physical violence. Senior centers, assisted living and long-term care facilities can become a “forced” communal living situation with a mixture of personalities and ways of relating to others that are lifelong behaviors. Some facilities and centers have adopted strategies to preempt aggressive behavior, including:
- Signing a code of conduct to treat peers with consideration and respect with written reprimands or other penalties if the code is not followed
- Resident ambassadors to help transition newcomers into a community
- Coaching by staff on how to cope with snubs and aggression
- Teaching elders empathy for the physical and cognitive difficulties of others.
In another article, Sara Hacala provides a “civility tool kit” to help reverse the trend of escalating rudeness in our society. Two of these tools that can have great impact within a senior community are: 1) making a habit of practicing kindness, generosity and gratitude towards others, and 2) nurturing social relationships (balancing the impersonal nature of the Internet with phone calls and in-person contacts).
We can all act as positive role models for each other and hopefully create a cultural shift away from bullying and rudeness and towards better connectiveness.
Medicare Covers Services to Maintain Patient’s Condition
For many years, individuals seeking rehabilitative services, either in a care facility or at home, have struggled against the very common misconception that Medicare will only cover medical services and rehabilitation therapies if the patient is continuing to improve.
New regulations from The Center for Medicare and Medicaid (CMS), which became effective in January, 2011, clarified that Medicare will cover such therapies that are necessary to maintain an individual’s condition. In other words, if the therapy is necessary to prevent the patient’s condition from declining, they do not need to demonstrate that they are improving.
As reported in the Spring issue of the NAELA (National Academy of Elder Law Attorneys) News, those of us who advocate for seniors must continue to advise our clients, and their service providers, that Medicare cannot legitimately deny coverage for physical therapy, occupational therapy, and the like for lack of “restoration potential.”
So Who Can You Talk To?
We all heard the outcry over end-of-life counseling described in earlier versions of legislation that ultimately became The Affordable Care Act. The drafters wanted private insurance and Medicare to pay for a doctor’s visit for the purpose of discussing end-of-life issues. Patients could then make informed decisions about what medical care they would or would not want should they be diagnosed as terminally ill and unable to communicate for themselves.
These are big decisions that are multi-faceted and variable. For example, you might want every possible effort undertaken to revive you if you had a car accident on the way to work, but you might feel differently about what should be done if you slipped into a coma following a long and painful illness.
In addition, the terminology is not always easily understood or well defined. What is a terminal condition? Who is unlikely to recover? Even if it is a chronic condition with no known cure, what is the prognosis for long-term quality of life? Does artificial feeding and hydration mean a feeding tube, or does it just mean that someone has to feed me? Is the thickening of liquids that I drink considered “artificial”?
These are all legitimate medical questions. And since the average doctor’s appointment is about seven minutes, the drafters of the Affordable Care Act wanted to allow for at least one appointment when this type of discussion was not squeezed onto the end of a physical exam. Unfortunately, opponents of the law characterized these appointments as “death panels,” during which the doctor would determine that care would somehow not be given to someone who is old or terminally ill, and it was dropped from the final bill.
While this meant that insurers were not required to cover an exam exclusively for this purpose, I continued to believe that a person could schedule an appointment for this purpose at his own expense. Unfortunately, this may not be true.
A client told me last week that he and his wife, who are both in their 60s and currently in good health, knew they needed to get their advance directives in place. They obtained appropriate forms and called to schedule an appointment with their family doctor to discuss the meaning of the various provisions contained in them. However, after consulting with the physician, the scheduler informed the couple that he would not make an appointment for this purpose. Instead, they should make their own decisions, and then bring the completed forms in for their file.
Apparently, this physician finds it easier to sleep at night when he refuses to answer his patients’ legitimate questions than he would if he thought he had in some way contributed to a decision for which he might be held accountable.
