Talk With Your Clinton, Flowood and Metro Jackson Area Elder Lawyer about Recent Medicare Changes

Recent changes to Medicare are giving elder lawyers and their clients some new options, and you may want to meet with your Mississippi attorney to see if they apply to you.  A class-action lawsuit was brought, and the proposed settlement has some big implications for those with disabilities and chronic conditions.

For decades, standard Medicare practice was to not provide skilled nursing and therapy for those whose conditions were unlikely to improve.  This has caused considerable problems for those with chronic or terminal conditions or with disabilities who would still have benefited from these services.  Now, home health care, outpatient therapy, and skilled nursing are much more likely to be covered for a chronic illness or disability.

The class-action suit was brought by a large group of people, with plaintiffs including organizations such as the National Multiple Sclerosis Society, the Parkinson’s Action Network, Paralyzed Veterans of America, and others.  As a result of the outcome, it appears that more than 10,000 individuals who had claims denied earlier may be able to have those same claims reviewed again with different results.

According to the agreement, Medicare will begin to cover these services when they “maintain the patient’s current condition or prevent or slow further deterioration.”  This is great news for those whose condition isn’t expected to improve but who still require assistance to improve their quality of life.

According to the New York Times, this change has potential to help those with:

  • Alzheimer’s
  • Multiple Sclerosis
  • Parkinson’s
  • Spinal Cord Injuries
  • Stroke
  • Traumatic Brain Injury

Elder lawyers in Clinton, Flowood and Metro Jackson Area  and the rest of the country see this as a positive change for clients who were often denied care because they simply couldn’t afford it and Medicare wouldn’t cover their needs.  There is still a potential for Medicare contractors to use more restrictive guidelines that could deny coverage for therapy or skilled nursing if the patient isn’t showing improvement.

The proposed changes are geared toward those in the traditional Medicare program, as well as to those with private Medicare Advantage.  Most Medicare recipients are 65 and older, which is why a skilled elder lawyer in Clinton, Flowood and Metro Jackson Area keeps abreast of these kinds of changes that might affect clients.

Families are Primary Long Term Care Providers

The American Association for Marriage and Family Therapy states that “more than ever before, families are providing long-term care to older adults with limitations in the ability to perform tasks necessary for independent living. Nearly 25% of American households are providing care to people age 50 years and over.  The Jackson, Mississippi metro are is no exception.  Families are the alternative foundation for a stressed healthcare system. Hospital stays are shorter than ever and family caregivers are often expected to do what healthcare professionals once did.”

Family caregivers in Mississippi take over various responsibilities for their elders.  It may be just handling finances, running errands, going to doctor appointments or taking on full 24 hour care services.  In most cases one sibling in the family will become the main caregiver, but most successful ventures are supported by the entire family.  Many times this duty falls on the child who lives in the same city, such as Jackson, Mississippi.  More frequently than not, it is the oldest daughter.

There is a saying that it takes a village to raise a child.  This may be true, but it takes a family to care for an aging parent.  As seniors lose physical and cognitive function they become vulnerable and unable to manage their own care.  Who better to know their needs and desires than their own children.  Even if professional care givers are providing services, family involvement makes the difference in quality of life for their parents.

“If one family member has been designated caregiver other members can give support with respite care, transportation to doctors, etc., everyone needs to be aware of all that is needed and be in total agreement to do it.”  “The 4 Steps of Long Term Care Planning

Experience has shown that even families that are close can quickly grow angry, jealous and hostile towards each other when an aging parent begins to need long term care. If a sibling moves into the parent’s home, others can easily be suspicious of ulterior motives and fear to lose their inheritance. On the other hand, the child doing the entire care taking becomes bitter and feels there is no support or help from siblings.

One example of a family misunderstanding is that of a brother accusing his sister of stealing all of the money from the sale of his parent’s home.

Karen, who was a single mom with two children, moved in with her parents when her father had a stroke to help her mother take care of him. Her mother was also disabled. Needing money to pay for a home care service, Karen helped her mother do a reverse mortgage on the home, which gave the needed funds. If communication had been open and Karen’s brother had known the need and been involved with his parents care, he would not have reacted so negatively when he eventually found out about the reverse mortgage.