Social Security Q & A
Sandra R. Perez, Public Affairs Specialist for the Social Security Admiistration, has passed along the following Frequently Asked Questions about Social Security and Medicare:
GENERAL
Question: I lost my Social Security card, should I get a new one?
Answer: If you know your Social Security number, you may not need a replacement card. You can replace your Social Security card for free if it is lost or stolen, but you are limited to three replacement cards in a year and 10 during your lifetime. Learn more at www.socialsecurity.gov/ssnumber.
Question: I worked for the last 10 years and I now have my 40 credits. Does this mean that I can stop working and get the maximum Social Security retirement benefit when it’s time to retire?
Answer: The 40 credits are the minimum number you need to qualify for retirement benefits. However, we do not base the amount of the benefit on those credits; we base it on your earnings over your working lifetime. To learn more about Social Security retirement benefits and how your benefit amount is figured, read our online publication, Retirement Benefits, at www.socialsecurity.gov/pubs/10035.html.
RETIREMENT
Question: I want to estimate my retirement benefit at several different ages. Is there a way to do that?
Answer: Use our Retirement Estimator at www.socialsecurity.gov/estimator to get an instant, personalized retirement benefit estimate based on current law and your earnings record. The Retirement Estimator, which also is available in Spanish, lets you create additional “what if” retirement scenarios based on different income levels and “stop work” ages.
Question: If both my spouse and I are entitled to Social Security benefits, is there any reduction in our payments because we are married?
Answer: No. We calculate lifetime earnings independently to determine each spouse’s Social Security benefit amount, and couples are not penalized simply because they are married. When each member of a married couple meets all other eligibility requirements to receive Social Security retirement benefits, each spouse receives a monthly benefit amount based on his or her own earnings. If one member of the couple earned low wages or failed to earn enough Social Security credits to be insured for retirement benefits, he or she may be eligible to receive benefits as a spouse. Learn more about earning Social Security credits by reading our publication on the subject at www.socialsecurity.gov/pubs/10072.html.
DISABILITY
Question: I am receiving Social Security disability benefits. Is there a way for me to try working and not lose my benefits?
Answer:We have special rules called “work incentives” that help you keep your benefits and Medicare while you test your ability to work. For example, there is a “trial work period” during which you can receive full benefits regardless of how much you earn, as long as you report your work activity and continue to have a disabling impairment. For more information about work incentives if you collect disability benefits and want to return to work, we recommend that you read the leaflet, Working While Disabled-How We Can Help at www.socialsecurity.gov/pubs/10095.html.
Question: I currently receive Social Security disability benefits. Is there a time limit on how long you can collect Social Security disability benefits?
Answer: Your disability benefits will continue as long as your medical condition has not improved and you cannot work. We will review your case at regular intervals to make sure you are still disabled. Learn more by reading our publication, Disability Benefits, at www.socialsecurity.gov/pubs/10029.html.
Answer:
Yes. A person who owns a home and lives in that home can be eligible for SSI benefits. Although there is an asset limit for people to qualify for SSI, some things don’t count toward that limit, such as a house, a vehicle, and some funds set aside for burial expenses. To learn more about SSI and the eligibility requirements, browse our booklet, Supplemental Security Income at www.socialsecurity.gov/pubs/11000.html.
MEDICARE
Question: I want to apply for Medicare Part B medical insurance this year. When is the deadline to apply?
Answer: If you didn’t sign up for Medicare Part B medical insurance when you first became eligible for Medicare, you now have an opportunity to apply — but time is running out. The deadline for applying during the general enrollment period is March 31. If you miss the deadline, you may have to wait until 2013 to apply. Medicare Part B covers some medical expenses not covered by Medicare Part A (hospital insurance), such as doctors’ fees, outpatient hospital visits, and other medical supplies. You can learn more about Medicare by reading our electronic booklet, Medicare at www.socialsecurity.gov/pubs/10043.html.
Ms. Perez also offers a link for an electronic fact sheet linking you to all of our online services. Click here