Every family is different. Some families are close and some have never been compatible. If your communication is strained, consider having a professional mediator present at a family meeting. The mediator will be able to keep things calm and running smoothly and help work out each persons concern.

Family matters.  The experience of working together for their parents care can give aging parents and family members a peaceful, memorable experience.

Estate Planning for Single People in Clinton

Do single people need a will or trust attorney?  Yes!

Really, “yes” is the only answer that’s really needed, but we’ll go ahead and create a whole blog post to offer some insight as to why estate planning is important for singles and not just for families.

One of the most important reasons for a single person to work with a will and trust attorney in Hinds County is best understood when you think about the consequences of not planning.  Should you have a medical emergency or pass away, what becomes of you and your estate will be entirely up to the state of Mississippi.  This means that if you are unable to communicate your wishes, the state will step in and impose its own plan on your body and your assets.

Imagine that for a moment.  If you were to have a medical emergency and be unable to speak up, who would be able to tell the doctors what you would want?  Hopefully, that person would be one of your parents or siblings, because it’s pretty likely that they are who the courts would appoint on your behalf.  If the best choice would really be a good friend, other family member, or possibly a significant other to whom you’re not legally married, the courts won’t care.  They will stick to the predetermined law, and that law will look at bloodline relatives first.

This is also the case with your finances.  If you are unable to take care of your own finances for any reason, the courts will likely appoint the closest blood relative to step in.  It doesn’t matter if you don’t want your family in your private financial affairs or not.  They will have access to your money and will be put in charge of managing it, paying your bills, etc.  Think about how your oldest sibling manages his or her money.  Would you be comfortable with that person being in responsible for yours?

Along the same lines, should you pass away without an estate plan, your assets will automatically go through the Hinds County probate process.  Again, the courts will step in and determine who is to inherit your property and money; and you will have absolutely no say in the matter.  How excited would you be for Mom and Dad to inherit your laptop or for your siblings to be given the jewelry which, by all accounts, should go to your best friend?

None of these scenarios is even a little bit exaggerated.  This is exactly what happens when a single person in Clinton chooses not to work with an estate planning attorney.  Remember, it’s not just about having a lot of assets to leave behind; it’s about making your own decisions regarding your medical care, your possessions, and your finances.  Having a small estate now simply means that the planning process will be less complicated!

How A Living Will Differs From A Standard Will

Because estate planning involves preparing for an event that will only take place once it is not something that most people delve into in any great detail except when they’re actively engaged in creating their plan. So there are a lot of financial instruments that are commonly used by estate planning attorneys that the average individual is not familiar with. However, there is one estate planning vehicle that is universally understood, at least in its most basic form: the will or last will and testament.

As we all know the standard will is a document that is utilized to express your wishes with regard to the distribution of your assets after you pass away. But there is another type of will that is commonly recommended by estate planning lawyers that is called the living will, or in Mississippi, it is called a Physicians’ Directive, and there are times when some people confuse a “living will” with a “living trust.” A living trust is a vehicle of asset transfer that allows you as the creator, also called the trustmaker, settlor, or grantor, to have access to the resources in the trust while you’re still alive, but the living will has nothing to do with monetary assets at all; it involves medical concerns.

A living will is an advance health care directive that you can use to state your preferences with regard to medical questions that you could be presented with at some point in time when you are unable to make these decisions for yourself in real-time due to incapacitation. The issue that is most frequently at the core of living wills involves artificial life support and whether or not you would want to be kept alive through the use of feeding tubes and other extraordinary measures should recovery be deemed medically impossible.

You can imagine now difficult it would be for your loved ones to make these decisions in your behalf if they had no input from you, and worse yet disagreements could arise between family members at the worst possible time. The execution of a living will can alleviate this possibility and make sure that your own wishes are honored come what may.

Most living wills or Physicians’ Directives request that life-support be withheld or withdrawn if the signatory suffers from a terminal condition and is in a permanent vegetative state. However, the living Will can express whatever the principal’s wishes are, including a desire to be kept alive as long as humanly possible by any and all artificial means available. It is the principal’s “will” or desire about such matter that is being expressed.

Durable Powers Of Attorney: The Hows & Whys

When you combine two very poignant statistics that are relevant to anyone planning for their twilight years a clear picture emerges. Firstly, people are living longer than they ever have before, and the numbers of the oldest old (people 85 years of age and older) are expanding very rapidly. And secondly, once you reach the age of 85, the odds become about 50-50 that you will be suffering from dementia. Though the degree of severity will determine exactly how limited your capabilities may be should dementia strike, it is very likely that you are not going to be able to make all of your personal, financial, and medical decisions for yourself.

If you were to become legally incapacitated due to dementia without making any advance preparations, a guardian could be appointed by the court and you could subsequently become a ward of the state. This is not a very pleasant proposition for most people, and the way to prevent it is to execute durable powers of attorney.

As most people know, a power of attorney is used to empower someone to act in your behalf legally. But a typical general power of attorney is no longer valid if the principal becomes incapacitated. The durable power of attorney does remain in effect after the incapacitation of the principal and this is why it is commonly used in estate planning. You can execute a financial power of attorney and empower someone of your choosing to handle your financial affairs, and a power of attorney for health care to make medical decisions in your behalf.

It is very possible that you will be able to make your own decisions with full clarity right up until you take your final breath. But it is comforting to move forward with the knowledge that you have empowered people that you know and trust to make decisions in your behalf should incapacity befall you at some point in time.

Incapacity, Alzheimer’s Disease, & Estate Planning

Estate planning involves the protection, optimization and preparation of your assets for transferal to your loved ones after you pass away. However this event does not take place in a vacuum, so this type of planning also involves recognition of the realities that you may well be facing toward the end of your life. Planning for this period of time is also part of any comprehensive estate planning strategy. Though it may not be the most pleasant thing to consider incapacity is a very real possibility, especially when you factor in the ubiquity of Alzheimer’s disease.

Everyone has heard of Alzheimer’s disease but few people who have not been touched by it personally or done a significant amount of research into it recognize just how widespread it is. It can be somewhat startling to hear that one in eight people 65 years of age and older are suffering from Alzheimer’s disease. To take this probing a step further half of all people who are at least 85 years old are suffering from Alzheimer’s disease.

The damages that this disease can inflect are severe, including full-scale mental and physical incapacitation in some cases. Alzheimer’s disease is the seventh leading cause of death in the United States at this time, and unfortunately it is very likely that more and more people will succumb to this disease as the population of the oldest old continues to grow.

Alzheimer’s disease causes dementia, which can make it impossible to make sound personal and financial decisions. This is why it is so very important to have an incapacity plan in place that protects you legally should you become unable to make decisions for yourself at some point in time.

In addition to the financial aspect you may want to prepare for the possibility of a stay in a long-term care facility that is equipped to assist those who are suffering from Alzheimer’s disease. If you’re ready to take action but not certain where you should start, you may want to arrange for a consultation with an experienced elder law attorney who can explain your options and help you make preparations for any and all contingencies.

Health Care Proxies & Unwed Couples

The field of elder law encompasses every aspect of aging from a legal and financial perspective, and one of the possibilities that must be addressed if you want to be prepared for any eventuality is that of incapacity. People are routinely living well into their late-eighties and beyond, and when you look at the statistics the possibility of full or partial mental and/or physical incapacity is very real when you reach such an advanced age. For this reason elder law attorneys recommend advance health care directives to their clients, and these include livings wills and health care proxies or durable medical powers of attorney.

A living will is a document within which you state your preferences with regard to the medical procedures that you would be willing to accept and those that you would deny should you be incapacitated and unable to communicate your decisions. The issue that is central to most living wills is that of whether or not you would want to be kept alive through the use of artificial life support systems if you were in a terminal condition. Health care proxies or durable medical powers of attorney are used to name a person that you empower to make medical decisions in your behalf in the event of your incapacitation.

Advance directives are useful for everyone regardless of your marital status, but when you are in a committed relationship but not legally married they are essential if you want your partner to have decision making power in your behalf. The health care proxy or durable medical power of attorney will accomplish this, but the inclusion of a living will is important as well. When you have stated your wishes in writing your proxy has a guide to go by if an issue arises that was not expressly covered in the living will, but in addition, the rest of your family will know that he or she is acting in accordance with your wishes.

The HIPAA & Your Advance Health Care Directives

Estate planning is just one of the branches of the tree we call elder law, and it is an important one but there are other legal issues that are intrinsically intertwined with the process of aging as well. As life spans continue to grow longer and medical technology advances the possibility of a period of end-of-life incapacity has become a very real one, and any comprehensive plan is going to prepare for this via the execution of advance health care directives.

The two advance directives that many would consider to be a must are a living will and a health care proxy or what is alternately referred to as a durable medical power of attorney. With a living will you express your health care preferences with regard to the types of medical procedures you would approve of if you were to become incapacitated at some juncture and unable to communicate your wishes. The central issue in a living will is usually going to be that of life support and if you would prefer to be kept alive by artificial means if there was no reasonable hope for recovery.

In addition to the living will, many people will also choose to include a health care proxy. With this document you name someone who you empower to make medical decisions for you should you be unable to do so for yourself.

If you included these directives in your long term plan some years ago they may not have addressed the relevant provisions that were contained in the Healthcare Insurance Portability and Accountability Act when it was passed back in 1996. This act states that health care providers cannot divulge any personal medical information without the consent of the patient. So depending on the way that your health care proxy document is worded, a given hospital may not recognize it and refuse to discuss your condition with your representative. This can be avoided by altering the document to include the correct verbiage or by adding an HIPAA release to your advance directives.

Preparing For Possible Incapacity

There is a Catch-22 involved in planning for incapacity, and it is actually difficult to discuss because the subject is so sensitive. Let’s start by pointing out the fact that people are living longer than ever, and the “oldest old,” people 85-years-old and up, are the fastest growing segment of the population. So when you are looking toward the future it is logical to expect that with each passing day, as medical capabilities advance, it is more likely that you will live past the age of 85.

Now to get into the sensitive part. Statistics indicate that more that half of the people in the United States who are over the age of 85 suffer from some degree of dementia. As you start to slip into a state of diminished mental capabilities, you are going to be less likely to recognize it. So you may be resistant to well meaning family members who try to help. This could result in one or more of them petitioning the court to appoint a guardian and/or conservator to manage your personal and financial affairs. If this was to take place you would have no control over who these people or entities would be.

This possibility can be circumvented if you take the correct incapacity planning steps. What you can do is appoint people of your choosing to act in your behalf through the execution of durable powers of attorney. You can execute a durable medical power of attorney and select someone that you would like to empower to make health care decisions in your behalf.

You would also want to use a durable financial power of attorney to appoint a financial representative. In this manner all of your bases are covered. Trusted family members or friends that you personally select will be handling your affairs and you can rest easy knowing that the decision making power has been placed in the right hands.

What Are Advance Health Care Directives?

We heard a lot of talk about end-of-life medical procedures during the debates surrounding health care reform, and this highlighted the reason why it is advisable to add an element of incapacity planning to your long term plan. People are living longer than ever, and the fact is that when you reach an advanced age decisions may have to be made in your behalf. For this reason it is important to let your wishes be known through the execution of advance health care directives like living wills and durable medical powers of attorney.

A living will is a document that contains your medical care preferences. Exactly what you choose to include in your living will is up to you; you can go into a lot of detail or keep it somewhat general. For many people the most important reason to draw up a living will is to express their wishes concerning life support systems and to what extent they would want to be kept alive through artificial means. One can also express their preferences pursuant to matters such as pain control and personal care and comfort in a living will.

Durable medical powers of attorney, alternately referred to as health care proxies, are legal instruments that empower a person of your choosing to make medical decisions in your behalf in the event of your incapacitation. There are those who choose to appoint a heath care proxy instead of executing a living will because it is difficult to address every possible medical scenario in a single document. Many would suggest that the best course of action is to have both a durable medical power of attorney and a living will in place. When you do this you state your wishes in writing so everyone concerned is aware of them, but you also have named someone to make decisions for you should a circumstances arise that had not been addressed in the living will.